Author archives: Peter Sprigg

Off-Label Use of Drugs Are Fine for Gender Transitions, but Not for Coronavirus, Say Liberals

by Peter Sprigg

March 31, 2020

Liberals and the media have been criticizing President Trump for touting the possibility of using some anti-malarial drugs to fight the coronavirus. Chloroquine, hydroxychloroquine, or a “drug cocktail” combining one of those with the antibiotic azithromycin have been proposed as possible drugs to prevent and/or treat the coronavirus, and what the Washington Post referred to as “tantalizing early results” of research showed that they might have promise.  

However, although these drugs have been around and used safely against malaria for decades, they have not yet been tested and proven safe and effective for use against the coronavirus. This has led to shock and outrage on the part of some. The Post’s headline read, “Trump keeps touting an unproven coronavirus treatment,” and their article reported:

The effort has raised concerns among health experts about safety risks — including the danger of fatal heart arrhythmia and vision loss associated with the drugs — and of raising false hopes in the American public.

In fact, the Post was alarmed enough to print an editorial on the subject as well, explaining:

Widespread testing for drug safety and efficacy is essential … Normally in the United States, a set of controlled clinical trials would be required before a drug is approved by the Food and Drug Administration . . .

A Bloomberg headline read, “Trump Pushes an Unproven Coronavirus Drug,” and the article opens with this:

A tiny trial of a malaria drug may or may not have helped several patients in France fight off their coronavirus infections. The FDA has said it needs more study. Some expert doctors are skeptical. President Donald Trump is all for it.

Slate downplayed the drugs’ potential, saying, “Trump cited a report in a scientific journal that only studied 20 patients and was not a controlled clinical trial.” And the left-wing magazine Mother Jones headlined, “Trump Keeps Promoting Unproven Drugs: The cocktail carries significant risks and may not fight the coronavirus.”

It is true that the “off-label” use of a drug means that it has not been scientifically proven to be safe and effective for that particular condition. Such use is not illegal, however—and is fairly common. It has been estimated that one in five prescriptions written in America is for an off-label use.

And liberals have been far more enthusiastic about “off-label” use of some drugs—if they support one of their ideological pet projects.

The Off-Label Use of Drugs for Gender Transition

Take gender transition medical procedures, for example. Pre-teens who experience “gender dysphoria” (distress regarding their biological sex) are increasingly being treated with a regimen featuring puberty-blocking drugs (such as Lupron), followed by cross-sex hormones (testosterone or estrogen) followed by gender reassignment surgery.

These interventions are touted with terms like “evidence-based” and “standard of care”—so it might surprise some people (including the patients subjected to them) that all of these are “off-label” uses of such drugs. Puberty blockers, for example, are intended (in children) to treat a medical condition called “central precocious puberty,” in which the child begins to show the biological signs of puberty prematurely, at an age far younger than would normally be expected. The drugs stop the physical progression of puberty until they are removed at a more normal age for such development. The effect of their use to stop normal puberty, followed by their withdrawal at an older age or when beginning to take cross-sex hormones, has not been well-studied.

Sex hormones like estrogen are officially used to treat symptoms of menopause or certain cancers. However, an article in the Journal of Sexual Medicine reported, “Long-term effects and side effects of cross-sex hormone treatment in transsexual persons are not well known.”

Gender reassignment surgery (while not subject to the same testing as medications) has also not been proven safe and effective. The Centers for Medicare and Medicaid Services in 2016 found that “there is not enough high quality evidence to determine whether gender reassignment surgery improves health outcomes,” in part because patients in the best studies “did not demonstrate clinically significant changes” after surgery.

Indeed, if you look closely, advocates of gender transition medical procedures do not even try to deny this. Fenway Health, which serves the LGBT community in Boston, writes that “no medications or other treatments are currently approved by the Food and Drug Administration (FDA) for the purposes of gender alteration and affirmation.” A 2018 article in the journal Transgender Health reiterated that “there are no medications or other treatments that are FDA-approved for the purpose of gender affirmation.” And the American Medical Association’s Council on Science and Public Health reported that “steroidal hormones,” “GnRH analogs” (puberty blockers) and “antiandrogens” are all used “off-label” for “gender re-affirming therapy”—because their use “lacks scientific evidence.”

Trusting Ideology Over Science

The “off-label” use of a drug—any drug—may sometimes be justified, but should always be pursued with caution. However, there is one big difference between the drugs President Trump has shown enthusiasm for and the drugs that social liberals so eagerly tout. The coronavirus causes very real physical disease, which is killing more and more Americans every day. Expediting the experimental “off-label” use of malaria drugs may be justified because of the massive scope of the public health problem we face.

The off-label use of drugs for “gender transition” is quite different. Not only is there no comparable public health crisis—there is not even a physical illness that is being treated. Neither puberty nor being biologically male or female is a “disease.”

Liberals should be careful showing self-righteousness about putting “our trust in the scientists.” Their hypocrisy is showing when it comes to the transgender movement.

Do Puberty-Blocking Drugs Make Transgender Kids Less Likely to Commit Suicide, or More?

by Peter Sprigg

February 13, 2020

Puberty blockers” are hormones originally intended to deal with “precocious puberty,” in which a child experiences the physical signs of puberty prematurely. Now, however, puberty blockers are being used as a treatment for “gender dysphoria.” The theory is that a child who is already unhappy with his or her biological sex may become even more unhappy when his or her body begins to develop.

The most extreme claim is that transgender children forced to undergo normal puberty will kill themselves. Into this debate came a new academic study published in the Pediatrics medical journal that resulted in headlines like these: 

There’s only one problem. These headlines are wrong.

The word “suicide” implies a fatality. The Pediatrics study was not a study of suicide—because none of its subjects were dead. It was based upon answers given in the 2015 U.S. Transgender Survey.

The key outcome referenced in the article was “lifetime suicidal ideation.” This means thinking about committing suicide. The finding that those who received puberty blockers had lower “lifetime suicidal ideation” than those who wanted them but did not receive them got the attention because it was the only one that reached the level of “statistical significance.”

However, “lifetime suicidal ideation” was only one of nine mental health outcomes that were listed in the study.

On four of the nine outcome measures—nearly half—the outcomes for those who received puberty blockers were worse than for those who did not. Most of these differences were small, but one figure jumped off the page. Those who received puberty blockers were twice as likely to have had a suicide attempt resulting in inpatient care (i.e., hospitalization) in the last 12 months as those who did not (45.5 percent vs. 22.8 percent). While we cannot reach definitive conclusions because of the small numbers involved, this raises important questions that are at least worthy of further research.

Also, the lifetime rate of suicidal ideation for those who received puberty blockers were lower than for those who didn’t—but it was still astonishingly high, at 75 percent. This hardly suggests that administering puberty blockers makes most children with gender dysphoria mentally healthy.

The authors acknowledge the study’s design “does not allow for determination of causation.” But they go further, raising doubt that puberty blockers cause lower rates of suicidal ideation—because it may be that people with suicidal ideation were simply considered poor candidates to receive puberty blockers.

Let’s be clear—we cannot conclude from this study that children who take puberty blockers are more likely to commit suicide than those who don’t.

But we also cannot conclude that they are less likely to commit suicide—notwithstanding the breathless media coverage.

Legislators considering restrictions on radical gender transition procedures for minors should make those decisions based on the harmful physical effects and risks of those interventions, many of which are well-known—not based upon the misinterpretation of psychological studies whose implications are far from clear.

The Evidence Suggests Gender Transition Procedures for Minors are Experimental

by Peter Sprigg

February 13, 2020

Several states have introduced bills that would prohibit certain physical procedures that alter the normal development or body of a child or adolescent for the purpose of facilitating a “gender transition.” These laws (sometimes called “Vulnerable Child Protection Acts”) would ban the use of puberty-blocking drugs, cross-sex hormones, or gender reassignment surgery in minors.

One of the arguments raised by opponents is that these procedures should not be restricted because they represent a standard of care that is “evidence-based.” “Evidence-based” is something of a buzzword in medicine, indicating that medical practices should not just be based on opinion (even “expert” opinion), but on sound scientific research.

But just how good is the “evidence” cited in support of gender transition procedures—especially for minors?

The Endocrine Society’s Influential Guidelines

One of the most recent and influential sets of guidelines for the medical care of transgender people was published in 2017 by the Endocrine Society (W. Hembree et al., “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline,” Journal of Endocrinology & Metabolism 102(11), November 2017, p. 3869-3903). This document explicitly sought to adopt an “evidence-based” approach:

The task force followed the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation group, an international group with expertise in the development and implementation of evidence-based guidelines.

The Endocrine Society issued specific guidelines in five separate areas:

  1. Evaluation of youth and adults (5 guidelines)
  2. Treatment of adolescents (6 guidelines)
  3. Hormonal therapy for transgender adults (4 guidelines)
  4. Adverse outcome prevention and long-term care (7 guidelines)
  5. Surgery for sex reassignment and gender confirmation (6 guidelines)

Evaluating the Quality of the Evidence

The key question is—what is the quality of the evidence in support of the guidelines? I decided to examine that issue.

There are three types of guidelines:

  • An “Ungraded Good Practice Statement”—essentially supported by no evidence (beginning “We advise . . .”)
  • A “weak recommendation” (beginning “We suggest . . .”)
  • A “strong recommendation” (labeled “We recommend . . .”)

Only with the strong recommendations does the task force express “confidence that persons who receive care according to [them] … will derive, on average, more benefit than harm.”

Then for each of the “recommendations” (weak or strong) they give a rating of the “quality of the evidence” in support of that recommendation, on a four-point scale: very low, low, moderate, or high.

How Strong is the Evidence Regarding Gender Transition Procedures for Minors?

If we omit category 3 (which applies only to adults), there are 24 guidelines that are generally relevant to the procedures at issue in Vulnerable Child Protection Acts—puberty blockers, hormones for adolescents, and surgery.

Of these 24 guidelines:

  • 5 are ungraded good practice statements (no evidence);
  • 2 are weak recommendations with very low evidence; and
  • 9 are weak recommendations with low evidence.

That means only 8 of the 24 “guidelines” are even “strong” recommendations—one third of the total. Of those:

  • 2 are supported by very low evidence;
  • 5 are supported by low evidence; 
  • Only 1 is supported by even “moderate” evidence;
  • None are supported by “high quality” evidence.

Evaluating the Recommendations

Several of the “strong recommendations” and other guidelines relate to controlling the potential negative side effects of gender transition, rather than actually recommending the transition procedure.

For example, the lone guideline supported by even “moderate” evidence was one warning patients to look into “fertility preservation” (some method of storing sperm or eggs), because the procedures may permanently sterilize the individual:

1.5. We recommend that clinicians inform and counsel all individuals seeking gender-affirming medical treatment regarding options for fertility preservation prior to initiating puberty suppression in adolescents and prior to treating with hormonal therapy of the affirmed gender in both adolescents and adults.

Some of the guidelines actually support what Vulnerable Child Protection Acts would do. Very few procedures which actually follow the Endocrine Society guidelines would also violate South Dakota’s VCPA, HB 1057.

For example, they recommend strongly (with low evidence) initiating cross-sex hormone treatment only after confirming “sufficient mental capacity to give informed consent, which most adolescents have by age 16 years” (2.4). (Guideline 2.5 says there may be exceptions to this, but it is supported by “very low” evidence.)

In addition, a “weak recommendation” with low evidence (5.5) suggests “that clinicians delay gender-affirming genital surgery … until the patient is at least 18 years old.”

Another weak recommendation (supported by very low evidence) suggests the timing of breast surgery be determined case by case, because “There is insufficient evidence to recommend a specific age requirement.” However, the lack of evidence would suggest that such radical, body-altering surgery should be postponed to a later age if possible, not accelerated.

Meanwhile, the key guidelines in support of puberty suppression (2.1 and 2.2) are only weak recommendations, supported by low evidence. The strong recommendation that some patients (over age 18) be referred for genital surgery is supported by “very low” evidence.

A Weak Evidence Base

In summary, the claim that these treatments are “evidence-based” is misleading, because the quality of the evidence in this field (even for the Endocrine Society’s “strong” recommendations) is low.

Until the quality of the evidence becomes higher, gender transition procedures must be considered experimental procedures at best.

FRC Opposes Guidance Attacking Sexual Orientation Change Efforts in Virginia

by Peter Sprigg

December 12, 2019

Editor’s Note: The following is a comment submitted on December 11, 2019 by Peter Sprigg on behalf of Family Research Council in opposition to a proposed regulation against so-called “conversion therapy” by the Virginia Board of Medicine.

I write in opposition to the proposed “Guidance Document on the Practice of Conversion Therapy,” and urge the Board not to adopt this policy.

Policy Statements Are Not Science

The guidance document is correct in stating, “Leading professional medical and mental health associations have issued position and policy statements regarding conversion therapy/sexual orientation change efforts …” However, “position and policy statements” are not the same as actual scientific findings. Unfortunately, “position and policy statements” are often the product of a highly-politicized process that is not representative of the professional population for whom they claim to speak.

Consider the first organization cited in the guidance document, the American Medical Association (AMA). According to a 2012 media report, there are 1.2 million physicians and medical students in the United States. Only 17 percent (217,490) are members of the AMA. (The AMA claims “approximately 250 thousand members” as of December 31, 2018.) Furthermore, AMA “position and policy statements” are not voted on by their entire membership, but rather adopted by a “House of Delegates” which consists of only 640 members as of June 2019. That means only one-quarter of one percent of all AMA members—and only a little more than one in every two thousand U.S. doctors—approve AMA position and policy statements.

The AMA press release announcing the new House of Delegates policy stated, “The AMA heard testimony, including first-hand accounts, regarding the significant harms triggered by conversion therapy …” Unfortunately, it has been documented that such “first-hand accounts” by LGBT activists are often implausible and sometimes demonstrably fabricated. What was not included in the AMA press release was any indication that the organization had undertaken a systematic review of the scientific evidence regarding either the effectiveness of sexual orientation change efforts (SOCE) or their alleged harms.

Concessions by the American Psychological Association

By contrast, the American Psychological Association (APA) did undertake a systematic review ten years ago. Although the resulting task force report was critical of SOCE, it did not call for legislative or regulatory restrictions on the practice. In fact, the APA made concessions that undermine the case for government intervention. For example:

1) Opposition to SOCE is based on the belief that people are born gay as a result of a “gay gene” or some other biological factor present at birth.

However, the APA admits that “there is no consensus among scientists” about what causes homosexuality, and that “nurture” may play a role.

2) Opposition to SOCE is based on the belief that sexual orientation is fixed and unchangeable.

However, the APA has acknowledged that “for some, sexual orientation identity … is fluid or has an indefinite outcome” (see page 2).

3) Opposition to SOCE, especially for children and adolescents, is based on the belief that individuals, especially children or adolescents, are often coerced into undergoing therapy (e.g., by parents).

However, the APA acknowledges that some people, including children and adolescents, may experience “distress” about having same-sex attractions and consider such feelings to be unwanted (see page 9).

The APA has also acknowledged that concerns about potential coercion could be mitigated by implementing a system of “developmentally appropriate informed consent to treatment” (see pages 74, 79, and 87).

4) Most of the therapy bans that have been enacted or proposed are specifically targeted at minor clients.

However, the APA acknowledges that there has been virtually no actual research done on SOCE with children or adolescents (see pages 33, 72-73, and 76).

5) Opposition to SOCE is premised on the belief that it has no benefits for the clients who undertake it.

However, the APA acknowledged, “Some individuals perceived that they had benefited from SOCE …” (see page 3).

6) Opposition to SOCE is based on the claim that it is always (or at least usually) harmful to clients.

However, the APA admits that there is no “valid causal evidence” that SOCE is harmful (see page 42).

7) The APA acknowledges that licensed mental health providers (LMHP) should “respect a person’s (client’s) right to self-determination,” allow the client to choose her or his own goals, and “be sensitive to the client’s … religion.”

However, legislative or regulatory restrictions on SOCE directly violate this core ethical principle of client self-determination.

A Literature Review of Studies Alleged to Show Harm from SOCE

When a recently-published book included an appendix titled, “Peer-Reviewed Journal Articles and Academic Books on ‘Conversion Therapy’ Outcomes that Include Measures of Harm,”[i] I set out to do a literature review (soon to be published) of this list of 79 sources. I discovered that a number of them make no reference to SOCE being harmful at all—it is inexplicable how they ended up on such a list. Of the remainder, approximately half are literature reviews or opinion pieces—not studies of actual SOCE participants.

All the entries that did study SOCE participants had significant methodological weaknesses, such as a lack of random sampling. Almost all of these studies represent anecdotal evidence only (via retrospective self-reports). Only one of the 79 sources used the gold-standard social science technique of a prospective and longitudinal design (that is, enrolling subjects at the beginning of or early in their therapy experience and interviewing the same individuals at different points in time to identify changes). That study found,

The attempt to change sexual orientation did not appear to be harmful on average for these participants. The only statistically significant trends that emerged … indicated improving psychological symptoms …” (emphasis added)

The most frequently cited article purporting to find harm from SOCE is a 2002 article by Shidlo and Schroeder. They asked respondents if they felt that “this counseling harmed you or had a negative effect,” and then followed up with a checklist of symptom areas. Oddly, the authors said in their article, “We do not report here on the frequency of responses to these items.” Because of this “qualitative” approach, the authors explicitly acknowledge,

The data presented in this article do not provide information on the incidence and the prevalence of failure, success, harm, help, or ethical violations in conversion therapy.”

Ironically, the one number that was reported—suicide attempts—showed that 25 participants had attempted suicide before “conversion therapy,” but only 11 had done so after such therapy. This would seem to suggest that SOCE is effective at reducing the risk of suicide, rather than increasing it as is sometimes alleged.

Conclusion

The evidence compiled so far regarding SOCE is either scientifically inconclusive or suggests that SOCE benefits those who seek treatment. It indicates a need for better and more extensive research on SOCE outcomes and techniques. The current state of research provides no valid scientific support for a draconian legislative or regulatory policy that would infringe upon the freedom of both clients and therapists to pursue the voluntary goal of sexual orientation change.

Unelected government officials should not insert themselves into the doctor/patient relationship, especially when relying on the politicized “policy statements” issued by a tiny minority of health professionals—statements that are unsupported by research and that are heavily qualified or even contradicted by the APA. I urge you not to adopt the proposed “Guidance Document on the Practice of Conversion Therapy.”



[i] “Appendix C: Measures of Harm: Peer-Reviewed Journal Articles and Academic Books on ‘Conversion Therapy’ Outcomes that Include Measures of Harm;” in Christopher Doyle, The War on Psychotherapy: When Sexual Politics, Gender Ideology, and Mental Health Collide (Manassas, VA: Institute for Healthy Families, 2019), pp. 365-74. The book’s author says that he received this list from A. Lee Beckstead (p. 107); but it is unclear whether Beckstead himself compiled the list.

Federal Judge Strikes Down Tampa Therapy Ban

by Peter Sprigg

October 8, 2019

In a major victory for the personal freedom of young people with unwanted same-sex attractions to seek professional help to achieve their goals, a U.S. District Court judge in Florida has struck down a local ordinance in Tampa, Florida that outlawed sexual orientation change efforts (so-called “conversion therapy or reparative therapy”) for minors when conducted by licensed professionals.

In Vazzo v. Tampa, U.S. District Court Judge William F. Jung, a 61-year-old Trump appointee who has been on the bench for a year, struck down the law and issued a permanent injunction against its enforcement. Plaintiff Robert Vazzo, a licensed marriage and family therapist, was represented in the case by Liberty Counsel.

Judge Jung chose not to directly address federal constitutional issues of free speech under the First Amendment, which has been the focus of other court challenges to therapy bans. Instead, he ruled that local governments in Florida had no authority to legislate on this issue because of an “implied preemption doctrine,” declaring, “The City Ordinance is preempted by the comprehensive Florida regulatory scheme for healthcare regulation and discipline.”

Judge Jung wrote that “substantive regulation of psychotherapy is a State, not a municipal concern,” and pointed out that “Tampa has never regulated healthcare substantively in any other way before” this ordinance was adopted in 2017.

Not only are local governments not authorized by Florida law to regulate the provision of mental health care services, but they are hardly competent to enforce such regulations. Judge Jung noted this in the following passage (emphasis added; citations omitted):

The City’s Department of Neighborhood Enhancement (formerly Code Enforcement) enforces the Ordinance. Although this is the City Department that usually enforces code violations like overgrown weeds and unpermitted contracting, the City’s Neighborhood Enhancement director testified that he would take any suspected violation of the SOCE Ordinance to the City Attorney before issuing a notice of violation. The Assistant City Attorney tasked as representative on this matter has been a lawyer for four years but has no training in counseling, therapy, or medicine; and stated that the City would consult Webster’s Dictionary to understand the terms in the Ordinance. If contested, the City would employ a “special magistrate” to adjudicate the alleged violation as a code enforcement proceeding. The City’s special magistrates are unpaid volunteers appointed by the mayor. The City has no plan in connection with the Ordinance to appoint someone who is a licensed mental health provider.

Not only would the enforcers of such a law be incompetent to do so, but the enactors of it did so in ignorance:

The main sponsor of the Ordinance on the council was unaware of the difference between talk therapy and aversive practices, and testified that council and participating staff are untrained in the mental health field.

Judge Jung’s reliance on “preemption doctrine” may help fuel other efforts to overturn (or lobby against) other local therapy bans across the country. Although 18 states have passed state-wide therapy bans, passing such local ordinances in more liberal urban areas is a tactic therapy opponents have employed in conservative states that have refused to adopt state-wide legislation.

However, Judge Jung’s opinion in the case is not so narrowly written as to be applicable only to local ordinances. For example, he ruled that the ordinance encroached upon at least five principles of state law in Florida which would apply to any proposed state therapy ban there (and possibly in other states) as well:

  • Florida’s Broad Right of Privacy” (“The Florida Constitution’s privacy amendment suggest that government should stay out of the therapy room.”)
  • Parental Choice in Healthcare” (“… [W]ith very few exceptions, parents are responsible for selecting the manner of medical treatment received by their children … until age 18.”)
  • Florida’s Patient’s Bill of Rights” (“A patient has the right to access any mode of treatment that is, in his or her own judgment and the judgment of his or her health care practitioner, in the best interests of the patient, including complementary or alternative health care treatments . . .”)
  • Florida’s Endorsement of Alternative Healthcare Options” (“It is the intent of the Legislature that citizens be able to make informed choices for any type of health care they deem to be an effective option … including … treatments designed to complement or substitute for the prevailing or conventional treatment methods.”)
  • Florida’s Well-Established Doctrine of Informed Consent” (“When the patient is denied the ability to exercise or even consider informed consent, the patient’s personal liberty suffers.”)

The judge’s decision also cited abundant evidence in the record of the case demonstrating scientifically how weak the case for any such therapy bans is (source citations omitted):

• Minors can be gender fluid and may change or revert gender identity.

• Gender dysphoria during childhood does not inevitably continue into adulthood.

• Formal epidemiologic studies on gender dysphoria in children, adolescents, and adults are lacking.

• One Tampa expert testified there is not a consensus regarding the best practices with prepubertal gender nonconforming children.

• A second Tampa expert testified consensus does not exist regarding best practices with prepubertal gender nonconforming children, but a trend toward a consensus exists.

• Emphasizing to parents the importance of allowing their child the freedom to return to a gender identity that aligns with sex assigned at birth or another gender identity at any point cannot be overstated.

• One cannot quantify or put a percentage on the increased risk from conversion therapy, as compared to other therapy.

• Scientific estimates of the efficacy of conversion therapy are essentially nonexistent because of the difficulties of obtaining samples following individuals after they exit therapy, defining success, and obtaining objective reassessment.

• Based on a comprehensive review of this work, the American Psychological Association 2009 SOCE Task Force concluded that no study to date has demonstrated adequate scientific rigor to provide a clear picture of the prevalence or frequency of either beneficial or harmful SOCE outcomes. More recent studies claiming benefits and/or harm have done little to ameliorate this concern.

• No known study to date [looking at 2014 article] has drawn from a representative sample of sufficient size to draw conclusions about the experience of those who have attempted SOCE.

• No known study [looking at same 2014 article] has provided a comprehensive assessment of basic demographic information, psychosocial wellbeing, and religiosity, which would be required to understand the effectiveness, benefits and/or harm caused by SOCE.

• Although research on adult populations has documented harmful effects of SOCE, no scientific research studies have examined SOCE among adolescents.

• With extraordinarily well-trained counseling “in a hypothetically perfect world” it may be an appropriate course of action for a counselor to aid a gender-dysphoric child who wants to return to biological gender of birth.

• There is a lack of published research on efforts to change gender identity among childhood and adolescents.

• As of October 2015 no research demonstrating the harms of conversion therapy with gender minority youth has been published. In 2018 an article was published on youth but causal claims could not be made from that 2018 report.

The Tampa ruling comes on the heels of New York City’s recent decision to repeal its adult therapy ban for fear of a negative precedent from a court case challenging it. Together, these two events have given welcome evidence that the days of such freedom-denying therapy bans may now be numbered.

New York City to Repeal Ban on Adult Sexual Orientation Change Efforts

by Peter Sprigg

September 19, 2019

It’s not often that a legislative body moves to repeal a law that it enacted less than two years earlier—especially when it passed by a vote of 43-2.

Nevertheless, this week Corey Johnson, speaker of the New York City Council (who openly self-identifies as gay) announced that he will move to repeal a city-wide ban on sexual orientation change efforts (SOCE), which critics of the practice call “conversion therapy.” My colleague Cathy Ruse has also written about this development at The Stream.

The law was enacted in late 2017 and just took effect last year.

Why the about-face? Unfortunately, it’s not because of a new-found respect for the rights of people with unwanted same-sex attractions to seek the help they desire.

Instead, they fear that the U.S. Supreme Court will strike the law down as unconstitutional.

In January 2019, an Orthodox Jewish therapist, Dr. David Schwartz, filed a lawsuit challenging the new law. He is being represented by the Alliance Defending Freedom.

As ADF points out in their complaint, “The Counseling Censorship Law is unprecedented. It is the first in the nation to censor speech between counselors and adult patients.” The 18 states, and other localities, that have already restricted SOCE have only prohibited the practice with minors—on the theory that they are more vulnerable to coercion and less able to give informed consent.

A bill similar to the New York City law, AB 2943, was considered in California last year, but was withdrawn by its sponsor at the last minute. California instead recently adopted a non-binding resolution, ACR 99, condemning SOCE.

Previously, therapy bans for minors in California and New Jersey had been upheld in federal circuit court decisions. Additional lawsuits are pending in Maryland and Florida.

What was different about New York City? For one thing, its scope. Not only did it ban therapy for adults (not just minors), but it also barred any such assistance “offered or provided to consumers for a fee,” regardless of whether the individual is a licensed mental health provider. Rather than facing a professional sanction such as the loss of a license, violators could be fined up to $10,000.

Although the Supreme Court has not yet heard a challenge to therapy bans, it has not been silent about them. In the 2018 case of NIFLA v. Becerra, the court struck down a California law that essentially required pro-life pregnancy centers to advertise for abortions, ruling the law violated the centers’ First Amendment free speech rights. California had defended the law (as they defended their therapy ban for minors in a case called Pickup v. Brown) by arguing that certain kinds of “professional speech” do not have the same First Amendment protections. Justice Thomas rejected that view in his majority opinion in the NIFLA case:

Some Courts of Appeals have recognized “profes­sional speech” as a separate category of speech that is subject to different rules. See, e.g., … Pickup v. Brown, 740 F. 3d 1208, 1227–1229 (CA9 2014) … . These courts define “professionals” as indi­viduals who provide personalized services to clients and who are subject to “a generally applicable licensing and regulatory regime.” … Pickupsupra, at 1230. “Professional speech” is then defined as any speech by these individuals that is based on “[their] expert knowledge and judgment,” or that is “within the confines of [the] professional relationship,” Pickupsupra, at 1228. So defined, these courts except professional speech from the rule that content-based regulations of speech are subject to strict scru­tiny. See  … Pickupsupra, at 1053– 1056 … .

But this Court has not recognized “professional speech” as a separate category of speech. Speech is not unprotected merely because it is uttered by “professionals.” This Court has “been reluctant to mark off new categories of speech for diminished constitutional protection.” And it has been especially reluctant to “exemp[t] a category of speech from the normal prohibition on content-based restrictions.” This Court’s prece­dents do not permit governments to impose content-based restrictions on speech without “‘persuasive evidence … of a long (if heretofore unrecognized) tradition’” to that effect.

This Court’s precedents do not recognize such a tradi­tion for a category called “professional speech.”

I wrote about the implications of this for therapy bans in a blog post in July 2018, “Will the Supreme Court Save Sexual Orientation Change Efforts?” It appears that some of the leaders of the LGBT movement may have come around to the same realization.

This is yet another illustration of the fact that elections—and judicial nominations—have consequences.

BREAKING NEWS: Vice President Pence Revealed to Be Conservative!

by Peter Sprigg

September 13, 2019

News broke today that in 1993, Vice President Mike Pence—then with the Indiana Policy Review Foundation, a conservative think tank—opposed an effort to add “sexual orientation” as a protected category in a Lafayette, Indiana human relations ordinance.

The biggest surprise here may be that anyone found this discovery—in an old issue of the Lafayette Journal and Courier—to be the least bit newsworthy.

After all, even in 2019, after decades of LGBT (lesbian, gay, bisexual, transgender) activism, most of the country—28 of the 50 states, plus the U.S. Congress—has rejected the idea that “sexual orientation” should be treated as the equivalent of race under non-discrimination laws involving employment and public accommodations.

Pence said in 1993, “It represents a very bad move in public policy”—and 26 years later, most of the country agrees.

Pence added, “It opens up from a legal standpoint … a Pandora’s Box of legal rights and legal difficulties once you identify homosexuals as a discrete and insular minority.” The use of the phrase “discrete and insular minority”—drawn from a 1938 Supreme Court decision—showed a sophisticated understanding of civil rights law on the part of Pence, who is himself a lawyer.

Can anyone really deny that the LGBT rights movement has led to “legal rights” (such as same-sex civil “marriage”) and “legal difficulties” (such as lawsuits against wedding vendors to compel speech the vendors disagree with) that might not have been obvious in 1993? This was a prescient, and entirely accurate, forecast.

Pence noted—again, correctly—a key factor historically in whether certain minority groups have been protected by “strict scrutiny” from the courts or by legislation. “Up to this point,” Pence told the paper, “our legal tradition has drawn a line over those things. I do not choose whether I am a black American . . .”

In other words, the characteristics which have merited the special protection of non-discrimination laws have usually been those which are inborn, involuntary, immutable, or innocuous. Those criteria apply to race and sex in a way they do not to “sexual orientation.” In the article, a Purdue political science professor made the same point—“that equating the path of sexual orientation ordinances with the civil rights movement, or to a lesser extent women’s rights, is misleading.”

A few of the quotes attributed to Pence could have used greater elaboration. For example, he is quoted as saying that “homosexuality at a very minimum is a choice by the individual.” LGBT activists insist, with reason, that most people do not choose to experience same-sex attractions. (This does not mean, however, that such attractions are innate. A recent study of the connections between genetics and homosexual conduct has disproved the claim, in an article to which CNN linked, that “homosexuality is largely determined by heredity.”)

Pence’s remarks seem to reflect what I have elsewhere referred to as the “homosexual conduct paradigm,” within which the word “homosexuality” is primarily a reference to homosexual conduct. Such conduct, along with self-identifying as gay or lesbian, clearly is a choice.

Pence is also quoted as saying, “Once you identify homosexuals as a … minority, then by definition they would need to be afforded constitutional protection.” Of course, homosexuals have, and have always had, the same rights under the U.S. Constitution that every other American has—rights such as freedom of speech, freedom of the press, and freedom of religion. I’m sure that Vice President Pence would agree.

The constitutional question, however, is whether laws perceived as having some impact based on “sexual orientation” must be subjected to “heightened scrutiny”—rather than just a “rational basis” test—when analyzed under the equal protection clause of the 14th Amendment. Pence was right in forecasting that enshrining sexual orientation as a protected category in statutory law would have an impact on how courts would view it from a constitutional perspective—and might distort that view in cases like the one ordering a redefinition of marriage.

Pence also told the paper that the effort in Lafayette was part of “a grassroots-generated movement for recognition of homosexual rights …” This is no conspiracy theory—it was a simple and accurate statement that the push for such legislation was part of a movement active at both the national and local levels. Pence said, “I suspect [homosexual rights] will be one of the biggest issues of the ‘90’s”—which was true, and has continued to be true in the decades since.

Most of the arguments Pence offered in 1993 are the same arguments that we at Family Research Council and other social conservatives make today in opposing radical LGBT rights legislation like the proposed federal Equality Act.

What would be news is if Mike Pence had ever taken any other position.

The Real “Fairness for All” is Freedom from Government Coercion

by Peter Sprigg

September 12, 2019

Concerns about religious liberty are one of the chief obstacles to passage of “non-discrimination” laws that would make “sexual orientation” and “gender identity” (“SOGI”) into protected categories at the local, state, and federal level. Only 20 of the 50 states have enacted SOGI protections for both employment and public accommodations, and a comprehensive (and radical) federal bill, the Equality Act (H.R. 5), has stalled in the Senate since its passage in May by the Democrat-controlled House of Representatives.

Utah Rep. Ben McAdams, a Democrat who voted for the Equality Act, recently told that state’s Deseret News that he thinks the bill “still needs work”—and he supports a so-called “compromise” called “Fairness for All.” The theory is that both “LGBT (lesbian, gay, bisexual, transgender) rights” and “religious liberty” could be protected by enacting a single bill that includes both SOGI protections and religious exemptions.

The model for “Fairness for All” proposals at the federal level is the “Utah compromise” that was adopted by that state’s legislature in 2015. It added SOGI protections to the state’s nondiscrimination laws regarding employment and housing (public accommodations were omitted), while creating exemptions for religious non-profit organizations and protections for some employee speech.

Unique factors in Utah—notably, the power and influence of the Church of Jesus Christ of Latter-Day Saints, which endorsed the “compromise”—make it doubtful whether this approach could be replicated elsewhere. LGBT groups at the national level seem determined to press forward the existing Equality Act, which contains no religious liberty protections and explicitly strips away those that might be asserted under the Religious Freedom Restoration Act (RFRA).

Nevertheless, because some may be tempted to believe that such a “compromise” provides a “win-win” solution in the clash between LGBT rights and religious liberty, it is important to reiterate why we believe this would be a serious mistake.

First, the fundamental presumption behind “Fairness for All” is that there is a balance or symmetry between “rights” or “protections” for people who identify as LGBT and “rights” or “protections” for people of faith. This is a fallacy. The “free exercise” of religion is guaranteed by the First Amendment, but there is no provision of the Constitution that references sexual orientation or gender identity.

The fundamental rights found in the U.S. Constitution—such as freedom of speech and the press and the free exercise of religion—do not place any limits on the actions of private individuals and organizations; on the contrary, they protect such actions against interference by the government. “Civil rights” laws that bar discrimination in employment and public accommodations, however, do not merely limit the government; they place a restriction upon the action of private entities (such as small businesses) in carrying out their private activity.

There is a place for non-discrimination laws (especially regarding characteristics that are clearly inborn, involuntary, and immutable, such as race). However, the burden of proof in every case must rest on those who seek to increase the number of categories or characteristics protected under such laws. That’s because the extension of laws against private discrimination is less a “win-win situation” than a “zero-sum” game. When one (such as an employment applicant) wins more protection, another (the employer) actually loses a corresponding measure of freedom.

The most publicized cases highlighting the clash between LGBT non-discrimination laws and religious liberty in recent years have involved businesses in the wedding industry that are owned and operated by Christians who prefer not to participate in the celebration of same-sex weddings. (Although one such business, Colorado’s Masterpiece Cakeshop, won an important decision at the U.S. Supreme Court in 2018, the decision was on narrow grounds and did not settle this area of the law.) It is not clear that religious liberty protections in any proposed compromise legislation would protect these businesses.

The wedding industry cases are by no means the only context in which this conflict arises, however. There have been cases challenging the right of Christian adoption agencies to decline to place children with same-sex couples; cases where Christian counseling students were punished for declining to affirm and support homosexual relationships; and cases in which Christian employees of government agencies were fired for privately expressing disapproval of  homosexual conduct. It is not clear that any of them would be protected by such “Fairness for All” proposals.

Further, “gender identity” protections would undermine the rights of organizations and businesses to set dress and grooming standards or have separate private spaces (e.g., in bathrooms, locker rooms, showers, dormitories, etc.) for biological men and women. These rights stand ready to be compromised by “Fairness for All” proposals.

Family Research Council believes that combining religious liberty and special privileges for sexual orientation and/or gender identity (SOGI) is unsustainable, for three primary reasons.

1)      It is wrong, in principle, to include sexual orientation and gender identity as protected categories, because they are unlike historically protected categories such as race. Historically, protections were reserved for characteristics that are inborn, involuntary, immutable, and innocuous, such as race, and/or in the U.S. Constitution (such as religion). None of these criteria apply to the choice to engage in homosexual conduct or the choice to present one’s self as the opposite of one’s biological sex.

2)      There is no religious exemption that would be acceptable to LGBT activists and would also be adequate to fully protect against all the likely threats to religious freedom.

3)      Non-discrimination laws always implicate moral beliefs. They send the message that it is morally wrong to disapprove of homosexual or transgender conduct. For such laws to be endorsed by citizens who believe that it is morally wrong to engage in homosexual or transgender conduct is a logical contradiction.

What would truly reflect “Fairness for All” would be to reject SOGI laws containing special privileges, and allow real religious liberty—the freedom to hold to one’s personal beliefs and to act on them without government interference or coercion.

Eighth Circuit: Minnesota Can’t Force Small Business to Make Same-Sex Wedding Videos

by Peter Sprigg

September 5, 2019

National media gave scant attention to an important court decision on August 23. The ruling in Telescope Media Group v. Lucero, by a three-judge panel of the U.S. Court of Appeals for the 8th Circuit, was another landmark in the ongoing debate about whether governments can force small businesses in the wedding industry to participate in same-sex weddings, over the conscientious objection of their owners.

Last year, the U.S. Supreme Court ruled in favor of Jack Phillips of Masterpiece Cakeshop, a baker who had declined to create a custom wedding cake for a same-sex couple. However, the court ruled that Phillips had been a victim of specific anti-religious discrimination by the Colorado tribunal that sought to punish him, so they did not definitively address the fundamental free speech concerns that his attorneys had raised.

Telescope Media Group (TMG) is a business founded by Carl and Angel Larsen, videographers who wished to create a business that would make wedding videos, and in the process promote natural marriages between one man and one woman. They sued Minnesota public officials to prevent them from using the Minnesota Human Rights Act to force the couple to make videos of same-sex weddings as well.

In a 2-1 decision, the 8th Circuit panel ruled in the Larsens’ favor, saying that “the First Amendment allows the Larsens to choose when to speak and what to say.” Perhaps that’s why it was largely ignored by the national media.

The breakdown of the vote also shows how important judicial appointments are. The opinion was written by David Stras, a 45-year-old Trump appointee, on the bench since January 2018. He was formerly on the Minnesota Supreme Court (having been appointed by former Republican Governor Tim Pawlenty). The other judge in the majority was 67-year-old Bobby Shepherd, appointed by George W. Bush and on the bench since 2006. Meanwhile, there was a dissent by Judge Jane L. Kelly, a 54-year-old Obama appointee who has been on the bench since 2013.

This was on appeal of the District Court’s decision to deny a preliminary injunction, so it is not a final decision on the merits. However, it is an encouraging decision in that it is based squarely on the free speech claims (or in this case, the right to be free from government-compelled speech) made by the plaintiffs. The court also accepted a “hybrid rights” claim incorporating the free exercise of religion.

Since precedent has established that videos represent a form of speech, whether the principles articulated would apply with equal force to bakers or florists may still have to be argued in other cases. However, the fact that this case was decided (at least for now) on free speech grounds, rather than the anti-religious discrimination grounds used in Masterpiece, makes it a stronger precedent for those concerned about protecting free speech and religious liberty.

Landmark Study Determines There Is No “Gay Gene”

by Peter Sprigg

August 30, 2019

An all-star team of scientists has just published a new “genome-wide association study” (“GWAS”) in the journal Science, on a massive sample of nearly half a million individuals, that attempted to identify if genetic factors contribute to same-sex sexual behavior.

The key take-away? “[T]here is certainly no single genetic determinant [of same-sex sexual behavior] (sometimes referred to as the ‘gay gene’ in the media).” Eric Vilain, a genetic medicine researcher, agrees, telling the Washington Post that the study marks the end of “the simplistic concept of the ‘gay gene.’”

The study does suggest that all genetic factors put together may account for, at most, a third of the variation in same-sex sexual behavior in the population. What does that imply? That at least two thirds of the variation is accounted for by social, cultural, and environmental factors—not genetics. So much for the idea that people are “born gay.”

The media is conceding that there is not one “gay gene,” while still pushing the idea of genes being involved in homosexuality as far as they can. The New York Times begins its headline, “Many Genes Influence Same-Sex Sexuality,” while the Washington Post headline emphasizes that “genetics are linked to same-sex behavior.”

While these statements are true, where the media fails the public is in not adequately distinguishing the idea of genetic “influence” or a “link” from the popular idea of the “gay gene” (or “genes”)—the belief that there is some genetic factor that determines, inexorably and immutably, that some individuals are destined to become homosexual.

There is a huge difference between genetic “influence” and genetic “determination.” Science has shown that many personality traits and behaviors are “influenced” by genetics, but no one would ever say those characteristics are inborn and immutable.

For example, here is how the study actually reports that “one third of the variation” figure I mentioned above:

[W]e estimated broad-sense heritability—the percentage of variation in a trait attributable to genetic variation—at 32.4%.

Put in decimal form, that is a “heritability” of about .32. But here are the “heritability” rates that scientists have identified for some other psychological traits:

  • Conservatism                        .45-.65
  • Right-wing authoritarianism   .50-.64
  • Religiousness                        .30-.45

Yet virtually no one would ever say that these traits are inborn and immutable—even though their “heritability” is as high or higher than for same-sex sexual behavior.

Yet even the study’s 32% “heritability” rating may exaggerate the link between any specific genes and homosexual behavior. The study identified only five locations on the genome with a statistically significant link to same-sex sexual behavior. (None of those were on the X-chromosome—where the original “gay gene” was supposedly located in a 1993 study.) Only three of those associations could be replicated in an analysis of other (smaller) databases. The study reported that “all tested genetic variants accounted for 8 to 25% of variation in same-sex sexual behavior”—a broad range, and lower than the 32% “heritability” estimate. The genetic differences were so small that they “could not be used to accurately predict sexual behavior in an individual.”

One methodological problem with the study is that the primary measure of “nonheterosexuality” is whether the respondent answered yes or no to the question of whether they have ever had sex with a person of the same sex. A large percentage of that population does not self-identify as “gay” or “lesbian,” and may not engage exclusively or even primarily in same-sex sexual relationships, so it is not at all clear whether this is the best way of approaching the question. The study did find there was a genetic correlation with the proportion of same-sex sexual partners—but it did not involve the same genetic variants as the “binary” variable!

The New York Times report suggests—at length—that some pro-LGBT spokesman and scientists were concerned about even conducting the research. This seems a backhanded way of admitting that the findings do not serve the political purposes of the LGBT political movement.

For example, the study showed that same-sex sexuality correlated not only with certain genes, but with certain personality traits (“loneliness,” “openness to experience”), risky behaviors (smoking, cannabis use), and mental disorders (depression and schizophrenia). The study cautioned:

We emphasize that the causal processes underlying these genetic correlations are unclear and could be generated by environmental factors relating to prejudice against individuals engaging in same-sex sexual behavior, among other possibilities . . .

But if the “causal processes underlying … genetic correlations” with mental illness and substance abuse “could be generated by environmental factors,” then the same must be said about the correlations with same-sex sexual behavior itself.

That movement has depended for decades on the myth that people are “born gay” and cannot change, probably because of some undiscovered “gay gene” that immutably determines their sexuality.  Demands for LGBT “civil rights” have rested largely on assertions that sexual orientation, like race, is a characteristic that is inborn, genetic, and immutable.

Although evidence for those claims has always been lacking, this study debunks them more decisively than any previous one. It is ironic that those on the Left routinely accuse conservatives of being “anti-science”—yet in this case, it is they who fear the results of a serious scientific inquiry.

For our part, Family Research Council is happy to embrace the study’s conclusion about the “complexity” of same-sex sexuality, and “the importance of resisting simplistic conclusions.” The authors are correct in saying that “there is a long history of misusing genetic results for social purposes”—but on this issue, it is the LGBT activists who have long promoted the myth of the “gay gene” who are most guilty.

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