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Do No Harm Stands with Parents in Supreme Court Case Challenging Washington Laws Aimed at Transitioning Gender-Confused Runaway Minors

Later this year, the Supreme Court will hear oral arguments in International Partners for Ethical Care v. Ferguson, which asks whether parents may challenge Washington state laws that shift decisionmaking authority over “gender transitions” from parents to children and the state. Do No Harm eagerly awaits the case’s outcome.  

In our recently filed amicus brief, we further explain the harms the petitioners in the case are seeking to avoid. 

In 2023, the State of Washington enacted legislation designed to provide runaway minors with “gender-affirming treatment” without parental knowledge or consent. Despite this novel transfer of power from parents to their children and the state, and its clear violation of parents’ constitutional rights to direct the care and upbringing of their children, the Ninth Circuit ruled that the plaintiffs lacked standing to challenge the relevant Washington laws. 

Behind these questions of standing lies a grim reality. The petitioners in this case are the actual parents of children with gender dysphoria but believe in the binary, biological reality of sex. They reasonably fear that, if they enforce their beliefs too sternly, their children will run away and use Washington’s laws to receive sex-denying interventions without parental consent.  

Too often, courts overlook exactly what such interventions entail, as proponents of so-called gender-affirming care bury the details beneath a mountain of euphemisms. Our brief attempts to correct this oversight, explaining in forthright terms why the harm the petitioners seek to avoid is indeed a grave one.  

To begin with, sex-denying interventions involve the physical manipulation and disfigurement of young bodies through medical and surgical means — all to treat a psychological condition (gender dysphoria) that has no corresponding physical symptoms.  

Second, sex-denying interventions frequently cause significant long-term negative health consequences in gender-dysphoric youth, as Do No Harm has previously explained.  

Third, recent medical evidence belies the notion that sex-denying interventions are justifiable treatments for gender dysphoria in children. In fact, recent evidence shows that such “treatments” may even exacerbate gender dysphoria’s psychological symptoms.  

In sum, the harms from which the petitioners in this case seek to shield their children are damaging interventions falsely disguised as support and care.  

Unfortunately, as multiple Justices have more recently observed, the question of legal standing is becoming an excuse for some federal courts to avoid contentious constitutional questions. Do No Harm looks forward to the Court’s resolution of these important issues.

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Do No Harm Report Debunks Claim That State Restrictions on Pediatric Sex-Rejecting Interventions Increase Adolescent Suicide Rates

Salt Lake City, UT: September 17, 2026 – Today, Do No Harm released a study finding no evidence for the widespread and alarmist claim that state prohibitions on surgeries, puberty blockers, or cross-sex hormones for gender-dysphoric minors increase suicide rates.

The study, titled “The Effect of State Bans on Gender Interventions for Minors on Teen Suicide Rates,” examines the claim that state bans on so-called gender-affirming care for minors lead to spikes in suicides. Employing three distinct analytical models, Do No Harm found no evidence to support the claim.

“The alarmist claim that protecting children from sex-rejecting procedures increases suicide is false,” said Jay Greene, Director of Research at Do No Harm. “We examined the evidence in a first-of-its-kind study of how teen suicide rates were affected by states adopting policies restricting so-called gender-affirming care for children. No matter how you examine the data, the result is consistently clear: These state policies did not increase teen suicide rates. Medical practice and policy must be grounded in evidence, not emotionally manipulative talking points. That principle is all the more critical when it’s a matter of children’s health and well-being.”

Do No Harm’s Three Models:

  • Difference-In-Difference Model: a statistical method comparing trends across states before and after policy changes. After accounting for national suicide trends, state economic conditions, and suicide rates among young adults, Do No Harm found a 0.3-percent reduction in suicides among 15–19-year-olds, a statistically insignificant change.
  • Callaway and Sant’Anna Difference-In-Difference Model:a newer statistical method designed to provide more reliable estimates when states adopt policies at different times. Do No Harm’s results were unchanged, showing no impact of bans on gender interventions for minors on suicide rates among 15–19-year-olds.
  • National Time-Series Model:analyzed monthly national suicide data among 13–17-year-olds to assess whether expanding prohibitions on sex-rejecting interventions for minors affected youth suicide rates. After controlling for age-adjacent suicide trends, seasonality, economic conditions, and national time trends, Do No Harm found no relationship between these policy changes and teen suicide rates.

Do No Harm’s study also debunks the flawed research cited by activists, media, and lawmakers to justify the suicide myth and claiming that “gender-affirming care” is “lifesaving.” These studies have profound methodological limitations and depend on unreliable evidence.

Read Do No Harm’s study here.

Do No Harm, established in April 2022, has rapidly gained recognition and made significant strides in its mission to safeguard healthcare from ideological threats. It has over 50,000 members, including doctors, nurses, physicians, and concerned citizens across all 50 states and 26 countries.

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We’re Breaking Through

Part of Do No Harm’s work of highlighting and counteracting divisive trends in medicine is talking to audiences whom we don’t always reach.

For an organization that means to help shape the conversation around “Diversity, Equity, and Inclusion” (DEI) and youth-focused gender ideology, breaking through to new readers couldn’t be more crucial.

We’re proud to share some of our recent excursions into new territory. Do No Harm’s ideas are landing, and we’ll be partnering with our members and allies to keep up the good work.

• The recent Washington Post article “How Trump administration threats could affect medical school admissions” spends much of its time quoting the talking points of “diversity” proponents — for example, Association of American Medical Colleges chief executive David J. Skorton, who announced in a 2023 webinar that “[l]ives depend on us successfully diversifying the health care workforce.”

Yet the article also quotes our own Ian Kingsbury, senior director of Do No Harm’s Center for Accountability in Medicine, in support of the Trump administration’s efforts to force medical schools to comply with the Supreme Court’s Students for Fair Admissions v. Harvard decision:

Every data point that we see speaks to continued and really pervasive discrimination within medical school admissions. […] As Pres. Reagan famously quipped, “When you can’t make them see the light, make them feel the heat.”

• Bloomberg, too, recently quoted one of our experts. In “Trump Asks DOJ to Probe Hospitals Over Trans Health Coding,” Do No Harm’s chief medical officer, Kurt Miceli, MD, explained that “gender ideologues are able to misuse medical diagnosis codes to avoid proper reporting and scrutiny and to enable potentially fraudulent billing practices.” Thus did Dr. Miceli share the central theme of our April report on that subject.

• Miceli also wrote letters to the editor at Neurology and JAMA Network Open earlier this year, making the case in both instances that unscientific narratives of structural injustice are shifting attention away from the proper practice of medicine and medical education. Miceli in Neurology: “Patients would be better served by a roadmap tackling neurologic disease, not political agendas.”

• Miceli’s contributions to STAT and KevinMD do similar work, urging physicians to focus on patients rather than advocacy. An excerpt from the latter is illustrative: “Diverting attention toward broad policy agendas risks diluting medicine’s core mission and for that we will all inevitably suffer.”

• Do No Harm’s Jay Greene, director of research, published his own JAMA Network Open letter earlier this year, explaining why a recent examination of racial disparities in black and white mortality rates suffers from methodological and interpretive problems. “[T]he evidence presented,” Greene writes, “does not sufficiently support the claim that systemic discrimination, via stress pathways, directly shortens lives in Black communities.”

These incursions into new territory matter. Too often, readers of mainstream publications have never heard an authoritative, evidence-based case against the progressive narratives and policy preferences that have come to dominate the American medical establishment.

To the extent that we’re storming those gates, we’re setting ourselves up for even more wins down the road.

That’s news we’re happy to make happen — and to share.

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Do No Harm Files CMS Comment on the American Medical Association and Medical Coding

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Earlier today, Do No Harm submitted an official comment to the Centers for Medicare & Medicaid Services (CMS) in response to the agency’s formal reconsideration of the relationship between the American Medical Association (AMA) and the medical coding standards that define clinical practice.

We support this inquiry and urge CMS to treat its Request for Information as the beginning of necessary reform rather than the end.

Federal regulation has long entrenched a single private association’s monopoly over the code set that defines physician services, and the revenue that flows from that monopoly is neither spent for the benefit of patients nor answerable to the physicians the AMA claims to speak for. That alone justifies the agency’s decision to ask these questions and to keep pursuing the answers.

This state of affairs is exacerbated by the fact that the AMA spends freely on political advocacy, using its medical authority to inappropriately prop up its activism.

Patients and the public need a payment system built on codes that align with medical necessity rather than on a copyright that funds activism. Thus, CMS is right to have opened this question, and the answer should not be the current, damaging status quo.

Please read the full comment here or below.

DNH Comment CMS Payment Systems Rule2 9-2026
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Politics in the Therapy Session

Once upon a time, therapists took care to hide their ideological views from their patients, presenting instead a “blank screen” that allowed the therapeutic relationship to function as intended.

Mark that down as one more casualty of the Age of Wokeness.

Elizabeth Bernstein’s recent Wall Street Journal article “Is Your Therapist Biased? Personal Agendas Are Creeping Into the Therapy Room” provides a useful entrée for the curious reader.

According to Bernstein, more and more therapists have begun to “push their own ideologies, encourage patients toward a path that worked for them, and even judge family members they have never met.”

Bernstein mentions therapist and former professor William Doherty, who argues that “many therapists are getting caught up in trends in both therapy and the culture, including the encouragement of victimhood, estrangements and the broadening of terms like ‘harassment’ and ‘abuse.’”

While Bernstein offers tips for prospective and current therapy-seekers (e.g., “Beware if [mental-health professionals] diagnose someone not in the room”), the reader gets the decided impression that the problem is becoming ingrained.

As clinical psychologist and psychology professor Joel Weinberger tells Bernstein, “It used to be that you didn’t tell your patient your personal view or orientation … [b]ut now there is this view that you do, because you’re sharing good values.”

This ongoing alteration of the therapeutic dynamic is not the first time that politics and ideology have intruded into the field of psychology.

As recent (and not-so-recent) students know, academic psychologists have embraced “liberation psychology,” “decolonial psychology,” and “climate psychology” for years, substituting vogue political grievances for such evidence-based therapeutic modalities as cognitive behavioral therapy.

Commenting on this trend in 2023, Chapman University’s Richard E. Redding remarked that the “political views of psychologists can and frequently [do] color and skew their teaching and research.”

That skew is what we’re observing today: Old-fashioned depression is out; “climate anxiety” is in.

Or consider the output of the American Psychological Association (APA), whose 2017 “Multicultural Guidelines” mention “privilege” and “oppression” more than 40 times each, with “social justice” appearing nearly a dozen times (and nearly a dozen more in the “References” section).

To the extent that therapists allow APA priorities to shape their practices, they will increasingly offer care along progressive ideological lines rather than on the basis of carefully gathered evidence.

Do No Harm covered this phenomenon recently. As we wrote last month, a number of mental-health professionals have begun advertising themselves as fellow activists and openly broadcasting their ideological priors (e.g., “I practice from a feminist and anti-oppressive perspective”).

So much for the blank screen: An activist therapist treating activists is almost certain to affirm when he or she ought to challenge, speak when he or she ought to be silent, or feed patients’ anxieties or delusions when he or she ought to alleviate them.

Sadly, we seem to be moving beyond the age of the apolitical therapist whose focus was on patient well-being, not mutual congratulation or complaint.

For the sake of the profession and patients, we should hope for a return to that standard.

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The APA’s ‘Inclusive Language Guide’ Hasn’t Helped

Future historians hoping to understand the Age of Wokeness will turn gratefully to the American Psychological Association’s “Inclusive Language Guide.” As a marker of progressive ideological anxiety and complaint, the 51-page document may be impossible to top.

Updated in 2023, the guide is intended by the APA to “dismantle the destructive hierarchies that have marginalized people from equitable representation and participation in society.”

So confident is the association that “certain terms are harmful to marginalized communities” that it includes a preemptive apology of its own: “We … understand that some of the terms and concepts that are included [in the guide] may be offensive and painful to different groups.”

What is this potentially debilitating language? A number of the words and phrases listed in the opening “General Terms Related to Equity and Power” section have long been a part of the American and international political conversation (e.g., “antisemitism”). Others have been popularized more recently, as theoretical academic discourse has filtered down to newspapers, magazines, public-radio broadcasts, and K-12 classrooms (e.g., “cultural competence”).

None are in any way provocative.

Or perhaps the APA has in mind the allegedly harmful language listed on an accompanying “Term to Avoid” / “Suggested Alternative” chart. There, for instance, readers learn that one ought not to say “mentally ill” when what one really means (or should mean, anyway) is “person living with a mental illness.”

Readers learn that, e.g., “smoker” is no longer in vogue. The preferred linguistic alternative is now “person who smokes.”

We linger on this point because the APA’s exaggerated fear of giving offense is at the heart of its Inclusive Language Guide’s intellectual misjudgments. The document’s very foundation is the unfalsifiable (and therefore unscientific) belief that delicate terminology somehow improves the lot of racial, ethnic, and religious minorities and the physically and mentally handicapped (apologies: we mean “persons with disabilities”).

Because this premise is irredeemably flawed, those committed to it have no choice but to search farther and farther afield for “acceptable” alternatives, as yesterday’s preferred terms inevitably become today’s rank abuse.

Consider, for example, the troubled career of “differently abled,” a phrase that once represented the height of good taste but is now one of the APA’s explicitly named “term[s] to avoid.”

Without question, that phrase has lost its stylishness. To argue that it is actively offensive, however, is to engage in unserious intellectual contortions. It is moral preening, not the mitigation of harm — clubbishness, not profitable advice.

Indeed, one gets the decided impression, reading the APA’s document, that the point is to create and maintain a clerisy rather than to look out for the needs of those whom the APA ostensibly wishes to help. All but the most uncouth members of society know that the phrase “mentally retarded” ought not to be used in polite company. Yet only an elite few know that “special needs” is now outré, as well. Thus does the APA maintain its professional exclusivity.

To be sure, the consequences of this way of thinking are sometimes comic. When, in January 2023, the Associated Press tweeted that writers ought not to “dehumanize[e]” their reporting subjects by referring to, e.g., “the poor, the mentally ill, the French, the disabled, [or] the college-educated,” the French Embassy to the United States jokingly suggested changing its name to the “Embassy of Frenchness in the US.”

“Handi-capable,” another verboten term as of the APA’s 2023 update, was, from the moment of its origination, a seeming parody of woke cluelessness.

Perhaps the APA is right to remind its members and site visitors to “[a]void terms that are condescending or patronizing,” as the final image above declares. Certainly all speakers and writers should treat others with respect.

There is a fine line, however, between that project and the policing of normal, harmless words. In its pursuit of progressive social outcomes, the APA has left that border far in the rear-view mirror.

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Behavioral and Biological Factors Related to Perinatal Cardiometabolic Risk

[Editor’s note: This piece originally appeared as a comment in response to “Intersectional Inequities in Age-Related Risk of Adverse Maternal Cardiometabolic Health,” published in JAMA Cardiology. That article can be read here.]

Elleni Hailu et al. observe that black women are at increased perinatal cardiometabolic risk compared to white women with that risk rising more steeply with age. Their discussion offers a list of theorized interpretations including “structural racism,” “experiences of racism,” “racism-related stress,” “chronic discrimination,” “bias and neglect in health care settings,” & “eco-social theory,” which as per Nancy Krieger, who introduced the term decades ago, “rejects the underlying assumptions of biomedical individualism.”

Yet, individual behavioral & biological factors should be considered to better understand the paper’s observation. Physical activity, diet, & cholesterol, along with genetics, all contribute to cardiovascular (CV) health. Every day of unmanaged risk factors worsens insulin resistance & arterial stiffness, for example, thereby compounding risk with age.

Read the full comment in JAMA Cardiology. 

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The American College of Obstetricians & Gynecologists Should Abandon Ideology

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If one ever needed proof that medical associations are subject to institutional capture by activists, the American College of Obstetricians & Gynecologists (ACOG) provides it.

Boasting 62,000 members, ACOG is, according to its own materials, “the leading professional membership organization for ob-gyns.”

The association states that it provides “comprehensive, expert-reviewed practice guidelines” to its members and that those practitioners “maintain the highest professional standards and are united in their delivery of exceptional, respectful, science-backed care for patients.”

Yet these encouraging pledges are joined on the same webpage by ACOG’s commitment to “equitable” care, a now-familiar indicator of politicization.

Moreover, the organization’s self-defined mission is to “support our members to improve the lives of all people” — not women — “seeking obstetric and gynecologic care.”

That particular word choice is explained on ACOG’s “Inclusive Language” page, which argues that “[v]aluing, respecting, and affirming an individual’s identity contribute to improved health outcomes.”

Later on the same page, the association declares, “To be inclusive of women and all patients in need of obstetric and gynecologic care, ACOG will move beyond the exclusive use of gendered language and definitions.”

Do No Harm notes with alarm the irreconcilability of the organization’s commitment to “science-backed care” and its assertion that “all people” may benefit from gynecologic medicine. (We concede that gynecologists may occasionally treat biologically male patients for sexually transmitted infections or screen biological men for anal cancer, but that has been the case since well before ACOG’s revision of its mission-statement language. The revision is about transgenderism.)

We note, furthermore, that ACOG’s policies and practices impact not only adult patients but minor children.

Among ACOG’s resources is a committee opinion titled “Health Care for Transgender and Gender Diverse Individuals,” which explicitly concerns both adults and adolescents and which directs site visitors to the radical World Professional Association for Transgender Health (WPATH) “[f]or guidance on the medical and surgical care of transgender adolescents.”

Elsewhere, on its “Adolescent Health” page, ACOG advocates for “privacy and the ability of adolescents to consent to health-care procedures” and argues that “education about … gender … empowers and prepares children, adolescents, and young adults to make educated decisions about their health and their relationships.”

Simply put, the organization’s embrace of transgender ideology is not limited to the “adult” corner of its operations. Minors, too, are necessarily implicated in ACOG’s woke “gender”-related ideas.

On the matter of DEI, the association is little better. As its “Diversity, Equity, and Inclusive Excellence at ACOG” page makes clear, the organization believes it “essential that the culture of our organization, membership, leadership, and fellowship be diverse, equitable, inclusive, and just.”

A “Collective Action Strategy” page condemns the “racial inequities present in our field,” while a statement of policy titled “Racism in Obstetrics and Gynecology” argues that “[r]acism has been and continues to be systemically embedded into our society and the practice of medicine.”

Echoing the totalism to which ideological progressives often fall prey, the second of those pages insists that “[r]acial and ethnic inequities in obstetrics and gynecology cannot be reversed without addressing all aspects of racism and racial bias, including the sociopolitical forces that perpetuate them” (emphasis added).

So much is wrong with these claims that one hardly knows where to begin. Most obviously, they substitute unfalsifiable, quasi-magical forces (“systemic racism”) for matters that physicians are equipped to address (e.g., patient behavior and medical discovery).

They encourage doctors to engage in policy work outside of their realms of expertise, thus lending the authority of medicine to policy prescriptions that may not be reasonable or practical.

Most importantly, they compromise the aforementioned standard of “science-backed care” to which ACOG pledges itself and to which all medical associations should be held.

Happily, the solution to these problems lies in plain sight: ACOG should depoliticize its activities and webpages and return to the irreplaceable business of providing evidence-based obstetric and gynecologic care to women and girls.

Do No Harm joins all who oppose the politicization of medicine in eagerly awaiting such a move.

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How Monopolistic Accreditors Enforce Ideology

[Editor’s note: This piece originally appeared as a letter to the editor in response to “Busting the ABA’s Accreditation Monopoly,” published Aug. 29 in the Wall Street Journal.]

The American Bar Association unfortunately isn’t alone in having an accreditation monopoly (“Busting the ABA’s Accreditation Monopoly,” Review & Outlook, Aug. 29). The same is true for many other organizations, including the American Psychological Association Commission on Accreditation, whose status as an accreditor is now up for renewal. Like the American Bar Association, the American Psychological Association is a professional association with an in-house accreditation arm. And, like the ABA, the APA temporarily suspended its DEI standards in 2025. But suspension isn’t the same as removal, and the Education Department is right to see to it that these standards are eliminated, as has been done by accreditors for schools of medicine, podiatry and optometry.

Read the full piece in the Wall Street Journal.

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Do No Harm’s Center for Accountability in Medicine Releases Second Medical School Rankings Based on Excellence and Merit

SALT LAKE CITY, UTAH: September 3, 2026 – Today, Do No Harm’s Center for Accountability in Medicine (CAM) released the second edition of its Medical School Excellence Index.

The Medical School Excellence Index is the only definitive ranking of U.S. medical schools based on their commitment to academic excellence, transparency, and opposition to divisive identity politics. The Index offers prospective medical students, medical schools, residency programs, and other interested parties an alternative to the traditional rankings systems that often favor schools with DEI programs or ignore their detrimental effects.

“We created the Medical School Excellence Index so that patients and aspiring medical school students have clear information about which schools are doing the best job of recruiting and training physicians,” said Ian Kingsbury, PhD, Senior Director of the Center for Accountability in Medicine. “Since launching the Index last year, we’ve seen several schools change their mission statements and applicant essay prompts in ways that eschew DEI-aligned activism. Unfortunately, we’ve also seen some backsliding by schools that infuse DEI into admissions and student grading policies. As we continue to make progress to restore excellence to medical education, this tool will be invaluable to the public and students who want medical schools to focus on training the next generation of highly qualified medical professionals.”

The Medical School Excellence Index was launched last year and is updated annually. It identifies the best and worst medical schools in the country by ranking each institution on three criteria: academic excellence, transparency, and the rejection of DEI.

Top 5 Medical Schools:

  • USF Health Morsani College of Medicine
  • Albert Einstein College of Medicine
  • Perelman School of Medicine at the University of Pennsylvania
  • Dell Medical School – University of Texas at Austin
  • Vanderbilt University School of Medicine

Bottom 5 Medical Schools:

  • Michigan State University College of Human Medicine
  • Charles R. Drew University of Medicine and Science College of Medicine
  • California University of Science and Medicine – School of Medicine
  • University of California, Riverside School of Medicine
  • Roseman University College of Medicine

The full rankings can be found here.

Do No Harm, established in April 2022, has rapidly gained recognition and made significant strides in its mission to safeguard healthcare from ideological threats. It has over 50,000 members, including doctors, nurses, physicians, and concerned citizens across all 50 states and 26 countries.

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A ‘Do-It-Yourself’ Hormone Website May Be Catering to Gender-Dysphoric Children

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Earlier this year, Do No Harm released a report demonstrating the ease with which minors may be able to purchase sex-rejecting pharmacological agents on the internet.

While some of the websites we mentioned appear to have since shut down, our more recent trips across the web indicate that gender-dysphoric children can still access inappropriate advice and supplies.

Take, for example, the website diyhrt.wiki. (The acronym stands for “do it yourself hormone-replacement therapy.) Visitors to the site need only click a button attesting “I am 18 or older” to gain access to the main page.

From there, anyone who wishes may view such subpages as “Transmasc Guide,” “Transfem Guide,” and “Injection Supplies.”

Lest anyone be confused, the last of those pages opens with a note: “All the links for injection needles are for 1 inch needles intended for intramuscular injection. Please consider using 0.5 inch needles if you wish to inject subcutaneously.”

And what will the self-professed “adults” in question be putting into their bodies? The homepage makes it clear: “This website intends to teach transgender people how to safely perform DIY Hormone Replacement Therapy.”

Websites of this kind are among those to which we drew attention in our March report, “The Lack of Barriers to Minors Ordering Cross-Sex Hormones Online.”

Included in our findings were a number of resources directing users to online pharmacies, distribution networks for “homebrew” hormones, and guides on self-administering cross-sex hormones once one has secured them.

Diyhrt.wiki is exactly this sort of project. In addition to providing sources for “pharmaceutical grade” hormones, the site links to “Homebrew Sourcing” involving the international shipping of, e.g., estradiol injections and transdermal gels.

(Note: Vanna Pharma appears at least temporarily to have closed. Otokonoko Pharmaceuticals’ URL has changed, but the site is easily searchable and relies on an effortlessly bypassed age-verification self-assessment.)

The site also offers advice (e.g., “Is this illegal?” and “What do I do if my package is seized?”) and tells “transfem” and “transmasc” site visitors what levels of estradiol and testosterone to aim for.

Perhaps most disturbingly, it advises secrecy among its users, some of whom could be underage given the absence of meaningful gatekeeping.

“Share the site with those who need it, but not to transphobes: use common sense!,” the homepage warns.

If your package is seized, “do not tell customs what is inside the package.”

Such winking and nodding appears to be a concession to the fact that Americans of any age shouldn’t be buying prescription drugs online without a valid doctor’s order. (Additionally, more than half of states have enacted laws specifically limiting minors’ access to “gender-affirming care.”) Yet the behavior being promoted is not only legally questionable but dangerous on its face.

Because vendors of “homebrew” hormones exist to allow customers (including minors) to bypass legal restrictions on sex-denying interventions, they necessarily sidestep oversight by the Food and Drug Administration (FDA), thus exposing children to unknown risks.

This is unsafe, offers no benefits, and must be stopped.

The FDA should continue investigating online pharmacies selling unprescribed hormones, including the “homebrew” variety.

Moreover, individual states should investigate and prosecute unlawful online sellers to the extent permitted by law. Indeed, new legislation may be necessary if vendors continue circumventing state restrictions on cross-sex hormones for minors.

Finally, U.S. Customs and Border Protection should exercise its legal authority to inspect inbound international cargo as circumstances warrant. “A trans woman in Brazil” should not be providing American children with “medicine” cooked up on “her” kitchen stove.

What we are calling for is common sense. Children mustn’t have unprescribed access to pharmacological agents, and websites that facilitate that access must be shut down.

That solution may not be politically easy, but we should aim for it nonetheless.

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An Activist Physician Is Spreading a Debunked ‘Racism’ Narrative

A popular narrative blaming racism for black maternal health disparities has been the subject of debunking efforts for years. Nevertheless, a top advocate of that conspiracy theory remains a celebrated speaker, writer, and continuing medical education (CME) contributor.

Later this week, Joia Crear-Perry, MD, will serve as keynote speaker at the inaugural Wyoming Maternal Health Summit, sponsored by the University of Wyoming College of Health Sciences’ Rural Health Institute.

Crear-Perry’s remarks will contribute to the summit’s theme, “Closing the Distance: Maternal Health Access and Innovation in Wyoming,” and will consider the alleged “challenges Wyoming faces” including “systemic factors driving preventable maternal deaths.”

In one sense, Crear-Perry is an obvious choice for such an event, having founded the National Birth Equity Collaborative (NBEC), a “nationally recognized organization on the front lines of the Black maternal health & infant mortality crises.”

Yet the “highly sought-after trainer & speaker” is, in another sense, a strange and disappointing choice. The theory of systemic racism and black maternal mortality that she advances relies on bad science and a misunderstanding of statistical data.

Do No Harm staffers have done much of the necessary debunking ourselves.

Whereas Crear-Perry argues that “Race Isn’t a Risk Factor in Maternal Health. Racism Is,” we demonstrate that having a doctor of the same race doesn’t improve patients’ healthcare outcomes.

Whereas Crear-Perry’s NBEC states that, “[i]n comparison to other high-income countries, the U.S. has the highest maternal … mortality rates despite the most healthcare spending, & [that] most of these deaths are preventable,” we explain that the U.S. rate may result from a reporting system that overestimates maternal deaths and whose metrics are not fully comparable to those of other developed nations given how deaths are ascertained.

Whereas Crear-Perry blames “exposure to racism” for the alleged fact that “Black women in the United States are the most likely of this country’s women to die from pregnancy-related complications,” we show that such a claim diverts resources from proper channels in an attempt to address “a nonexistent factor in poor health outcomes.”

Moreover, we explain how activists have traditionally misinterpreted the CDC data that undergird the systemic-racism theory of black maternal mortality. To wit,

it’s hard to draw society-wide conclusions from such a small sample. It’s even harder when you recognize that the CDC statistics include deaths that occurred up to a year after delivery, as well as those caused by underlying and preexisting medical conditions that pregnancy may have aggravated. And the CDC admits that the systems for identifying mortality rates are prone to error.

Given the flaws in her argument, Crear-Perry ought not to be the fêted and “highly sought-after” medical “expert” (read: activist) that contemporary racial anxieties have made her. Alas, her work as a speaker, educator, and medical celebrity is going smashingly.

In addition to her upcoming Wyoming address, Crear-Perry has participated in a CME opportunity offered to physicians by the American Medical Association. In that video session, “Prioritizing Equity: The Root Cause,” Crear-Perry contends that “[r]acism, classism, and gender oppression” are the “root causes” not only of health inequities but of “most all inequities in the United States of America.”

Crear-Perry has been celebrated in a 2021 Lancet article, “Joia Crear-Perry: collaborating for racial and reproductive justice,” which boasts that she “works on ‘reframing the conversation’ about race to develop a ‘shared vocabulary and understanding of why health inequities exist’ because ‘it’s really racism that is causing the harm.’”

We will not argue that there is any insincerity in Crear-Perry’s “racism” theorizing. She very clearly believes what she preaches.

And let’s also be clear: Maternal mortality is a serious matter deserving of thoughtful, evidence-based study. As Do No Harm has previously written, policymakers and the medical community ought to be focusing their efforts on better hospital training programs for responding to complications and greater use of prenatal care, not looking around every corner for alleged physician bias.

Yet it is just as obviously the case that the woke takeover of the medical establishment has made Crear-Perry’s message irresistible, never mind its poor basis in science.

Crear-Perry’s fame, in other words, is a mere symptom. The widespread — indeed, the “systemic” — eagerness to embrace progressive ideological narratives in medicine is the disease.

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Children With Gender Dysphoria Deserve Real Treatment

[Editor’s note: This piece originally appeared as a letter to the editor in response to “Medicaid and Transgender Treatments for Kids,” published Aug. 18 in the Wall Street Journal.]

Your editorial “Medicaid and Transgender Treatments for Kids” (Aug. 18) correctly notes that public funding will continue to support the mental-health needs of children with gender dysphoria after the Trump administration’s recent rule change for Medicaid and the Children’s Health Insurance Program. Funds through those programs simply can no longer go to puberty blockers, hormone therapies or gender surgeries for minors. This is good news. Let’s hope that in general mental-health services stop perpetuating the “affirmative” model of care that has already led so many children to use these irreversible, invasive medical practices.

Read the full piece in the Wall Street Journal.

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University of Illinois College of Medicine’s DEI Evolution Is Unconvincing

Another day, another DEI office name change. Yet this one has been so halfheartedly done that we question the point of the exercise.

Until at least May 24 of this year, the University of Illinois College of Medicine (UI COM) operated a “Diversity, Equity and Inclusion” office dedicated to “foster[ing] a diverse, equitable, and inclusive UI COM-munity.”

In recent months, however, that unit has been renamed the “Advocacy and Engagement” office.

A few things have indeed been altered as a result of the shift. Whereas the DEI office’s homepage previously noted that UI COM meant to “[d]evelop and implement a diversity, equity and inclusion framework that [would] coordinate efforts at the individual, unit, department, campus and college level,” that particular language has now vanished.

So has UI COM’s pledge to “[e]nrich faculty/staff diversity through recruiting by growing the diverse candidate pool and improving the conversion rate (i.e., hires) of candidates.”

A third commitment has been reworded. Previously, UI COM promised to “[r]ecruit, matriculate, support and graduate a diverse body of students and trainees who embrace UI COM’s vision and values.”

Now, however, the institution will recruit “students and trainees from economically and educationally disadvantaged communities who reflect the communities we serve and uphold UI COM’s vision and values.”

We concede that these revisions modestly soften the institution’s DEI-related language. A tour of the renamed office’s website, however, gives us reason to wonder if cosmetic edits have been the extent of the change.

For instance, the office continues to be run by Gloria Elam, previously associate dean of diversity & inclusion and now associate dean for advocacy and engagement. Dean Elam’s four listed colleagues remain the same, though several of their titles have been altered along similar lines.

Both the old site and the new link to “Strategic Planning” pages that boast of DEI-related accomplishments. In the case of the old, one representative example is “Conducted Implicit Bias Training for UI COM faculty and staff.” The new, meanwhile, lists as a highlight “Developed and Conducted Unconscious Bias Training for UI COM faculty and staff through the BRIDgE Program.”

Though the acronym “DEI” has given way to “AACE,” both the old site and the new link to a “Collaborators” page listing many of the same academic and administrative units. One of these, the Odehmenan Health Equity Center, offers such events as “‘There can never really be justice on stolen land’ – An Indigenous Methodology Approach to Police Violence.”

Finally, both sites include a “Land Acknowledgement” recognizing “the traditional birthright of indigenous peoples who were forcibly removed.” The particular language therein has not changed at all.

Given these similarities in both resources and personnel, we have our suspicions about UI COM’s evolution. Had the institution unwound its public DEI commitments or reassigned (or parted ways with) its DEI staff, we would celebrate the depoliticization of the education it offers.

Because it clearly did neither, we must simply roll our eyes. Call it whatever you like: A DEI office by any name remains an affront to unideological medical education.

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Do No Harm Files EEOC Comment on Rescinding Racial-Reporting Requirements

Last week, Do No Harm submitted an official comment in support of a proposed rule from the U.S. Equal Employment Opportunity Commission (EEOC).

The rule in question would rescind certain racial-reporting requirements to which American employers have been held for 60 years. In doing so, it would eliminate a process that exceeds what Title VII of the Civil Rights Acts of 1964 authorizes, that cannot survive strict scrutiny, that costs more than a quarter of a billion dollars a year, and that corrodes the merit principle on which American medicine and American business depends.

We strongly support the new rule rescinding these requirements and urge the EEOC to finalize it.

For six decades, the Commission has warned employers that asking an applicant’s race is evidence of discriminatory intent, while in the same breath requiring employers to record the race of everyone they hire. This tension cannot be resolved and must end.

Please read the full comment here or below.

DNH Comment in Support of Reporting Requirements FINAL
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Continuing Medical Education Shouldn’t Include Activist Rants

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What do you get when political activists shape continuing medical education (CME)? Whatever the answer is, it has very little to do with science.

Take, for example, “When Identity and Genetics Intersect,” a 34-minute podcast and quiz offered by the American Medical Association (AMA) for 0.5 credits of CME.

While the activity’s learning objectives themselves raise our hackles — containing as they do the woke claim that “research in human genetics can cause harm to underrepresented populations” — perusal of the podcast transcript produces much greater alarm.

The troubling comments in question proceed from podcast guest Kellan Baker, at recording time the executive director of the Whitman-Walker Institute (WWI). According to Baker,

  • “structural racism and anti-LGBTQ bias [affect] HIV risk among LGBTQ people of color”;
  • “too often, diversity of gender identity [is] treated as a pathology … [i]nstead of being treated as a foundational element of who people are”;
  • “everyone has a gender identity, regardless of how it is or is not encoded in the genome”;
  • “[t]he question of how you know who you are is too often tracked back to genetics in this very deterministic fashion that says[,] in the case of sex and gender, for example, that if you have two X chromosomes, you’re a female, you’re a woman, you’re a girl”;
  • similarly, an “XY chromosome [is taken to mean] you’re male, you’re a man, you’re a boy, no questions asked. And that is actually not the situation for transgender people”;
  • “looking to the genome … has major ramifications for policy” — for example, “[t]he ability to play on sports teams for transgender people. And genomics and genetics are really being invoked to create a very simplistic, anti-scientific, binary world that totally excludes the realities of transgender people”;
  • the U.S. is trying “to criminalize the provision of best practice medical care to transgender people”;
  • “[s]tates are rushing to ban transgender people from public life and from accessing appropriate medical care.”

These are ideological talking points barely disguised as scientific discourse. Nevertheless, as the following screen capture indicates, the AMA provides not only CME but “[m]edical [k]nowledge” points for physicians enrolled in the American Board of Internal Medicine’s Maintenance of Certification program, to name just one institutional participant.

Perhaps we ought not to be surprised by Baker’s thinly veiled activism. After all, the now-former WWI executive director currently works for the progressive Movement Advancement Project as senior advisor for health policy, helping that organization to “advance equity” by, e.g., releasing a “Talking About Transgender Youth Participation in Sports” educational messaging guide.

The far-left opinion journal Mother Jones recently quoted Baker’s lament that the Department of Health & Human Services’ August report on the financial incentives behind “gender medicine” is “part of a broader pattern from this administration: [u]sing the power of government to attack science and target health care providers instead of helping families get the care they need.”

No, the real surprise lies in the fact that the AMA continues to endorse Baker’s CME even now, despite its obvious politicization and lack of scientific content. That decision should shock anyone who cares about the actual continuing-education needs of physicians and the grounding of medicine in actual facts.

But perhaps we should say we wish we were surprised. Given the now-decades-long intrusion of wokeness into the medical establishment, the sad truth is that we’re not.

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Debunking Bad Research: Slavery Is Not the Cause of Modern Health Disparities

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Rates of slavery in a Southern county in 1860 are the root cause of modern health disparities, claims a new study published in the Proceedings of the National Academy of Sciences. According to the article, “Our model estimates ~22 additional deaths per 100,000 among Black Americans relative to White Americans for every 10% increase in the 1860 enslaved population. […] Our analyses held even after controlling for a comprehensive suite of historical and contemporary covariates. These findings are consistent with a model wherein slavery’s legacy continues to shape present-day Black–White racial health disparities via enduring structural inequities.”

If it seems hard to believe that slavery in 1860 is killing black people today, that’s because these findings are simply not credible. A careful examination of the authors’ own results reveals that variation in modern health outcomes is caused by current health practices and behaviors and not by the enduring legacy of slavery.

The authors are aware that “counties with more slavery in 1860 may differ in other ways that shape health today, so an association between slavery and mortality need not be causal.” To overcome this concern and convince the reader that historic slavery is the actual cause of recent health disparities, they conduct an instrumental variable (IV) analysis in which cotton suitability of the land predicts the rate of enslaved people in a county in 1860. They then use the predicted rate of slaveholding to account for disparities in all-cause mortality rates during 2010–2020, controlling for other observed factors.

The key to this type of analysis is that the instrument, in this case cotton suitability, should be predictive of the independent variable of interest (rates of slavery) but not empirically or theoretically associated with the dependent variable (disparities in mortality rates). The authors attempt to justify their use of cotton suitability as an instrument to isolate the causal effects of slavery on modern health disparities by arguing that “there is no obvious reason why soil properties that favor cotton cultivation should be associated with mortality disparities if not through slavery. However, this exclusion restriction assumption cannot be directly tested and may only be inferred through failed attempts to falsify it.”

The authors, and apparently the reviewers and editors at PNAS, must have been so attracted to the conclusion of this study that they failed to devote any time to considering why it is not “obvious” that soil properties couldn’t influence modern health other than through the effects of slavery. In fact, it should be fairly obvious that the favorable soil conditions for the production of cotton would continue to shape economic arrangements and migration patterns in these areas for many years, with direct implications for health disparities.

Because the land was suitable for cotton, and because a railroad infrastructure had been built for bringing the crop to ports, there were reasons to continue growing and exporting it after slavery ended. Without enslaved labor to grow the cotton, cotton production turned to sharecropping. About two-thirds of sharecroppers were white, and about one-third were black, but all were very poor and, relatedly, had weak health outcomes. In more recent decades, however, factories began to locate in these areas to take advantage of the low cost of land, the absence of organized labor, and railroad access to ports. That brought into these areas higher-skilled, predominantly white and Hispanic workers, who tended to have better health outcomes than the “native” sharecroppers. In other words, the suitability of the land for cotton led to the construction of railroads, which attracted factories and exacerbated health disparities in a previously low-income and predominantly agricultural area. In this scenario, the railroad, not slavery, was the mechanism by which cotton suitability caused health disparities.

In addition to the differential effects of cotton suitability on attracting healthier white workers in recent years, areas that were good for growing cotton had differential effects on black migration. Critically, the decision whether to stay or pursue economic opportunities elsewhere was not random. Rather, it was informed in part by the reality that high-quality cotton soils produced stronger economic incentives for both landowners and laborers to establish an arrangement that kept former slaves on the plantation. The result is that those who were enslaved in regions with better soil would have been less likely or slower to migrate out of the rural South. Specifically, according to a 1989 economics study, “Tenants and sharecroppers in the plantation regions of the South tended to move far less frequently than those outside the plantation regions…. Southern tenants on plantations had on average been living on their present farm roughly twice as long as tenants not on plantations in the 1930s.”

Postbellum migration patterns and their link to soil quality mean that, on average, those who were enslaved in areas with better soil and their descendants would have been less mobile due to decisions made after emancipation. This means that rural areas that were less suitable for cotton would have lost more of their population to the Great Migration. At the same time, more recent opportunities in Southern cities would have attracted back from the North, as well as from the Caribbean and Africa, wealthier blacks with better health outcomes on average. These migratory patterns, correlated with cotton suitability but not caused by the legacy of slavery, could account for modern health disparities and clearly violate the “exclusion restriction” required for the instrumental variable to render causal estimates.

Additional evidence of the absurdity of this new study is found in “Supplemental Analysis S9,” where the researchers predict the effect of slavery on black–white disparities in mortality in 1968–1978 rather than during the years 2010–2020, as they report in the main text of their study. Oddly, they find that “higher instrumented slavery predicted lower Black-White mortality disparities in 1968–1978 and higher disparities in 2010–2020. This pattern is consistent with the historical record: the civil rights era brought convergence in racial health outcomes in high-slavery counties, while the post-civil-rights period saw a reversal of those gains as structural inequalities reasserted themselves.”

This is both historical and medical nonsense. Mortality rates during the period 1968–1978 would be the cumulative result of health practices and behaviors over several decades. The passage of the Civil Rights Act of 1964 and the Voting Rights Act of 1965 did not cure black Southerners of the health problems they had acquired over time and that might have caused their deaths over the following decade. Nor does the “historical record” show that structural inequalities reasserted themselves to impact mortality outcomes from 2010–2020, resulting in a reversal in mortality rates. In fact, national data on black and white mortality rates clearly show a gradual and persistent closing of that gap over time. (See figure below generated by AI from CDC data.)

In addition, claiming that slavery caused lower mortality disparities between 1968–1978 but also caused higher mortality disparities between 2010–2020 because of a change in the progressivity of the civil-rights environment concedes that gains or reversals in civil rights, not slavery, cause mortality gaps. Slavery couldn’t flip the direction of its causal effect, since it long ago ceased to exist. The authors might try to contend that slavery has an enduring effect, but slavery did not cause progress or reversals in civil rights and therefore cannot be described as the cause by the authors’ own interpretation of their own results.

Of course, our alternative railroad explanation is perfectly consistent with the results they report in “Supplemental Analysis S9.” Areas that were suitable for growing cotton had low disparities in mortality because black and white sharecroppers shared poor outcomes. Those areas historically had slavery, but it was sharecropping that drove low disparities in mortality rates well into the 20th century. By the end of the 20th century, however, the existence of cheap land and railroads attracted factories that also drew higher-skilled white and Hispanic workers who tended to have better health outcomes, exacerbating mortality disparities.

Just because researchers use an instrument variable and declare that they cannot think of another mechanism by which cotton suitability might contribute to health disparities other than through the legacy of slavery, that doesn’t mean that they have demonstrated a causal relationship. A little bit of thought easily yields other paths by which areas suitable for growing cotton might generate economic systems and migration patterns that cause modern health disparities. And finding that slavery actually had a positive effect on disparities in 1968–1978 undermines the authors’ claim that they are observing the enduring legacy of slavery rather than the varying responses to current economic and political conditions.

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A Taxpayer Win on Pediatric ‘Gender-Affirming Care’

Do No Harm is celebrating. Under a rule finalized last week by the Centers for Medicare and Medicaid Services (CMS), the bill for irreversibly damaging sex-denying interventions for children will no longer fall on federal taxpayers.

We have long called for such a measure. Earlier this year, for example, in response to CMS’s request for comment on the proposed rule, Do No Harm submitted a response arguing that the potential regulation was praiseworthy for two central reasons.

First, because so-called gender-affirming care is a “medical scandal,” the proposed rule was a critical step to protect children, interrupting as it did the funding pipeline by which harmful interventions were frequently performed.

Second, because cracks had already begun to appear — in both the U.S. and Europe — in the alleged transgender consensus, it was inaccurate to say that the medical establishment uniformly supported “gender-affirming care” for minors.

CMS has now accepted this reasoning. As the new rule’s “summary” makes clear, “[s]tate Medicaid plan[s] must provide that the Medicaid agency will not make payment under the plan for sex-rejecting procedures for children under 18.” Moreover, the rule “prohibits the use of Federal Medicaid dollars to fund sex-rejecting procedures for individuals under the age of 18” (emphasis added).

And there’s more. State Children’s Health Insurance Program plans (CHIP) must also henceforth “provide that the CHIP agency will not make payment under the plan for sex-rejecting procedures for children under 19.” Here, too, the prohibition is also federal: The new rule “prohibits the use of Federal CHIP dollars to fund sex-rejecting procedures for individuals under the age of 19.”

Do No Harm lauds CMS and Administrator Mehmet Oz, MD. Yet we also look forward to a future in which sex-rejecting procedures will no longer be performed on minors at all.

Until then, the question of payment is an important one. Taxpayers shouldn’t be made to open their wallets for false and detrimental “care.”