February 7, 2023

Clever rhetoric has been utilized to advance causes since at least the 5th century B.C., but even the ancient Greeks couldn’t match the level of sophistry being practiced in Florida these days, to win support for restrictions on reproductive and transgender rights.

The ballroom drama event of the week came Thursday when Gov. Ron DeSantis announced the suspension of a duly-elected state prosecutor for what he called “neglect of duty.” Florida state attorney Andrew Warren is accused of believing that he “thinks he has the authority to defy the Florida Legislature and nullify… criminal laws with which he disagrees,” said DeSantis at a news conference in Tampa that his press secretary promoted on Twitter as the “liberal media meltdown of the year.”

“State Attorneys have a duty to prosecute crimes as defined in Florida law, not to pick and choose which laws to enforce based on his personal agenda,” the governor said.

Since then, politicians, pundits and protesters have sounded off about Warren’s removal, condemning the move. Some prominent members of Florida law enforcement hailed DeSantis’s decision at his news conference, but there have been crickets and “no comments” from Hillsborough County police chiefs and other officials.

The governor has found support from his followers on social media and in an interview with Fox News anchor Tucker Carlson, who blamed billionaire George Soros for “funding soft-on-crime prosecutors across the country.” It should be noted Carlson made no mention of the hefty financial support conservative attorneys general and judges have received in their races from the likes of the Koch family and Federalist Society executive vice president Leonard Leo, an advisor to former President Donald Trump.

What proof does DeSantis have?

The Republican, who is running for re-election this fall and reported to be considering a run for president in 2024, suspended Warren in an executive order he signed Thursday, dramatically citing evidence labeled “Exhibit A” and “Exhibit B.” The first is a June 2021 letter Warren signed along with other prosecutors, vowing not to use their “limited resources” on enforcing any laws that criminalize trans people or physicians that provide gender-affirming care.

“Bills that criminalize safe and critical medical treatments or the mere public existence of trans people do not promote public safety, community trust or fiscal responsibility,” the letter said. “They serve no legitimate purpose.” The letter goes on to vow prosecutors will use their discretion when it comes to enforcement of those anti-trans laws. At present, Florida is one of 18 states that bans trans student-athletes but has not thus far enacted any laws barring gender-affirming healthcare.

However, there is a new development: when the Florida Board of Medicine met today, Friday, to consider the DeSantis administration’s proposal to deny Medicaid coverage for all gender transition-related care for both trans youth and adults, the panel voted to adopt new state guidelines that would ban and restrict gender dysphoria treatments, but only for children and adolescents, according to WKMG-TV. Next, the Florida Board of Medicine will follow the rules-making process to determine a standard of care for state physicians and medical experts.

“B” as in “ban” on abortions

“Exhibit B” is a letter that was signed on June 24 of this year by local prosecutors nationwide, opposing enforcing abortion-related crimes. Warren was the only Florida-based state attorney to sign on.

Within days of the Supreme Court decision that overturned Roe vs. Wade in June, Warren—a Democrat—also made his feelings clear in a tweet that labeled state restrictions on abortion “unconstitutional.”

On Thursday, Warren tweeted again, this time issuing a statement in response to his suspension and replacement, calling it a “political stunt” and accusing DeSantis of “using his office to further his own political ambition,” going against voters who “elected me to serve them, not Ron DeSantis.”

As the Tampa Bay Times reported, DeSantis’ order said those two letters Warren signed amounted to a blanket refusal to enforce, or a “functional veto,” of the law, which amounts to neglect of the state attorney’s responsibilities.

What happens now?

Provided Warren fights his suspension, it’ll be up to the Florida Senate to decide whether to reinstate him or remove him from office after a hearing in which both sides will be able to make their case by presenting evidence, calling witnesses and having them give sworn testimony. According to State Senate rules, a notice of an initial hearing has to be announced within 90 days of the suspension, and the Senate’s final decision must be made by the end of the next legislative session, which does not start until next March and ends in May 2023.

That timeline may change should Warren take the governor to court, according to the Tampa Bay Times.

Doubling down on anti-trans rhetoric

At that same news conference introducing Hillsborough County Court Judge Susan Lopez as the judicial district’s new prosecutor, DeSantis referred to gender-affirming healthcare as “disfiguring young kids.” He repeated an analogy he’s made before: “A 12-year-old boy can’t go in and get a tattoo, but yet somehow, if the legislature were to say, that you can’t get a sex change operation…” DeSantis paused for applause before continuing.

“They are literally chopping off the private parts of young kids,” he claimed, and hinted at future legislation on “protecting child welfare,” which he said is currently being done “administratively and with medical licenses,” as WPEC-TV reported.

The main problem with these statements by Gov. DeSantis is that they are not true.

Some facts

As The Washington Post has reported, no surgeons are “chopping off the private parts of young kids.”

  • “Transgender children are not offered puberty blockers or hormone treatments until they reach puberty.”
  • “Medical guidelines generally do not recommend genital gender-affirming surgeries before a child reaches age 18.”
  • “Chest surgeries can be performed on transgender teenagers before the age of majority in a given country (age 18 in the United States), according to standards of care from the World Professional Association for Transgender Health, ‘preferably after ample time of living in the desired gender role and after one year of testosterone treatment.’”

It should be noted that there are always exceptions, such as South Florida reality TV star and author Jazz Jennings, who underwent a vaginoplasty—commonly referred to as “bottom surgery”—at age 17. That operation involves or is preceded by an orchiectomy, the surgical removal of the testes, which are often repurposed in the creation of a neovagina in gender confirmation surgery. In his remarks on Wednesday, in which he chose to misgender trans girls who are actually too young to get this operation, Gov. DeSantis called it “castration.”

DeSantis also used a phrase that fell out of favor during the era of bell bottom jeans, “sex change,” and called for doctors who perform such operations to be sued, but he did not specify by whom.

According to the latest Standards of Care published by the World Professional Association for Transgender Health (WPATH), mastectomies, often called “top surgery” in relation to trans boys, trans men and nonbinary individuals, are not considered “genital surgeries.” It’s actually plastic surgery and there’s no minimum age. According to statistics from the American Society of Plastic Surgeons, 64,470 cosmetic surgical procedures were performed on people age 13 through 19 in 2015.

Read “What You Need to Know About Transgender Children” from the Washington Post by clicking here.

Twitter: Favorite tool of the Florida spokespeople

While spoken rhetoric is especially useful in the era of TikTok and YouTube, that doesn’t mean it’s the end of the era of written propaganda, especially when it comes to transgender youth. Especially when there’s Twitter to spread that propaganda.

The day before DeSantis suspended Warren, Florida officials pumped up their spin machine in response to two bombshell reports. One was a study published in the peer-reviewed journal Pediatrics, which poked a ginormous hole in the claims that “social contagion” is to blame for a suspected spike in the number of youth identifying as trans, and that they do so to “flee LGB-related stigma.” As Stanford child psychiatry fellow Dr. Jack Turban tweeted, neither claim was supported by their research.

The spokesperson for Florida’s department of health, retired chemist Jeremy Redfern, didn’t challenge Dr. Turban’s study directly. He instead retweeted a thread of questions from writer/filmmaker Nathan Williams, and added a GIF from the opening scene in the film, Ace Ventura: Pet Detective. It’s apparently meant to convey, “Oops!”

Turban didn’t respond to a request for comment as of press time.

“NO, this is NOT an appropriate use of our work”

The other blockbuster report this week revealed that state health officials working to put an end to gender-affirming healthcare in Florida reportedly misrepresented what 10 researchers found in order to bolster their claims.

As Vice News podcast producer Sam Greenspan tweeted on Wednesday, their investigation started with their own curiosity. They’re a former Floridian and transgender, and not a scientist.

Greenspan tweeted, “My reporting revealed a concerted attempt by a very small group of people working to seed evidence for lawmakers, muddying the waters of actual science and providing confirmation bias for anti-trans agendas.”

The ten scientists told them they were shocked to learn their research was being used by Florida’s Department of Health to justify denying gender-affirming care to all minors in the Sunshine State.

“NO, this is NOT an appropriate use of our work,” one researcher cited in Florida’s memo reportedly told Vice News. “This does not mean denying transgender youth and certainly not gender-affirming care!”

The department issued its memo in April, following the enactment of what opponents have called the “Don’t Say Trans or Gay” law.

That memo goes so far as to recommend against the practice called “social transition,” usually marked by a change in gendered clothing and adoption of pronouns that differ from those a child used previously.

In addition to reporting that the researchers were unaware of how Florida was misusing their findings, Greenspan noted that all 12 of the citations in the health department’s memo were distorted or relied upon anti-trans activists who oppose the use of gender-affirming care to treat trans youth. They wrote that officials “reverse-engineered” their rationale for a policy completely counter to research-based medical best practices.

Florida officials respond, and don’t hold back

While Redfern dismissed Greenspan, telling them the data supported the state’s policy and suggesting they do some reading about “how the ‘burden of proof’ works in the sciences,” it fell to this reporter to seek further comment from the state government.

Brock Juarez, communications director for the Agency for Health Care Administration (AHCA), responded to an introduction from DeSantis press secretary Christina Pushaw. Juarez is in his fifth month on the job following his 18 months as the director of corporate and strategic initiatives at Florida Healthy Kids Corporation, and before that working for Chief Financial Officer Jimmy Patronis.

“The Agency for Health Care Administration released a report that found several services for the treatment of gender dysphoria promoted by the Federal Government—i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers—are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects [sic],” Brock wrote in an email, apparently meaning to type “effects.”

“The Biden Administration was found to be using ​low-quality studies to affirm the guidance they released,” he said. “The Agency’s report is an evidence-based report that speaks for itself.”

If it did speak for itself, it would be lying. Juarez’s claim that the treatment of gender dysphoria he mentions “are not consistent with widely accepted professional medical standards” is entirely false.

The Transgender Legal Defense and Education Fund (TLDEF) has on its website links to almost 30 respected medical associations which endorse such treatments:

As to Juarez’s claim about gender-affirming treatments being “experimental,” Dr. A.J. Eckert and Dr. David Gorski write in sciencebasedmedicine.org that this is a red herring.

“The intent behind this disparaging and dismissive use is to promote the view that the safety and efficacy of GA [meaning “gender-affirming”] care is so much in doubt that it cannot be generally used and requires more clinical trials to evaluate its efficacy and safety before it can be recommended,” they wrote. “Of course, there is also a not-so-subtle implication behind labeling GA care ‘experimental,’ namely that it is also dangerous, which then often leads to further claims that clinical trials of GA care would be unethical. In essence, those promoting these bills seem to be deceptively conflating experimental medicine (i.e., unproven treatments) with ‘disproven’ treatments, safe in the knowledge that most people outside of medicine will not know the difference.”

What about that claim gender-affirming care like puberty blockers could have “harmful long-term” effects?

“This assertion is, quite simply, untrue,” they write. “A systematic literature review of research from 1991 to 2017 noted 52 studies (listed here, along with links to the individual studies) showing overall improvement in the well-being of trans people following GA medical and/or surgical interventions, four studies showing mixed or null findings, and zero studies that GA interventions cause overall harm. More recent studies confirm that gender-affirming care can be immensely beneficial in properly selected candidates.” Eckert and Gorski provided the hyperlinks to research that supports their statement.

“FDA slaps warning on puberty blockers”

Earlier this month, nearly every conservative news media outlet and even some television stations based in red states posted bulletins with incendiary headlines like, “FDA Officials Warn Of Brain Swelling, Vision Loss In Minors Using Puberty Blockers”

The real story, of course, is a whole lot less alarming. On July 1, the FDA did indeed add a new warning to the label for gonadotropin-releasing hormone (GnRH) agonists, which are mostly used to treat precocious puberty in children, as well as in gender-affirming care as puberty blockers. The medication hasn’t been recalled and no treatments have been banned; it’s just an update for prescribers to note and be aware of a new risk related to this treatment.

The warning is about something called pseudotumor cerebri, aka “idiopathic intracranial hypertension,” a condition that occurs when pressure inside the skull increases for no obvious reason, according to the Mayo Clinic. It can happen to any child or adult, but it’s most often found in women of childbearing age who are obese.

It becomes evident with several symptoms: headache, papilledema, which means swelling around the optic nerve, blurred or loss of vision, diplopia, which means double vision, pain behind the eye or pain with eye movement, tinnitus, dizziness and nausea.

You would think from the headlines that hospitals coast to coast were going to be inundated by an epidemic of brain-swelled, suddenly blind trans kids. While no one wants to see even one child fall ill because of a reaction to a medication, the truth is there have so far only been six cases of pseudotumor cerebri linked to GnRH: five cisgender girls and one trans boy, ranging in age from 5 to 12 years. Only the trans boy was prescribed GnRH for transgender care; the rest were being treated for precocious puberty.

Already, three of the six patients have recovered and are experiencing no symptoms at all, according to the FDA, and one patient was on their way to a full recovery. No information was available about the other two. Three of the six patients discontinued use of the medication. And again, GnRH is still being prescribed and used, mostly to treat cisgender children, as it has been for generations.

“Quality of Evidence”

Juarez’s other claim, that “The Biden Administration was found to be using ​low-quality studies” is unsubstantiated and appears to be a matter of opinion. This one gets even deeper into the weeds, but what I learned is that his claim relies upon a concept called “quality of evidence” that Redfern, in a separate email, explained with a quip: “It appears that you need to check out the evidence-based pyramid.” Here’s what he sent me:

I shared Redfern’s response with Dr. Lynne Kelly, an author and award-winning professor of research communication—among other things—at the University of Hartford. Although she said this pyramid isn’t something she uses to teach graduate students, she agreed to help me help readers understand what “quality of evidence” is, and what Redfern and Brock are claiming when they call peer-reviewed studies “low quality.”

“The figure that you were sent illustrates different forms of research evidence that can be evaluated in terms of their quality,” Kelly wrote in an email. “The figure suggests that as you go from the bottom (bright green) to the top (pink), the evidence increases in quality but that’s debatable. Depending on how it is done, someone might find a randomized control trial to be superior (i.e., higher quality evidence) than a critically appraised individual synopsis, but it also depends on how those terms are being used in the figure. I would agree that these are all forms of evidence that can vary in quality.”

So, it appears that the determination a study is of “low quality evidence” is merely a matter of opinion, not a scientific fact.

That didn’t stop Juarez from continuing to make his claim when pressed for a comment on Greenspan’s investigation for this report.

“I am sure as a journalist focused on writing a factual non-biased story you will be sure to note many of the ‘experts’ refuting our report are relying on studies and surveys deemed low or very low quality and insufficient to meet medical necessity criteria. Many of these ‘experts’ have also shown a remarkable blindness to what is happening in Northern Europe on this very topic. I am still waiting for the critics to provide a logical and well-reasoned case based on quality evidence. However, rather than cite quality evidence, they have simply ignored the AHCA report’s main arguments while disseminating misinformation and making false claims. Our main focus has always been on the actual evidence, rather than the eminence of a medical society or association.”

“If Mr. Juarez had read our article, he might have been surprised to learn that the experts refuting Florida’s ‘report’ are the same experts he himself is quoting,” responded Greenspan. “That was the crux of our entire endeavor. We did reach out to Juarez for this story, but did not receive a response.”

Read more about Vice News’s investigation, “How Florida Twisted Science to Deny Healthcare to Trans Kids,” by clicking here.

“Gender-affirming healthcare”

In his report, Greenspan noted Redfern “often uses his personal Twitter account to tweet disinformation about gender-affirming care and troll members of the press when they seek clarity on the state’s policies.”

“I would just note that “gender affirming healthcare” is a political term, not a scientific or factual one,” wrote Christina Pushaw, press secretary for DeSantis. Together, with Redfern, these two spokespersons spend a rather sizable amount of their time tweeting.

And lately, those tweets have been to troll journalists—including Vice News managing editor Leah Feiger—about the phrase, “gender-affirming healthcare.”

It’s unknown why Pushaw has no use for the hyphen in “gender-affirming,” an adjective modifying the word “healthcare.”

“As Governor DeSantis noted at the press conference,” Pushaw wrote in her Thursday email to me, “the reality of ‘gender affirming care’ is life-altering experimental pharmaceutical and surgical interventions on children, such as double mastectomies and puberty blockers that can cause blindness and sterility. Reporters should strive to be accurate in describing procedures and medical interventions, rather than cloaking the reality in misleading euphemisms like ‘gender affirming care’. The public, especially parents of kids with gender dysphoria or confusion, need to understand what that actually comprises. So if Vice wants to discuss ‘twisted science,’ perhaps they should scrutinize those who promote these radical procedures on kids and teens, based on low quality evidence.”

“’Gender-affirming healthcare’ is, in fact a medical term,” said Greenspan in a response to Pushaw’s statement. “But its history and usage, especially in light of anti-trans legislation, the term has been weaponized.”

Last word on the “gender-affirming healthcare” debate goes to Joanna Harper, a doctoral researcher at Loughborough University in the U.K. She’s a medical physicist by profession, an avid distance runner by choice and the only person in history to publish a peer-reviewed article on the performance of transgender athletes. In fact, she is the first author on four peer-reviewed papers on the subject of transgender athletes. She was the first transgender person ever to advise the International Olympic Committee on matters of gender and sport.

“There is plenty of peer-reviewed research showing the positive benefits of gender-affirming care,” Harper told me. “It is unfortunate that the politicians running Florida refuse to accept it.”

What do Floridians think?

Last month, Axios reported a majority of Floridians disapprove of the Supreme Court’s decision to overturn Roe vs. Wade, with 44% saying that they “strongly disapprove.” Those are the findings of a statewide poll from the University of South Florida and Florida International University. Roughly a third said the state should pass a law protecting the right to an abortion.

According to GLAAD, an estimated 4.6% of Floridians identify themselves as LGBTQ+ and 24% of LGBTQ+ people in Florida are raising children. The state ranks 3rd in the nation with the most same sex couples, behind New York and California.

So when GLAAD released a poll of LGBTQ+ Floridians on Aug. 1, its findings bear relevance here, even though the survey was conducted a few weeks prior to this week’s news.

As GLAAD noted, the Florida governor’s race of 2018 was decided by only 32,463 votes out of 8+ million. If there’s a similar result his November, this poll suggests LGBTQ+ and ally voters could be decisive: 77% of LGBTQ+ and ally voters have an unfavorable opinion of DeSantis.

The pollsters say voters want their political candidates to address these top issues: restoring abortion rights (47%), reforms for gun safety (31%), high housing costs and inflation (22% each), and protecting LGBTQ+ equality (19%).

With 70% of respondents saying Florida’s anti-LGBTQ+ laws and policies are designed to attack LGBTQ+ people and are emotionally damaging to the population, leaders for equality hope to see a big turnout on Election Day in November.

“Florida’s LGBTQ voters and ally voters have grave concerns about their basic human rights, including access to abortion, freedom of speech, and evidence-based healthcare for LGBTQ youth,” said GLAAD President and CEO, Sarah Kate Ellis. “They’re motivated to make a difference in this crucial election.”

“The stakes are as high as ever: our civil liberties, the progress we’ve won, and our very democracy are on the line,” said Equality Florida Press Secretary, Brandon Wolf.

“It is imperative that Floridians use the power of their votes to hold Governor DeSantis and his right-wing allies accountable for the hate and bigotry they have unleashed on our state.”

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