Just the Facts with Gerald Posner

There has been a recent wave of comparisons between the massive late sixties and early seventies antiwar protests and today’s campus Israel-Palestinian demonstrations. While these parallels are largely imperfect, they share a common element: activist professors and radicalized teaching assistants can significantly intensify campus unrest.

I experienced this first-hand growing up in San Francisco during the 1960s and attending UC Berkeley from 1972 to 1975—a period marked by significant protests against the war in Vietnam, Laos and Cambodia, the rise of the Black Power movement, and an anti-capitalism fever. As a political science major, I was surrounded by professors who were not just educators but also fervent advocates, with some quoting Mao’s Little Red Book and fostering a spirit of revolution over academic inquiry.

Those professors, whom we dubbed "Mercedes Maoists," seemed to lead comfortable lives in the affluent Berkeley Hills, driving vintage Mercedes, while preaching revolutionary ideals. This wasn't mere posturing; they genuinely believed America was fundamentally flawed, a sentiment echoed by a sizable contingent of radical university teachers who distort Middle East history into a victim narrative in which Israel and western colonialism are the root of all evil.

Students now arrive at college already steeped in an extreme mix of ideology and misinformation—many boasting a "history degree from TikTok." Unlike fifty years ago, we couldn't blame social media for our skewed world views.

By the time I entered the Berkeley freshman class, I had embraced Dr. Benjamin Spock’s views on Vietnam. Yes, that Dr. Spock. The pediatrician whose 1950s book about raising children was a bible for my parents and many millions of others. Spock had created a revolution of sorts by suggesting our parents use less discipline and instead encourage our instincts and reinforce our independent thinking.

Spock’s perspective was a precursor to the cultural revolution of the Free Speech/Haight Ashbury/Woodstock era in where cultural gurus such as psychologist Timothy Leary urged a “Human Be-In” crowd of 30,000 hippies in Golden Gate Park in 1967 to “Turn on, tune in, drop out.”

As adolescents, we quoted Leary as if it was some deep philosophical revelation, the 50-year-old version of ‘going viral.’

The tumultuous political climate in northern California made it seem to us as kids that the structured world of our parents was crumbling, and that society was on a precipice of some great but unknown change. Huey Newton and Bobby Seale had founded the Black Panther Party for Self-Defense (later mercifully shortened to the Black Panthers) across the Bay in Oakland. It was a Marxist revolutionary group that called for arming all Blacks, exempting them from the military draft, and releasing all incarcerated Black prisoners. The Panthers were ahead of their time by also demanding reparations for “centuries of white exploitation.” Martin Luther King’s activism was my parents’ style. That meant I wanted to be cutting-edge and oppositional by embracing the Panthers.

When the Ohio national guard shot at hundreds of student protestors at Kent State University and killed four and wounded eight, it shocked the country. For those of us who grew up in the Bay Area, however, the police shooting at demonstrators was not new.

A year before Kent State, Berkeley police had killed one and wounded dozens when they opened fire with buck and bird shot at demonstrators at a community garden called People’s Park. The city declared martial law and imposed a curfew. Ronald Reagan, who had run on a law-and-order platform when he was elected California’s governor in 1967, wasted no time sending in the national guard. Then troops arrived en masse with unsheathed bayonets and live ammunition. Military helicopters sprayed tear gas across the campus. Alameda county sheriffs, many of whom were Vietnam veterans, were let loose with truncheons on the crowds.

As I started my first semester at Berkeley, hundreds of thousands protested Nixon’s mining of North Vietnamese ports by taking to the streets nationwide for massive marches, silent vigils, traffic‐blocking sit‐ins, and often violent clashes with police. A few months earlier an all-white northern California jury had acquitted Angela Davis for her role in providing the guns used in a takeover of a Marin County courthouse in which four were killed.

All the political chaos meant that by the time I got to Berkeley I was primed to be receptive to the leftwing propaganda that my teachers passed for scholarship.

One professor hung his favorite Mao quote in a placard over his classroom doorway: “A revolution is not a dinner party, or writing an essay, or painting a picture, or doing embroidery; it cannot be so refined, so leisurely and gentle, so temperate, kind, courteous, restrained and magnanimous. A revolution is an insurrection, an act of violence by which one class overthrows another.”

An oversized Che Guevara poster greeted us at a “comparative economic systems” class. A different professor who taught about American imperialism in Central and South America encouraged us to write congratulatory letters to Chilean president Salvador Allende getting the 1973 Lenin Peace Prize. None of us were particularly bothered that the Soviet government appointed and controlled the panel who chose the winner. Allende shared the award that year with the Soviet leader, Leonid Brezhnev.

At Berkeley, professors often joined us in protests, providing solidarity with a revolutionary zeal. They also played on student fears that we would be drafted to fight an “unjust war.” Teachers helped feed a contagion that infected many students, one whose underlying philosophy was that resistance and revolution was far more important than worrying about good grades and some future job.

The culmination of insanity came in 1974, just before my 20th birthday, when heiress Patty Hearst, was kidnapped from her Berkeley apartment by the Symbionese Liberation Army, a self-described Marxist guerrilla group.

On an audiotape released to the media two months after her abduction, Hearst announced she had joined the SLA and adopted the name Tania as a tribute to one of Che Guevara's comrades. Two weeks later, she carried an M1 carbine into a San Francisco bank branch and announced to the stunned customers and employees, “I'm Tania. Up, up, up against the wall, motherfuckers!”

How did that play at Berkeley? Many students and faculty cheered her on. “We Love You Tania” posters sprouted up around campus. One teaching assistant on “political discourse” held a nightly vigil to show “solidarity” with the SLA.

When a campus environment reaches the extreme edges, what passes for the middle is still pretty far out. The middle at my Berkeley poly sci classes was represented by the small faction of pacifists who contended Hearst should not have been armed during the robbery.

Leaving Berkeley and going on to Law School at UC San Francisco was the time for detoxing from the political fervor. I came to realize how the writings of Spock and the lectures by many poly sci professors were riddled with errors and steeped in an ideology of anti-imperialism. Contract and criminal law discussions replaced lectures about the Bolshevik revolution and Mao’s Great Leap Forward. My law school years - 1975- 1978 - coincided with the end of the Vietnam war and the disintegration of the violent Weather Underground. The “revolution” preached by the tenured Mercedes Maoists had turned into a quickly fading memory of a period when the earth seemed slightly off its axis.

Today’s campus protestors might not be able to forget their past so easily. Omnipresent technology allows outdated and sometimes vile ideas to retain some cachet on Tik Tok. I am forever grateful that social media did not exist during my time at Berkeley. Today’s students will learn the hard way that ignorance and hate live forever on the internet. There will always be online evidence of who called for the destruction of Israel, denied October 7 terrorism, proudly claimed their support for Hamas, and attacked Jews for nothing more than being Jews.

The university professors who have celebrated October 7 and urged “resistance at any cost” might eventually pay a price with their careers as schools investigate how tenured teachers can be dismissed for hate speech. If there is anything I learned from my Berkeley student days, it is that the influence of a radicalized faculty sets the framework by which students feel not only empowered but sanctioned by those in authority. Students should bear the ultimate responsibility for what they do. However, without taking effective action against the teachers who sanction and foment the extremist hate, I know from experience the craziness will never end.

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California has reaffirmed that convicted male sex predators who have declared themselves to be women can serve their sentences in all-female prisons. The state says it is following federal law by “expressly prohibit[ing] housing decisions based solely on an incarcerated person’s external genitalia.”

Mishandling this fundamental common sense issue was a key factor in Nicola Sturgeon’s resignation last year. (Check my December 2022 article, “Does Scotland’s New Gender Law Put Women at Risk.”)

California is pushing the progressive gender boundaries with the legislation, named by its proponents as The Transgender Respect, Agency and Dignity Act, and signed into law by Governor Gavin Newsom in 2021. Similar laws are also in Washington state, Rhode Island, Connecticut, Massachusetts, and New York City.

California does not require any medical diagnosis of "gender dysphoria." Anyone can declare on a Gender Identity Questionnaire that they are a different gender than their biological sex. The ease with which men can transfer to female prisons is set out in the portion of the law named, Housing and Searching Incarcerated People Consistent with their Gender Identity.

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Although the state has spent more than $3 million on medical procedures for inmates wanting to “transition” to a different gender, the California Department of Corrections and Rehabilitation (CDCR) does not require that the prisoners take any medications or have any medical procedures. The CDCR says it “does not determine an incarcerated person’s gender identity. Every incarcerated person self-identifies.”

Prisoners must serve their sentences at “an institution consistent with their gender identity.”

Of the 93,000 inmates in state prison, only 3,700 are women. A remarkable 90% of those female prisoners have a history of being beaten or battered. The state says that as of this month, there are “1,919 incarcerated people identified as transgender, non-binary and intersex.” All, of course, “based on incarcerated people who self-identify using the Gender Identity Questionnaire.” The vast majority of those are biological men.

What does California say about the safety of transferring men, even sex offenders, to female prisons? It flips the focus to the risk facing trans-identified prisoners. “Since transgender, non-binary and intersex people may be singled out for violent attacks by other incarcerated people and are at a higher risk for victimization, CDCR must make every effort to protect this vulnerable population. Housing transgender people according to their gender identity, when safe to do so, increases safety in prisons, upholds CDCR’s duty to protect all incarcerated people and promotes successful rehabilitation.”

Some commentators have suggested California convert a small prison into one exclusively for its 2,000 trans inmates. It cannot, the state claims, because a federal law, the Prison Rape Elimination Act, states, “The agency shall not place lesbian, gay, bisexual, transgender, or intersex inmates in dedicated facilities, units, or wings solely on the basis of such identification or status …”

Of the 363 prisoners who have asked as of March 2024 to be transferred for gender, 347 are biological men. They include murderers, kidnappers, rapists, and sexual abusers. A snapshot report from 2022 revealed that one-third of those asking for a transfer to an all-women’s prison were registered sex offenders. A quarter were serving their current sentence for some sex related crime. After that report, the state stopped providing the breakdown data. (A UK study by its Ministry of Justice reported that half of transgender prisoners were sex offenders or '“dangerous category A inmates [“those that pose the most threat to the public”] In Canada, a startling 85% of “gender diverse offenders” have a history of sex crimes as men.)

Although the California law has established a cursory review process for transgender transfer requests, it does not give authority to prevent a move based only on the man’s criminal record. Last year, a report from the California Office of the Inspector General, concluded that, “If a person with a history of raping women requests to transfer to a women’s prison, this [law] may prohibit the department from denying the person’s transfer request based solely on the prospective transferee’s history of raping women.”

With this background, my primary question for the Department of Corrections was whether there have been sexual assaults by men who have transferred to all female prisons?

That state’s answer is that its “reporting mechanisms do not track assaults by gender identity.” Which means they have no idea. That is evident in a March 2024 report in which the Department of Corrections gives lip service only to “proactive measures designed to prevent sexual violence.” To make it more difficult for anyone to discover the real numbers, California offers transgender men the option of a new prison identification number.

The Geneva Convention mandates that male and female prisoners should be housed in separate facilities. That is only an interesting historical footnote in California and other gender progressive states that have embraced the movement’s two core doctrines: gender always trumps sex and self-identification determines gender.

In the case of the California prison system, it is not transgender inmates who are suffering the greatest discrimination and risk of injury. It is women who are most at risk. Putting biological men, many of them convicted sex offenders, into women’s prisons, is a misogynistic policy that at first seems so ludicrous as to be impossible. The women there have no escape from a predator. But as demonstrated in California, where trends that spread to the rest of nation often hatch, it is all too real.

Amie Ichikawa, herself a former inmate in California, works with Woman II Woman, a faith-based nonprofit that was created by formerly incarcerated women to help those still in prison and others as they are released. Ichikawa believes that biological men who pretend to be transgender are exploiting female inmates in what amounts to “cruel and unusual punishment.” She is in daily contact with women serving their time across the Golden State. It is "like they're being erased and that they do not matter at all."

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Many Just the Facts subscribers requested the full OpEd published in the NY Post, not simply a link to the paper. It is below in full. I have included a voice over for those who prefer audio. It will also be available as a Just the Facts podcast.

Thanks to everyone for the overwhelmingly positive response.

Secret files show how international group pushes shocking experimental gender surgery for minors

Newly leaked files from the world’s leading transgender health-care organization reveal it is pushing hormonal and surgical transitions for minors, including stomach-wrenching experimental procedures designed to create sexless bodies that resemble department-store mannequins.

The World Professional Association for Transgender Health documents demonstrate it’s controlled by gender ideologues who push aside concerns about whether children and adolescents can consent to medical treatments that WPATH members privately acknowledge often have devastating and permanent side effects.

Yet the US government, American doctors and prominent organizations nonetheless rely on WPATH guidelines for advice on treating our youth.

The files — jaw-dropping conversations from a WPATH internal messaging board and a video of an Identity Evolution Workshop panel — were provided to journalist Michael Shellenberger, who shared the documents with me.

Shellenberger’s nonprofit Environmental Progress will release a scathing summary report, comparing the WPATH promotion of “the pseudoscientific surgical destruction of healthy genitals in vulnerable people” to the mid-20th-century use of lobotomies, “the pseudoscientific surgical destruction of healthy brains.”

The comparison to one of history’s greatest medical scandals is not hyperbole.

It is particularly true, as the files show repeatedly, when it involves WPATH’s radical approach to minors.

When the organization adopted in 2022 its current Standards of Care — relied on by the National Institutes of Health, the World Health Organization and every major American medical and psychiatric association — it scrapped a draft chapter about ethics and removed minimum-age requirements for children starting puberty blockers or undergoing sexual-modification surgeries. 

It had previously recommended 16 to start hormones and 17 for surgery.

Not surprisingly, age comes up frequently in the WPATH files, from concerns about whether a developmentally delayed 13-year-old can start on puberty blockers to whether the growth of a 10-year-old girl will be stunted by hormones.

During one conversation, a member asked for advice about a 14-year-old patient, a boy who identified as a girl and had begun transitioning at 4. 

The child insisted on a vaginoplasty, a surgery that removes the penis, testicles and scrotum and repositions tissue to create a nonfunctioning pseudo-vagina. It requires a lifetime of dilation. Was he too young at 14?

Marci Bowers, WPATH’s president and a California-based pelvic and gynecologic surgeon who is herself transgender, said she considered any age limit “arbitrary.”

But she would not do it. Why?

“The tissue is too immature, dilation routine too critical.”

In lay terms, that means boys who are too young do not have enough penal tissue for the surgery and the surgeon must harvest intestinal lining to build the faux vagina. Even Bowers admits that can lead to “problematic surgical outcomes.”

She would know since she has performed more than 2,000 vaginoplasties. Her highest-profile patient is 17-year-old Jazz Jennings, the transgender star of reality TV show “I Am Jazz.”

Three corrective surgeries were required to fix problems from the original vaginoplasty.

“She had a very difficult surgical course,” Bowers admitted in a 2022 appearance on the show. “We knew it would be tough — it turned out tougher than any of us imagined.”

Still, Bowers told her colleagues in the internal discussion forum of the best age for an adolescent to undergo surgery: “sometime before the end of high school does make some sense in that they are under the watch of parents in the home they grew up in.”

Christine McGinn, a Pennsylvania plastic surgeon and herself transgender, agreed. McGinn has performed “about 20 vaginoplasties in patients under 18” and thinks the “ideal time in the U.S. is surgery the summer before the last year of high school. I have heard many other surgeons echo this.”

Waiting until teens are older than 18 and in college is problematic, she said: “there are too many stressors in college that limit patients’ ability to dilate.”

WPATH assures patients that surgical and hormonal interventions are tested and safe. It is a different matter in private.

President Bowers, for instance, said publicly in 2022 that puberty blockers are “completely reversible,” although in the internal forum she conceded it is “in its infancy.”

What about children who are infertile for life since they started hormone blockers before they reached puberty? 

Bowers told her colleagues the “fertility question has no research.”

At other stages, members talk frankly about the complications for the transition surgery for girls, a phalloplasty in which a nonfunctioning pseudo-penis is fashioned from either forearm or thigh tissue. 

It requires a full hysterectomy and surgical removal of the vagina. They also discuss other serious consequences, including pelvic inflammatory disease, vaginal atrophy, abnormal pap tests and incontinence.

A 16-year-old girl who had been on puberty blockers for several years before she was put on testosterone for a year had developed two liver tumors that an oncologist concluded the hormones had caused. Another member described “a young patient on testosterone for 3 years” who had developed “vaginal/pelvic pain/spotting . . . [and] atrophy with the persistent yellow discharge.”

Several colleagues described patients with similar conditions, some with debilitating bowel problems or bleeding and excruciating pain during sex (“feeling like broken glass”). 

Vaginal estrogen creams and moisturizers as well as hyaluronic acid suppositories “can be helpful.”

One WPATH member seemed surprised: “The transgender people under my surveillance do not complain about this matter. However, I confess that I have never asked them about it.”

The litany of transition surgery’s side effects did not stop WPATH from endorsing far more radical “nullification” surgeries for patients who do not feel either male or female and identify only as nonbinary.

Several dozen so-called “de-gendering” surgeries are designed to create a sexless, smooth cosmetic appearance that is unknown in nature. There is even an experimental “bi-genital” surgery that attempts to construct a second set of genitals.

In 2017, when tabloids reported a 22-year-old man had spent $50,000 to surgically remove his sex organs so he could “transform into a genderless extra-terrestrial,” it seemed a one-off oddity.

But WPATH has enshrined that concept in its Standard of Care — the same document in which the group endorsed for the time first time chemical or surgical castration for patients who identify as eunuchs. (WPATH even linked to the Eunuch Archives, where men anonymously share castration fetishes.)

These science-fiction-like surgeries are not only reserved for adults.

“How do we come up with appropriate standards for non-binary patients?” asked Thomas Satterwhite, a San Francisco-based plastic surgeon who has operated on dozens of patients younger than 18 since 2014. “I’ve found more and more patients recently requesting ‘non-standard’ procedures.”

What are nonstandard procedures? They include “non-binary top surgery,” a mastectomy without nipples. There are brutal procedures for girls that eliminate all or part of the vagina and for boys that amputate the penis, scrotum and testicles.

The goal, as one San Francisco surgical clinic proclaims on its website, “is a smooth, neutral body that is cosmetically free of sexual identification.” On TikTok the trend is called a “flat front.”

A particularly intense subject of discussion was whether minors could understand the lifelong consequences of their gender treatments. Minors are presumed by law to be incapable of making an informed decision about having a vasectomy or tubal ligation.

Gender surgeries are an exception, however.

WPATH’s Standard of Care allows all procedures so long as the minor “demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.”

In a May 2022 internal workshop, “Identity Evolution,” WPATH members conceded that was all but impossible.

Daniel Metzger, the British Columbia endocrinologist who cowrote the Canadian Pediatric Society’s position paper on health care for trans minors, said, “I think the thing you have to remember about kids is that we’re often explaining these sorts of things to people who haven’t even had biology in high school yet.”

Metzger noted adolescents are incapable of appreciating the lifelong consequence of infertility. “It’s always a good theory that you talk about fertility preservation with a 14-year-old,” he said, “but I know I’m talking to a blank wall. They’d be like, ‘ew, kids, babies, gross.’ Or, the usual answer is, ‘I’m just going to adopt.’ And then you ask them, ‘Well, what does that involve? Like, how much does it cost?’ ‘Oh, I thought you just like went to the orphanage, and they gave you a baby.’ . . . I think now that I follow a lot of kids into their mid-twenties, I’m always like, ‘Oh, the dog isn’t doing it for you, right?’”

There is extensive research showing adolescent brains are wired to have little control over rash behavior and are not capable of grasping the magnitude of decisions with lifelong consequences. It is why society doesn’t allow teens to get tattoos or buy guns. Car-rental agencies set 25 as the minimum age for renting a car, and Sweden sets the same limit for deciding on sterilization.

Although many WPATH members privately doubt that adolescents can give truly informed consent to life-altering procedures, they must affirm whatever children say about their gender.

Unless, the WPATH files disclose, the patient wants to reverse course and become a so-called detransitioner.

WPATH members mostly dismiss those cases as insignificant or overblown by the media and question whether minors who want to revert to their birth sex really understand what they are doing.

It’s a question that would never be asked for minors who declared themselves to be gender dysphoric.

One case involved a 17-year-old boy, just graduated from high school, who had been on testosterone for two years. He was reported to be “very distraught and angry. He reports he feels he was brainwashed and is upset by the permanent changes to his body.”

A self-described “queer therapist” did not believe any young person could be brainwashed. “In my experience, those stories come from people who have an active agenda against the rights of trans people.”

WPATH President Bowers said that “I do see talk of the phenomenon [detransitioners] as distracting from the many challenges we face.”

The leaked files put a spotlight on the danger of mixing ideological activism with medicine and science. They should serve as an urgent wakeup call for the medical associations and government agencies that rely on WPATH guidance for transgender health.

The files might even prompt investigations into how those with distorted personal agendas seized control of the organization at the expense of science and patients.

Investigating what has gone wrong at WPATH might prove uncomfortable for some gender progressives in the Biden administration, none more so than Adm. 

Rachel Levine, the assistant secretary for health. Levine, the first transgender four-star military officer, is a WPATH member and has lavished praise on the organization.

She says it “assesses the full state of the science and provides substantive, rigorously analyzed, peer-reviewed recommendations to the medical community on how best to care for patients who are transgender or gender non-binary. It is free of any agenda other than to ensure that medical decisions are informed by science.”

Either Levine is unaware of the hormonal and surgical experimentation the group promotes or refuses to acknowledge it.

“The Frankenstein files.” 

That is how a pediatrician described the leaked documents after I shared them with her. 

Unfortunately, this is no horror novel. 

It is a medical travesty playing out in real time, and the casualties are our children.

This is another in my occasional series on the trans industry.

The United States has one of the world’s most progressive standards of gender affirming care for minors. It requires that professionals, including physicians, therapists, and teachers, must confirm the self-diagnosis of children and young teenagers who believe they are a different gender than their birth sex. The judgment of children cannot be challenged. How did we get here?

It starts with a couple of words that are tossed about without most people knowing what they mean: Gender Dysphoria.

The term is only ten years old.

It was introduced as a treatable psychological condition in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Healthcare professionals worldwide rely on the DSM as the authoritative guide to diagnose mental disorders.  A dozen leading psychiatrists and mental health professionals worked for a year on developing the gender dysphoria diagnosis.

How was gender dealt with before 2013?

The first DSM published in 1952 did not mention the word gender. It did not appear until the 1968 second edition. That listed mental distress associated with gender identity as a “sexual deviation” in adults. The condition did not apply to children or adolescents.

Twelve years later (1980), the DSM third edition introduced transsexualism as a psychological disorder. That was defined as “a desire to live and be accepted as a member of the opposite sex…and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with the opposite sex.” Patients had to exhibit the desire to be the opposite sex for two years before psychiatrists could make a conclusive diagnosis.

A revised DSM in 1987 (DSM-III-R), changed the disorder’s name from transsexualism to gender identity disorder (GID). It expanded the disorder to include people who did not want hormones or surgery.

The fourth major DSM published in 1994 kept gender identity disorder but again expanded the eligibility criteria to patients who exhibited “discomfort” with their birth sex and demonstrated “clinically significant distress or impairment in social, occupational, or other areas of functioning.”

When the fifth edition replaced gender identity disorder with gender dysphoria in 2013, it liberalized the criteria to include patients who exhibited a “marked incongruence between one's experienced/expressed gender and one's assigned gender.” The previous requirement for at least two years of symptoms before a diagnosis could be confirmed was slashed to six months.

And most importantly, in 2013, the disorder was applied for the first time to minors.

To make a diagnosis that an adolescent (ages 10 to 19) had gender dysphoria, in addition to the feelings of “marked incongruence” over gender, there had to be at least two from a list of ten symptoms:

A strong desire to be treated as the opposite gender or a desire to get rid of one's own sex characteristics

A strong preference for wearing clothes typical of the opposite gender

A strong preference for cross-gender roles in make-believe play or fantasies

A strong preference for the toys, games, or activities stereotypically associated with the opposite gender

A strong preference for playmates of the opposite gender

A strong rejection of toys, games, and activities typical of one's assigned gender

A strong dislike of one's own sexual anatomy

A strong desire for the primary and/or secondary sex characteristics of the opposite gender

A strong belief that one will grow up to have the primary and/or secondary sex characteristics of the opposite gender.

A strong desire to participate in the stereotypical games and pastimes of the opposite gender

As for children younger than 10, the DSM said they had to exhibit six of those symptoms.

While gender dysphoria was a frequently changing diagnosis in the psychiatric world, most professionals agreed that even in the instances in which it might be a correct diagnosis, it was a very rare occurrence. As little as .001 percent of the population had gender dysphoria that was accompanied with a desire for hormonal and surgical treatments. 

The missing standard of care for adolescents and children

The 2013 DSM’s introduction of gender dysphoria — and its extension to adolescents and children — created a new world in medicine and psychiatry.

What should the standard of care be for the small number of cases in which doctors, therapists, or other professionals confirmed a diagnosis of gender dysphoria in children or young teens?

There were no guidelines for minors in 2013

A German-born endocrinologist who practiced in New York City, Dr. Harry Benjamin, had developed a protocol for cross-sex hormone therapy and for surgery for transgender adults who felt trapped in the wrong biological body. Benjamin is often called the father of modern transgender medicine [in a future article, I will write about the four endocrinologists and psychiatrists I call the Gods of Gender; Benjamin, John Money, Robert Stoller and Richard Green].

Benjamin was a strong advocate not just for international medical standards but also for gender affirming care for adults (also called “gender confirmation care”). He thought that in most instances, medical professionals should confirm the diagnosis as quickly as they could responsibly do so and then proceed to hormones and surgery. 

Benjamin founded a medical association in 1979 to promote the treatment of gender dysphoria (it was called the Harry Benjamin International Gender Dysphoria Association (HBIGDA), renamed later the World Professional Association for Transgender Health (WPATH))

However, Benjamin had not addressed the issue of affirming care for minors in his professional writings. He did not treat minors in his clinical practice. Benjamin died in 1986, 27 years before the DSM introduced gender dysphoria and applied it to children and teens.

Still, many gender advocates contended that the same standards — gender affirming care for adults — should be applied to minors.

The organization Benjamin founded is today at the progressive forefront of interpreting gender affirming care and is essentially an advocacy group operating under the veneer of a medical guidelines association.  Dozens of medical groups rely on the WPATH gender-affirming care guidelines, which have been updated eight times over twenty years. WPATH wields outsized influence on trans policies for adults and minors on the WHO, the American Pediatric Association, and the American Association of Clinical Endocrinology.  LGBT advocacy groups rely on WPATH’s pronouncements on trans policies to lobby policy makers and the public that the science is settled.

That is false.

The science is anything but settled.

There has never been a double-blind clinical trial, medicine’s gold standard, for determining the short-term safety and long-term consequences of puberty blockers or cross-sex hormones for minors. There are no large-scale studies tracking patients who were given puberty blockers, or cross-sex hormones, or surgical interventions as children to determine if they were satisfied or unhappy with their gender decision.

The Dutch Model and the Introduction of Puberty Blockers

Although gender dysphoria was not a recognized condition that might apply to minors until 2013, the Netherlands had pioneered the concept of hormone blockers to what it called “juvenile transsexuals” in 1998 (many doctors still call it the Dutch Model.) It was developed by three Dutch clinicians based on observations of a handful of patients (only 7 children under the age of 16 had been put on puberty blockers by 2000). The researchers subjectively concluded hormone blockers reduced gender dysphoria agitation (they omitted that one teen died after puberty suppression and a vaginoplasty). Without any clinical research to support their conclusions, the trio claimed that puberty blockers were “completely reversible….in other words, no lasting undesired effects are to be expected.”

A later British study designed to confirm the Dutch results was withheld for years from publication because it did not show psychological improvement and enhanced mental health for the minors.  American studies that have attempted to reinforce the Dutch Model have been of poor quality and produced mixed and poor results.

The Drug Industry Money behind the Dutch Model

Two of the original Dutch researchers in 2006 published a paper in the European Journal of Endocrinology. They concluded that puberty blocker “treatment appears to be an important contribution to the clinical management of gender identity disorder in transsexual adolescents.”

Largely ignored in a footnote in their acknowledgments was: “The authors are very grateful to Ferring Pharmaceuticals for the financial support of studies on the treatment of adolescents with gender identity disorders.”  The study’s authors had presented their paper in Paris at the 2006 Ferring Pharmaceuticals International Pediatric Endocrinology Symposium. 

Why did Ferring pay for the study? It had a patent on Triptorelin, one of the most expensive puberty blockers, used under the brand names Gonapeptyl and Diphereline. The study recommended puberty blockers for gender dysphoric children identified “by the first growth of pubic hair and for girls by budding breasts and for boys by growing testicles—as long as they had reached the age of 12…”  The study recommended that cross-sex hormones not be dispensed before the age of 16.

Two of the Dutch researchers were leading advocates for expanded transgender treatment and served as directors of the Harry Benjamin International Gender Dysphoria Association (HBIGDA). When HBIGDA adopted puberty suppression as a recommended standard of care for minors in 2006, it copied it from the Dutch protocol, with the exception that it did not specify a minimum age.

Puberty blockers were prescribed to 111 minors between 2000 and 2008 (70 of them were the subjects of a much-challenged study published by the Dutch researchers, again confirming their own hypothesis.

Not very many clinicians adhered to the liberal Dutch rules. Some children were given endocrinological exams as young as ten. Cross-sex hormones were dispensed to children as young as thirteen.

America’s Permissive Gender Guidelines for Children

The Gender Management Service at Boston Children’s Hospital, founded in 2007, was the first dedicated clinic for transgender minors in America. Its co-founder, Norman Spack, was an endocrinologist who once said he was “salivating” at the possibility of treating his minor patients with puberty blockers. The Boston clinic followed the Dutch protocol, although it did not set a minimum age under which it would not prescribe the drugs. One of the Boston psychologists was dispatched to Amsterdam to be trained by the Dutch lead author.

When the Endocrine Society leadership decided it was necessary to address the first clinical guidelines for “transsexual persons,” it tapped the two primary Dutch authors and Boston’s Spack to lead the committee. It is not surprising that their recommendation was an endorsement of puberty blockers for gender dysphoric children. This formal endorsement by a leading medical society moved the medicalization of children forward.

Within a year of the DSM listing gender dysphoria as a treatable diagnosis for adolescents, the number of clinics specializing in “gender-nonconforming children and adolescents” had skyrocketed from the single Boston clinic to 32 (as of 2023, there are 60 clinics dedicated solely to gender affirming care for minors, and about 350 more that are clinics or medical offices that offer hormonal interventions for children and adolescents).  

The U.S. clinics have adopted the most permissive interpretations of the Dutch protocol, everything from the starting ages to the duration of treatment. An international advocacy organization, the Gender Identity Research and Education Society, told parents who lived in Europe that if they wanted their gender dysphoric children to receive puberty blockers, that they should “consider taking their children to the USA.” 

American gender clinics have expanded the boundaries of gender affirming care for minors.  Children as young as 3 have been treated at Yale’s Pediatric Gender Program.  U.S. clinics sharply downplay the role of psychotherapy that had been suggested by the Dutch as a parallel standard of treatment. The Dutch clinicians had also tried reducing the number of false positives, those children whose desire to change their birth sex was a “transient phase” that would pass before they reached 18. To avoid putting those children for whom gender dysphoria was a fleeting stage of adolescence, the Dutch discouraged early social transitioning of minors (such as using the child’s new pronouns and names).  However, American clinics, and many U.S. school districts have instead made social transitioning the accepted standard.

The American approach is to put children on hormone blockers at ever younger ages, preferably before they start puberty. That is the only guarantee, contend advocates, for a less complicated series of surgeries for those who ultimately decide to cosmetically transition. It turns out that putting children on puberty blockers assures they will at least move on to cross-sex hormones. Ninety-five percent of minors on puberty blockers go on to further cross-sex hormones or surgeries. However, a study shows that upwards of 90% not taking puberty blockers change their minds and remain with their birth sex. A Canadian study by a psychologist running a gender dysphoria clinic, meanwhile, showed that without pharmacological or surgical treatment, approximately 80% of trans patients went on to identify as having a same-sex attraction.

The liberal U.S. approach has had a stunning effect on the number of minors put on hormones.  A review of data at 43 major children’s hospitals shows that puberty blockers were never dispensed to minors from 2004 to 2009; from 2010 to 2016, 92 children were put on them.  A larger study of all insurance claims filed for patients aged 6 to 17 in the U.S from 2017 and through 2021, reveals that almost 5,000 were put on puberty blockers, and another 15,000 skipped puberty blockers and went directly to cross-sex hormones.

Even one of the original Dutch clinicians who helped develop the protocol for giving puberty blockers to children, Dr. Thomas Steensma, expressed his concern in 2021 that the “rest of the world is blindly adopting our research….We just don’t know. Little research has yet been done on the treatment with puberty inhibitors and hormones in young people. That is why it also seen as experimental.”

What is Gender Affirming Care for Minors?

Gender affirmation is the standard of care adopted in 2018 by the American Academy of Pediatrics, the world’s largest association of doctors who treat children and adolescents. The American Psychological Association has similarly embraced “culturally competent, affirmative care for transgender and gender nonconforming people, including adolescents.” The Human Rights Campaign, one of America’s most influential LGBTQ+ lobbying groups, with 3,000,000 members, declares that gender affirming care is a medical necessity when it comes to gender dysphoria.

Gender affirming care covers a broad range of treatment options but always involves a confirmation of gender dysphoria by doctors, psychiatrists, and other medical and mental health professionals.

A pediatrician who prefers to stay anonymous shared with me guidelines he received from the large urban hospital with which he is affiliated: “Gender identity is a deeply personal and subjective experience, and individuals should be respected and believed whenever they reveal their gender identity. Therefore, it is generally considered best practice for healthcare professionals to validate and affirm the gender identity of their patients who are seeking gender affirming care. Your role is not to invalidate or question a patient's gender identity but instead to provide compassionate and respectful care that addresses the patient's individual goals. While a formal diagnosis of gender dysphoria is helpful for the patient’s access to full medical services, it should not be a prerequisite for patients who wish to obtain gender affirming care. The decision to seek gender affirming care should therefore be made by the individual based on their own life experience and needs.”

A particular problem with gender affirming care is that it is at odds with therapeutic exploration. It requires that therapists only confirm a minor’s self-diagnosis of transgender and facilitate their access to hormones and surgeries. The professionals cannot question whether the gender dysphoria is a “transient phase” or possibly the result of an underlying mental disorder. To do so would be to question the self-diagnosis, and that is forbidden. In lay talk, that means that professional discretion is eliminated. 

This is one issue when it concerns adults, but quite another when children and teens are involved.

When minors self-diagnose with gender dysphoria, however, there is a unique preliminary medical intervention: the dispensing of hormones that block puberty. The idea is that if the birth sex hormones of a prepubescent child are blocked before a child later begins cross-sex hormones, any full transition to the opposite sex will supposedly be easier (no long-term studies have been done, it is a theory that has been put into standard practice).

Administering puberty blocking hormones is problematic because the process has evolved in America so that in many cases, children are making decisions about starting a process with lifelong consequences.  

Who Put the Kids in Charge?

All this might be written off as another contagion from social media that affects teens at their most vulnerable time of lack of self-confidence and in a state of brain development where they have little control over impulsive behavior or are not fully appreciating the magnitude of decisions that have life-long consequences. 

In interviews with several psychologists who have studied the field, I learned that adolescents cannot fathom risk. They cannot digest long-term consequences; they can only appreciate the gratification from something immediate.  Children, especially adolescents, are susceptible to the pressure and influence of their peers, and the outside world has a huge, overdetermined impact on their development.

Social media and internet chatrooms that target children and teens who think they might have gender dysphoria have created a confusion matrix. With more than 100 genders available from which to choose, adolescents and children seem particularly susceptible to the contagion of believing they might be trapped in the wrong body. Experts who visit schools and study trends among minors have observed startling increases, especially among teen girls. Ten years ago, one percent might have talked about gender, now, in some schools upwards of 20 percent of teen girls identify as being the opposite gender.

The social media influence creates a false sense that the child has made a reasoned decision.

“If you're Johnny and you want to be Julie,” a Miami Beach-based psychologist told me, “and parents say, ‘Oh, okay,’ the child gets a charge from that response. Forget the content for a moment. The charge of that response is what kids will react to; hang on to it, it becomes an artificial structure. It's no different than being fed all the increasingly lurid and damaging YouTube or TikTok videos. Children are hypersensitive to external stimuli, and it pulls kids out of themselves, and then they're doing it just to again get the attention that their parents gave them when they said, ‘I want to be Julie.’ Many parents and professionals go along because it is, like a cult phenomenon. They are being bombarded with a particular type of narrative over and over and over again.”

These are the reasons society does not allow teens to get tattoos or buy guns. That is why car rental agencies make twenty-five the minimum age for renting a car; Sweden has twenty-five as the minimum age to decide on sterilization. The brain doesn’t stop its pruning and settle into something that has a degree of reliability before then.

Gender dysphoria is the only area of mental health in which patients are allowed to diagnose themselves, and physicians and psychologists are barred from making any independent medical judgment.

Those who present themselves to doctors or psychiatrists and announce they have depression, anxiety, or schizophrenia are never accepted at their word. But that is precisely what happens under gender affirming care for children and teens.

Failing to fully “affirm” in some countries will land a doctor in professional disciplinary proceedings. In some instances, doctors who refuse to go along with a process they believe is not in the best interests of the children because it is contradicted by science have been dismissed from their jobs and professionally ostracized as transphobic.

Doctors, psychiatrists, and psychologists are not the only ones who can get into trouble if they do not affirm the gender dysphoria presented by a minor. Parents who say no to their children are at risk in some places, such as Sweden, of losing their children to state control. Sweden’s Board of Health and Welfare can place a child into state custody if any third party reports the parents for refusing to approve puberty blocker treatment. Until recently, Karolinska Hospital, Sweden’s medical clinic for treating those aged 17 and younger who self-diagnose with gender dysphoria, had an online, pre-printed template for a report to be filed against resistant parents. A hospital official told reporters that “We refuse to see any children without their guardian’s approval.” That guardian can be the government.

The state of Washington has not let Sweden get too far ahead of the progressive gender trend.  Parents who do not affirm and provide treatment for their child's gender choice will be legally at risk of losing custody due to “neglect.”

 Oregon bypasses parents.  A 2015 law permits 15-year-olds to get puberty blockers or start gender reassignment surgery without parental consent. Fifteen is the same age in Oregon where teens do not need parental consent to get birth control, have a pregnancy test, and get an abortion. Oregon does, however, ban teens until they are 18 from buying cigarettes and marijuana, voting, getting a tattoo, or using a tanning bed.

“It is the greatest medical scandal since lobotomies”

The United States has moved far beyond the Dutch standard of care, in which no surgeries were offered to patients younger than age 18. In contrast, an NIH-funded study reveals that minors as young as 13 can get mastectomies in the U.S. There are instances in which children as young as 12 have started crowdfunding to raise money for surgery.  A recent US-based study shows that the average age for mastectomy in minors — dubbed “masculinizing chest surgery” — is 16, with a range of 14-18.  A recent Vanderbilt University study found that the number of radical mastectomies performed on teen girls had surged fivefold in recent years.

At Vanderbilt itself, double mastectomies were performed on girls from 16 to 17 years of age. The clinic also provided cross-sex hormones, which can lead in some instances to lifelong sterilization, to kids as young as 13.

California’s Kaiser Permanente Oakland recorded 70 “top surgeries” in 2019 on teenagers between the ages of 13 and 18. Before that, it had only performed five in total since 2013, according to a study.

Until a recent Florida law banned it, Dr. Sidhbh Gallagher, a Miami-based plastic surgeon, performed 40 “top surgeries” per month, including on minors, according to The New York Times. Most patients, she told the Times, were 15 or older, but she admitted she had done the procedure on children aged 13 and 14. Since the Florida law came into effect, she has moved on to so-called bottom surgeries, such as vaginoplasties and phalloplasties.

“It is the greatest medical scandal since lobotomies,” a British physician told me.

It is worth noting that in the last couple of years, the U.K., Finland, and Sweden have all stopped or radically cut back on medical transition of minors. Their retrenchment is the result of a spate of recent studies that have concluded that while the medical interventions have little demonstrable benefit, the potential for lasting harm is not fully known.

When will United States medical associations responsible for treating children follow the lead of progressive European nations and stop embracing the cult of transgender ideology? How many more thousands of children will suffer from getting hooked on the trans contagion will depend on that answer.

An alarming report released Wednesday by the Defense Department Inspector General reveals that the U.S. has lost track of nearly all of the 40,000 sophisticated weapons sent to Ukraine’s front lines since February 2022.

The redacted report underscores that the advanced technology and compact size of these untracked weapons — including more than $1 billion in kamikaze and switchblade drones, Javelin anti-tank missiles, Stinger shoulder-fired missiles, and night vision goggles — make them particularly appealing for arms smugglers and black market dealers.

Approximately 60 percent of the weapons were “delinquent,” meaning they were neither initially logged into a tracking database, nor added after shipment from American stockpiles.

Over a year ago, the Biden administration tried fixing this problem by providing Ukrainian troops with handheld bar code scanners to instantly upload weapon serial numbers into U.S. databases. However, this effort has had a minimal impact. Only ten scanners were sent to Ukraine and none reached the front lines, where the weapons are deployed.

The Inspector General said that determining whether any weapons were illegally diverted “was beyond the scope of our evaluation.”

The issue is a significant behind-the-scenes concern for American officials, particularly given Ukraine’s history of arms smuggling.

A senior Interpol official, on the condition of anonymity, told Just the Facts that the international crime fighting organization believes that “some undetermined number of U.S. weaponry intended for Ukraine has gotten to criminals.” Albanian crime syndicates are at the top of Interpol’s suspect list.

Interpol has no public comment. It will not even acknowledge that it is officially investigating the diversion of the U.S. arms. However, last June, Interpol chief Jürgen Stock warned publicly that “Once the guns fall silent [in Ukraine], the illegal weapons will come. We know this from many other theaters of conflict. The criminals are even now, as we speak, focusing on them. Criminal groups try to exploit these chaotic situations and the availability of weapons, even those used by the military and including heavy weapons. These will be available on the criminal market and will create a challenge. No country or region can deal with it in isolation because these groups operate at a global level.”

The Interpol official who spoke to Just the Facts said that Stock’s concerns had materialized earlier than thought likely.

“We anticipated that the conflict would end before we confronted weapons of war finding their way to the illicit market. The sheer volume of weapons, coupled with the difficulty in tracking them, has presented a challenge for law enforcement problem sooner than we had expected.”

The report, and news of Interpol’s apprehension about some American weapons entering the black market, comes at a bad time for the Biden administration. It is likely to fuel increasing Republican congressional opposition to further aid to Ukraine.

Thank you to the 5000 loyal subscribers to Just the Facts.

This Substack is somewhat unorthodox. It does not adhere to the typical model of focusing on a single subject. Some of you discovered my work from articles about OxyContin or Fentanyl, only to find the next piece discussing the dangers of puberty blockers for minors or the risks posed to free expression by increasing censorship. Just when you think you spot a theme, I am sure to deliver something unexpected; how Sweden became a gangland paradise, the latest news from those still-sealed JFK assassination files, or the emergence of an October 7 denial movement. Just the Facts tries to break some news while also delivering a view of a topic that is fresh from the mainstream media coverage.

The nature of investigative journalism means Just the Facts has no set publication schedule. It depends on when I finish my reporting on a story. Sometimes a promising lead takes much longer than expected or ends up in a dead end. And many times, I am pulled away from Substack — which I keep free of charge — to fulfill commitments for books, articles, and documentaries.

Currently, there are several Just the Facts projects in progress. A couple have the potential for groundbreaking revelations. Additionally, next year, I plan to feature occasional articles by guest investigate reporters.

Remember, some of the stories I am chasing come from your tips. I encourage whistleblowers to contact me through my Swiss-based, encrypted email, [email protected], or via Signal at 917-300-9834. Response times may vary due to deadline pressures, but rest assured, I will get back to you.

For those wanting to send general feedback, or suggest a future topic, please write to me via Substack or at [email protected].

Outside of Just the Facts, you can follow my daily updates on X (formerly known as Twitter). Finally, my wife and reporting collaborator, Trisha — the author of the international bestselling The Pharmacist of Auschwitz, and the founder of the non-profit Antisemitism Watch — also shares her daily insights on X. Trisha has a much less frequently updated Substack, No More Nice Jewish Girl.

Thanks once again for your steady support and encouragement.

Wishing everyone a good New Year and start to 2024.

Gerald Posner

The Supreme Court will hear oral arguments tomorrow morning about whether it should invalidate Purdue Pharma’s approved bankruptcy plan, the largest and most consequential in legal history. The elaborate $10 billion bankruptcy was approved in 2021 but is on hold at the request of the U.S. Trustee, the Department of Justice division that oversees bankruptcy cases. 

The question the Supreme Court must decide is whether the Sackler family, owners of the company that sold $35 billion of its narcotic painkiller, OxyContin, should be granted full immunity from all civil litigation because they contributed several billion dollars to the settlement.

The Sacklers are one of America’s richest families.  As directors of the privately owned Purdue, they carefully orchestrated and oversaw the aggressive marketing campaign that made OxyContin into a lethal blockbuster. No Sackler has ever gone bankrupt.  So why did the bankruptcy judge, Robert Drain, give them a free pass from all litigation, something meant to be available only to those who have filed for bankruptcy?  The Sacklers’ blue-chip law firms successfully argued that bankruptcy courts have expansive powers for creative outcomes (Judge Drain retired from the bench shortly after approving the Sackler deal in Purdue Pharma and went to work for Skadden Arps, a firm that was Purdue’s “special counsel” before and during the bankruptcy).

Purdue’s lawyers cited the precedent of a 1985 case in which A.H. Robins, the manufacturer of the Dalkon Shield contraceptive device, filed for bankruptcy. Plaintiffs had sued the Robins family owners, charging they had deceptively concealed evidence that the Dalkon Shield was dangerous. None of the Robins family had filed for bankruptcy. The court still discharged them from all liability. 

Proponents of the Purdue settlement contend that the court had to impose a global resolution, as unfair as it might seem, or otherwise litigation would drag on for years. That does not persuade any of the families of the victims of OxyContin overdoses, a crisis that has taken over half a million lives. I have spoken with dozens of them in the lead up to the Supreme Court hearing. Several advocacy organizations, and individual victims, will hold a “Last Chance for Justice” rally in front of the court tomorrow morning. Others plan to line up overnight to get seats in the Court’s public gallery in order to hear the hour-long oral arguments. 

The families whose lives have been upended by OxyContin believe that if the Supreme Court approves the Purdue bankruptcy, the Sacklers will benefit at the expense of all victims.

Upholding the legality of the Purdue bankruptcy plan will reinforce the common perception that individuals rich enough to take advantage of the legal system’s loopholes, can get away with the most appalling conduct. The Purdue bankruptcy will be the only major one in which no principal has faced criminal charges. Ed Bisch, a father whose son died from OxyContin twenty-two years ago, summed up the feeling of many others: “It was a bankruptcy scam from day one.”

At stake before the Supreme Court is much more than whether so-called “third party releases” are permissible under bankruptcy law. What is at stake is determining whether there will ever be an equitable accounting of responsibility for America’s prescription opioid epidemic. Justice requires at the very least that the Sackler family not be allowed to keep billions in OxyContin profits while walking away free from all legal liability.

The Supreme Court has a chance to do the right thing by the millions of Americans who have suffered a personal loss from the Sacklers’ addictive drug. There is still time for a measure of real justice for those responsible for creating the most deadly prescription drug crisis in American history.

A Note to Readers: I have written editorials about the Sackler/Purdue bankruptcy fiasco in the Los Angeles Times, and twice in The New York Times. Here are the links for those interested in more information.

“The Sacklers’ Last Poison Pill,” The New York Times, with Jonathan Lipson, December 5, 2020

“The Sacklers Could Get Away With It,” The New York Times, with Ralph Brubaker, July 22, 2020

“How to Hold Purdue Pharma Accountable for its Role in the Opioid Epidemic,” Los Angeles Times, May 17, 2020

There has been a lot of talk from the Biden administration and European allies since October 7 about the need for a two state solution.

OK, let’s find out what the moderates in Gaza think about that.

Ghazi Hamad is widely considered a Hamas moderate. He was a Deputy Foreign Minister in the Hamas government, and the chairman of the Border Crossing Authority in Gaza. He holds a veterinary medical degree, speaks Hebrew and English in addition to his native Arabic, and was the editor of Al Watan, the Hamas newspaper. This week he gave an interview to Lebanese TV.

Here is a one minute clip.

Some of the highlights:

“Does that mean the annihilation of Israel?” “Yes, of course”

“We are the victims…therefore no one should blame us for what we do.”

“On October 7, October 10, October 1,000,000, everything we do is justified.”

The discussions at Wednesday’s Republican presidential debate in Milwaukee will largely be about the absent Donald Trump and subjects important to Republican primary voters. Opinion polls list one of the top issues as the lethal opioid crisis, especially that fentanyl is now the #1 killer of Americans and is pouring over the southern border.

The fentanyl epidemic, however, might not have existed if the groundwork had not been set with Purdue Pharma’s blockbuster opioid painkiller, OxyContin, and the lethal opioid crisis it triggered.

Asa Hutchinson is the only candidate who once had a chance early on to possibly stop the opioid crisis in its tracks. And he did not. I hope one of the FOX debate hosts, or his fellow contenders, will finally confront him about that missed opportunity.

I reported the background to this in my book, PHARMA. For those not familiar with it, in December 2001, Asa Hutchinson was the head of the DEA. The drug agency had just begun to focus on the problem of OxyContin being diverted to the black market. There were reports of rising abuse and overdose deaths.

The DEA’s point person was Laura Nagel, a 22-year veteran who was the second in charge of the Office of Diversion Control (the Edie character, played by Uzi Aduba, in Netflix’s Painkiller, is loosely based on Nagel).

Nagel was convinced that Purdue Pharma was not doing nearly enough to stop OxyContin reaching the black market. Purdue could not account for batches of pills made at a manufacturing plant in Totowa, New Jersey.

In April 2002, Nagel and some of her DEA team, met with Richard Sackler, as well as Purdue’s Chief Financial Officer, its general counsel, and the company’s medical director. Nagel presented evidence that abuse of OxyContin had spiraled since the drug had gone on sale in 1996.

At one stage, Nagel told Richard Sackler: “People are dying. Do you understand that?”

That meeting ended in a stalemate.

Later that month, Nagel again met with Purdue executives and this time was joined by Deborah Leiderman, the FDA’s director for controlled substances in the Center for Drug Evaluation and Research.

Nagel hoped the FDA would use its authority as the nation’s drug regulator to restrict how OxyContin was dispensed. The FDA had previously done that for barbiturates, amphetamines, and benzodiazepines; the diversion of each of those had led to widespread drug abuse. Leiderman had no interest in recommending that the FDA put any restrictions on OxyContin prescriptions.

As I report in PHARMA, “A retired DEA officer familiar with what transpired next told the author that Nagel and Gauvin [a DEA pharmacologist] were so incensed by Leiderman’s intervention on the side of Purdue that they discussed whether she might have sabotaged their investigation. They had no evidence of any wrongdoing and did not think she was in Purdue’s pocket. Instead, they wondered if it was Leiderman’s way of pushing back against the DEA for overreaching its authority by seeking prescription restrictions.”

A month later, the Sackler family hired “America’s mayor” to represent Purdue Pharma. Rudy Giuliani had opened Giuliani Partners, a consulting firm, only a few months earlier. He was riding high from his two terms as New York’s mayor. He had been widely praised for his calm leadership after the 9/11 terror attacks; Time had named him Man of the Year and Britain’s Queen Elizabeth had given him an honorary knighthood.

As a former United States attorney for the prestigious Southern District of New York, Giuliani offered high-level access and influence. He was friendly with many top-ranking Justice Department officials. As for Asa Hutchinson, the Drug Enforcement Administration director, the duo had known each other for twenty years.

Maybe, thought the Sacklers, Giuliani might find a way to put a check on an investigation opened recently by a West Virginia U.S. Attorney. And, Purdue told him, it wanted him to extinguish the brewing DEA firestorm in Washington.

Purdue Pharma was the ex-mayor’s first major client. (While the fee agreement remains a secret since both Purdue and Giuliani Partners refuse to disclose it, litigation documents produced later by Purdue reveal it was paying about $3 million a month to its team of high-powered attorneys). It could certainly afford it. OxyContin was bringing in $30 million a week, about 90 percent of Purdue’s profits.

When Laura Nagel heard the news about Giuliani’s retainer, she said, “My reaction was that they went around me. They went and got Rudy.… They thought they were buying access and insight into how to manage things politically.”

Giuliani assigned New York’s former police commissioner, Bernard Kerik, who had joined Giuliani Partners, to conduct a security appraisal of the New Jersey manufacturing plant where unaccounted-for Oxy had attracted Nagel’s attention.

Giuliani set an August meeting with the DEA.

“The mayor and I met with Asa Hutchinson, the director of the DEA; his staff; and people from Purdue [general counsel Udell],” Kerik told New York Magazine. Karen Tandy, the associate attorney general responsible for Drug Enforcement oversight, also attended.

“We don’t want Purdue put in a position where it winds up being taken over by the courts,” said Kerik. “Or they get put out of business. What I’d like to see come out of this is we set model security standards for the industry.”

A week before the first 9/11 anniversary, Giuliani joined Asa Hutchinson and Attorney General John Ashcroft at the opening of a DEA exhibit about terrorism and drug trafficking. Giuliani gave a short speech that raised $20,000 for the DEA’s Museum Foundation. When he finished, Hutchinson asked Laura Nagel to set a meeting with the ex-mayor.

A week later, Asa Hutchinson and Laura Nagel were in Giuliani’s twenty-fourth-floor office overlooking Times Square. A Purdue OxyContin team Giuliani had created ran through a thirty-minute PowerPoint designed “to keep OxyContin out of the wrong hands.” They emphasized that Oxy was “a good drug” and claimed they were doing all they could to spot abuse and diversion.

The DEA pair said little. “We were receivers of the information,” Hutchinson later said.

Nagel was anxious to return to headquarters. When she did, colleagues recall that she railed against that “dog and pony show.”

Laura Nagel had built a damning case against the cavalier way Purdue Pharma handled the manufacturing of a controlled substance. Over two years, she initiated several hundred OxyContin abuse and diversion cases connected to Purdue. Giuliani, however, had managed to make certain Purdue faced only civil charges. Purdue ultimately paid a $2 million civil penalty for its security lapses that allowed the drug to be diverted to the black market. By then, OxyContin sales were up twentyfold since its 1996 introduction; it was on its way to $2 billion that year in sales. Two million dollars was not an insignificant amount, but it was, as one Purdue executive boasted, “less than a day’s [OxyContin] revenue.”

Why didn’t Asa Hutchinson listen to Laura Nagel and use the DEA’s full enforcement power against Purdue and Oxy? It is a question never satisfactorily answered by Hutchinson or Giuliani. Maybe Wednesday, somebody can finally put Hutchinson on the spot and get an answer in front of millions of viewers on live television. It’s about time.

Just the Facts reached 3,000 subscribers today. I am grateful to all of you. Some have been with me since the start and others subscribed only today. The growth has been slow and steady.

One of the first bits of advice another writer offered when I set up my Substack was to stick to a single topic.

“Carve out a niche on one subject and you will get a following fast,” he assured me.

Those of you who have stuck around for a while know I never did that.

On Just the Facts you get something about the gender wars one week, then opioids, maybe a condemnation of censorship before moving on next to the JFK assassination, or Nazi loot, possibly Big Pharma, maybe The Four Tops, or antisemitism, questions about Princess Di’s death, Afghan officials’ corruption, FBI mistakes in the Oklahoma City bombing or the Anthrax investigation, even how Sweden became a gangland paradise.

From the messages I get from readers, I know some of you subscribed hoping I’d always write about only one of those topics. I am thankful you stayed the course. And, sometimes, my favorite notes are those that say, “I never thought I’d be interested in that, but you hooked me.”

Just the Facts will remain an eclectic mix of news and reports from the frontlines of the culture wars.

And it will remain free. Paid Substack subscriptions is not how Trisha Posner and I pay our bills. We do that through books, articles for traditional media, and documentaries (I do not have an air date yet for the R. J. Cutler-produced 6-hour documentary made from my last book, Pharma, but when I do, I will blast it out).

I also want to thank some of the other great Substacks — among others, Public , Skeptic , Bill Rice Jr.'s NewsletterThe Vaccine Court From Symptoms to Causes, Margaret Anna Alice Reality’s Last Stand Christina Buttons BROADview by Lisa Selin Davis — that have generated subscribers by recommending me. Substack is a community of writers. Supporting one another seems an indispensable element toward growing readers for all of us.

Share Just the Facts with your friends. I’ll let you know when it reaches another subscriber milestone. And in the meantime, thanks again for sticking around and spreading the word about this writing habit of mine.