Target-ing the Children

The mother was desperate. Seemingly out of the blue, her 14-year-old daughter had announced she was actually a boy and wanted to immediately begin the process of transitioning to meet her new gender identity. She had picked out a new name, and wanted to be referred to by male pronouns. Unsure of what to do and afraid she was losing her daughter, she turned to me for help. I had no choice but to say yes, as I had known the patient since birth and the mother for several years prior.

As much as I wanted to help and was willing to do so I was extremely nervous about the visit. The treatment of children with gender identity concerns has become a philosophical and political minefield and doctors who try to navigate the minefield do so at their peril. A single misstep can have devastating repercussions.

As a family physician who tries to “get it right” in every encounter and who regularly searches the medical literature to stay up to date with the current guidelines for diagnosing and treating my patients, I quickly learned that the treatment recommendations for patients who presented with gender dysphoria were different that those for any other condition I treat.

In the not-too-distant past gender dysphoria was an extremely rare condition. The incidence of males identifying as females was estimated to be somewhere between 1/10,000 and 1/30,000 individuals. Females identifying as males were an even rarer phenomenon, estimated to be from 1/30,000 to 1/100,000. Primary Care Physicians could expect to pass their entire careers without being asked to care for a single gender dysphoric patient. As the condition was so exceedingly rare the standard of care was to refer all gender dysphoric patients to a psychiatrist. The statistics I was taught, and which were unquestionably accepted, declared that 85% of adolescents with gender dysphoria, if left alone, would eventually identify with the sex they were assigned at birth.

When I went to review the current guidelines on the subject, I discovered that everything had changed, and had changed over a very short period of time. In a Pew survey conducted in 2022, 1.6% of adults and 2% of people under the age of 30 identified as transgender. If we add in those who consider themselves “non-binary”, the incidence increases to 5%. To put it another way, the incidence of gender dysphoria has increased by a factor of somewhere between 60,000% to 500,000%. My personal experience reflects this. From the day I started practice in 1993 until 2020, I did not encounter a single transgender individual. Since then, I have encountered 4 transgender patients in my practice and 2 within my own family.

When I read these numbers, a single question jumped to the front of my brain. “What happened?”

If the incidence of any other condition of disease had increased by such an amount an epidemic would have been declared and millions of dollars spent searching out the cause. When I read the available medical data on the subject, I discovered the world of academic medicine was remarkably uninterested in explaining or understanding the reasons for the dramatic change. Every article I found simply declared transgenderism as “normal” and something to be affirmed in every patient.

Given the lack of scientific evidence to support the medical establishment’s recommendations about gender dysphoria and my understanding of the mental and emotional history of the 14-year-old girl I was about to see, I did not feel comfortable affirming her new identity. I knew she battled depression and struggled in school, I knew she was the child of divorce, and I knew her parents loathed each other. It seemed to me she was struggling with a multitude of issues in her life and had somehow mistakenly decided her gender was the root of her problems.

While I had read the guidelines calling for “gender affirming care” for young people in such circumstances, the lack of serious investigation into the trans epidemic led me to question the wisdom of affirming her declaration of maleness. While I knew “experts” in the field often called for name and pronoun changes, puberty blockers, testosterone injections, breast binders and even mastectomies, I was worried these things would result in irreversible changes. I was also aware of the consequences I could face if I didn’t use her new pronouns and support her new identity. I had read about doctors and mental health practitioners who had their reputations destroyed on social media and review platforms such as Yelp for “misgendering” or “deadnaming” a patient. There was so much at stake.

When the day of her appointment with me arrived I was nervous, and I entered the exam room with a significant amount fear and trepidation, as I was taking an approach that would place me at neither end of the gender ideology spectrum. Instead of challenging her sexual identity and saying she was mistaken or affirming her identity and working to help her mother accept it, I would encourage her to work on other aspects of her life before addressing such a momentous issue.

I encouraged her to consider how difficult it was for any parent to process a child’s new gender identity and encouraged her to give her mother grace and as she worked through feelings. Her mom would almost certainly use female proteins and the name she had been given at birth, and not necessarily because her mom was not supportive of her feelings.

As there were very few treatments she could pursue without her mother’s support, I encouraged her to work with a therapist to become as emotionally healthy as she could. “Your parents will be much more likely to support your thoughts and feelings when they know you are coming from a healthy place,” I told her. I suggested she work on her depression, on being a better friend and daughter, and doing better in her schoolwork. “You will be a better, happier person by working on these things, regardless of your gender identity,” I said.

I don’t know if it was because of the therapeutic relationship I had achieved over the years, the simple truth in my words, or the fact I did not argue with her about her gender identity or try to talk her out of it, (I told her several times I was not questioning the validity of her feelings in any way), but she accepted my recommendations readily.

A year passed before I received an update on how she was doing, though I thought of her often. Her mother came to see me for an unrelated issue and doing the visit joyfully told me, “You will never guess what happened. Last weak Suzy came to me and said, ‘Mom I was so stupid last year. I’m not a boy.’ Can you believe it?”

After the mother left the office, I found myself wondering how the outcome might have been different if her daughter had seen a different provider, a doctor who has accepted the new recommendations on how to treat children who present with gender dysphoria without pausing to critically assess the shaky foundation on which these recommendations have been build.

Finally, I grieve over the failure of my profession to stand against the tide of political opinion and protect children, especially young women, against what has become an assault on womanhood. This attack takes many forms, from television shows and movies that deny basic biology, to misled educators who seek to teach our children to question that which is normal and accept that which is not, to massive corporations and retailers who propagate falsehoods about gender in the pursuit of profits.

As a Family Physician who cares for families, this issue has been heavy on my heart for a long time. I have resisted the urge to write about it for fear my words could be misconstrued or taken out of context. After reading about recent controversy with Target marketing trans clothing to young children, I decided to write this post from a very personal perspective. I am motivated by a simple question. If Family Doctors to not speak out in defense of our children, who will?

Bart

PS: There a few sources I have found quite helpful-

Irreversible Damage, by Abigail Shrier

When Harry Became Sally, by Ryan Anderson

Easter: Yes or No?

Easter is a big deal to me. As our kids have grown and gotten married and with the loss of my mother-in-law, family Easter lunches have faded away (a source of annual sadness), but the importance of the day remains. I do not exaggerate when I say that almost everything I hope for, every aspiration for which I strive, and even the values that guide my practice, have the meaning of Easter as their source.

While I was walking my dogs this morning before church, I found myself reflecting on the holiday and wondering how I could communicate Easter’s significance to my friends who do not share my faith. Most non-Christians are at least marginally aware of Easter’ standing as a religious holiday, and I suspect the majority have heard someone say it is the day Christians celebrate the resurrection of Jesus. Despite this passing knowledge, it has been my experience that the essentialness of the day escapes them. (It has been my experience that the essentialness of the day is lost upon many who profess the Christian faith as well.)

The first observation to enter my mind was that Easter is the only “Yes or No” holiday. I say this because the central claim of Easter, that two thousand years ago a man named Jesus was executed and then rose from the dead, is one that people either believe or reject. They either respond to the resurrection claims by saying, “Yes, he did” or “No, he didn’t.” (I am sure there are some who might say “I don’t know if that is true,” but in my experience these folks are usually leaning one way or the other.)

The implications of the Easter claim that Jesus rose from the dead are profound. If he did, he is unlike all other prophets or religious teachers. He becomes more than just a man, he becomes the Son of God. (One could say that the resurrection is in itself an argument for the existence of God). The Apostle Paul, in his letter to Roman Christians wrote that Jesus was “declared to be the Son of God in power… by his resurrection from the dead. To put it another way, if Jesus rose from the dead, all of his teachings and assertions are proven true and we would be fools if we did not follow them.

If Easter’s claim is false, it is profoundly important in another way. If Jesus is still dead, every Christian religion is a waste of time. Every dollar spent on the church, bibles, missionaries, and seminary training is a dollar wasted. Every minute spent on prayer, bible study and church attendance is a waste of time. If he is not risen, there is nothing special about Jesus’ teachings, and he was nothing more than a mentally ill man with grandiose claims. The Apostle Paul understood this, in one of his letters writing, “if Christ has not been raised, your faith is worthless.”

I was in my early twenties when I first recognized the importance of being able to answer questions about the resurrection. Though I had heard and read the gospel accounts dozens of times, I had never explored the available historical evidence. I was a little trepidatious at the outset and wondered what I would do if I found the evidence lacking! To my great relief, what I learned strengthened my faith and deepened my commitment. I feel confident each Easter when I say, “He is risen, indeed!”

I know this post is not very entertaining and some may consider it too preachy, but it is Easter! These were the thoughts going through my mind this morning and I thought I would share them. If you are interested in reading about the historical arguments in support of the resurrection, you will find links to articles at the bottom of this post.

Bart

One final note to my patients who read this-

My commitment to loving and serving each and every person who walks through my door is based on my faith, not yours. There never has been, nor will there ever be, a time when my faith prevents me from giving you my best!

Bart

references:

https://www.desiringgod.org/articles/historical-evidence-for-the-resurrection

https://www.amazon.com/Son-Rises-Historical-Evidence-Resurrection/dp/1579104649

https://www.christianitytoday.com/ct/2020/april-web-only/justin-bass-bedrock-christianity-resurrection-appearances.html

https://ca.thegospelcoalition.org/article/10-concise-pieces-of-evidence-for-the-resurrection/

Falling in Love with Tennessee

He was the salesman from whom I ordered all the medical supplies for my office, the only medical supply salesman I ever did business with. Our relationship was purely business related at the start, with our conversations centered on the products he sold and I used and our only non-business remarks limited to the occasional, “How’s your family?” and “Just fine, thank you.”

He came by the office every few months to check in, and as our conversations were limited I did not know him well. I knew he was from Tennessee, primarily because he gifted me salt water taffy from Gatlinburg each Christmas and spoke with an accent. I knew he was a man of faith because of conversations around the holidays, and I knew he was honest and reliable, which is one of the reasons I continued our business relationship.

Our relationship changed a few years after I moved my practice into its current home in a converted home on Beach Blvd. He dropped by the office one day for a sales call just as I was finishing up my work for the morning. We exchanged greetings, and I then surprised him by asking if I could buy him lunch. He laughed and said it was the first time a doctor had ever offered to buy him anything, but he readily accepted. That lunch was the beginning of our close friendship. We went out to lunch nearly every other month, trading responsibility for the check each time. It wasn’t too long after that first lunch that he invited me to stay at his cabin in the Smoky Mountains.

“We gotta get you y’all out to the cabin. You need to go to Tennessee. Y’all will love it,” He would tell me, repeating the invitation almost every time I saw him. I conveyed the invitation to my wife, and Lisa responded in the fashion I have come to realize is typical for people from Southern California.

“Why would we want to go to Tennessee? What would we do there?” she said.

After a few years of politely declining his invitations, in 2007 I told Lisa we might as well go, as Jim’s vacation cabin was near the national park and the lodging would be his treat. Our first trip to Tennessee was in June of that year and we enjoyed it so much we traded our timeshare week and went back the following summer. We loved the beauty of the park and the frequent wildlife sightings (especially black bears!), our visits to Dollywood, and the kindness of the people. We loved the ability to create a different vacation each morning, choosing whether we want to spend the day exploring nature, floating down a river, visiting a historical site, going to a theme park, or sitting on the porch. A surprising highlight of our second trip was a visit to a cemetery in Maryville (pronounced Mare-ville, as if there is no “y”). Lisa had begun doing genealogy, and to her surprise discovered she had ancestors from the region, some of whom had been buried just 45 minutes away. There was something incredibly moving about standing on the exact spot your ancestors had stood generations earlier.

We told ourselves we would return to the area soon, but life got in the way. Our son started college and became engaged, then got married in 2012, and family vacations became harder to organize and pull off. The one thing that didn’t change was Jim, who continued to invite us to return. When he retired in 2017, I told Lisa I wanted to return to the Smokies, in no small part because it meant I would be able to visit my friend, who had moved back to the area in which he had grown up. Jim had often raved about the beauty of the Smokies in autumn, so we booked a trip for October 2018 so we could see the fall colors.

That year was an incredibly stressful one for me, as I had become the chairman of the ethics committee at Hoag Hospital and as a result was responsible for performing every end-of-life consult. When October rolled around I was physically, emotionally, and spiritually drained. That week in Tennessee restored my soul. Not only were the colorful leaves spectacular, Dollywood was hosting a southern gospel music festival! All over the park, from open to close, Christian artists were singing songs of the faith. At the end of the week I told Lisa, “This is the most healing, restorative vacation of my life. I want to come back here every year at this time!”

When we got back to the cabin that night I started looking on Zillow, curious to see how much a vacation cabin would cost. I talked to Jim and learned how much rental income he was able to generate on VRBO. Lisa and I talked about it, and it seemed like it might be a worthwhile investment. Even if we didn’t turn much of a profit there was a pretty good chance we could cover the costs of upkeep and maintenance. In addition, though it was a sad and morbid thought, I knew Lisa’s mother, who was on hospice at the time, would likely leave her an inheritance that could help pay for a cabin.

We signed on with a realtor soon thereafter, and began reviewing cabin listings in earnest. When we saw one that seemed promising the realtor would visit the property and take us on a video tour. I limited my search to properties of at least two bedrooms, hoping to find a place large enough for our whole family to be able to visit together. Two weeks before Christmas I accidentally stumbled across a cabin that seemed perfect. Although it was over 2200 square feet, it was listed as a one bedroom! I had forgotten to limit the search to 2 BR or more, and it popped up right away. I was so excited I woke Lisa up to tell her about it. (She did not share my excitement at that moment!) I flew out to Tennessee the following week for a one-day trip, and after seeing the property and taking Lisa on a Facetime tour of it, we made an offer. When I landed back home in Orange County, I learned our offer had been accepted. Escrow closed in January, three days after my mother-in-law passed away. Lisa and I often say, “Mom bought the cabin for us.”

The cabin has been my place of refuge ever since, in ways I never could have imagined. A year after buying the cabin I came down with a painful nerve disease that beats me down on a daily basis. Our cabin in the Smokies is a place where I can rest, a place where the beauty of God’s creation restores my soul and gives me the strength I need to go on.

The cabin has been an unexpected blessing in other ways as well. Two of Lisa’s adult nieces and one of her cousins have fallen in love with the Smokies as well, staying at the cabin her mother bought for us. The cabin has forged a bond between us and kept us connected in ways we know would make mom happy.

One Dead Child. Two Foolish Parents.

I first shared this post 6 years ago in the midst of the Disneyland measles outbreak. Sadly, it remains relevant.

“A one year-old just died. Paramedics were called but he was gone by the time they got there,” the resident spoke softly, obviously affected by the news. “What happened?” I asked. She told me that the child had been seen in the ER two days earlier, was diagnosed with measles and sent home. My heart sank. I had sent home a one year-old child with measles two days earlier. Was this the same child? It was. He had looked so good two days earlier, responsive, alert and in no distress. The careful follow up instructions that were given were not followed and the child developed complications and arrested. I will never forget how I felt when he died.

He died, needlessly, because his mother and aunt did not believe in immunizations. He was one of 7 cases of measles in the family, 4 of whom were hospitalized. I was so angry at his parents and his aunt. I held them responsible for the child’s death. Their decision to believe false information from vaccine fear-mongers over the advice of their doctor was to blame for his death. Arrogance and ignorance ended his life. 

The year was 1990, the peak of the last epidemic of measles in the United States. It was a year of frustration for doctors as we were forced to deal with a disease that was close to disappearing just a few years earlier. Prior to the development of the measles vaccine, measles was an incredibly contagious scourge. The numbers from the late 1950’s are staggering. It is estimated that there were nearly 4 million cases a year, only a fraction of which were reported to health officials. The yearly averages were frightening, 150,000 pneumonia like complications, 48,000 hospitalizations, 4000 devastating brain infections and 450 deaths. Measles was a disease as unavoidable as it was harmful. Over 90% of the population was believed to be exposed in their lifetimes.

In 1988 the story was different. Cases were rare with the majority of cases occurring in non-immunized immigrants. Measles cases were estimated to be fewer than 10,000 a year. There was talk that we might accomplish with measles what had been miraculously accomplished with smallpox, complete eradication of the disease. Then something happened. From 1989-1991 measles made a comeback. The boy I saw die was one of 55,000 cases and 123 deaths during that time.

What happened was that some parents decided not to immunize their children. As it is extremely contagious, measles does not need much of an opportunity to regain a foothold. That opportunity was provided by a false belief in some parents that immunization was unnecessary or even harmful. Parents who were too young to have experienced the disease became more fearful of the vaccine than the disease and their unvaccinated children became innocent victims.

In response to the epidemic in 1989-1991 the medical community mounted a counteroffensive. Doctors aggressively educated their patients about the safety of vaccines and the dangers of the disease. Measles faded from the scene, returning to its status as a rare disease seen mostly in textbooks and rarely in medical practices. Measles remained rare and hidden for 20 years, with only about 60 children becoming infected annually in the United States.

It’s back.

This generation has seen a large cohort of parents, skeptical of the medical profession and supremely confident in their own knowledge and judgment, repeat the mistakes of the past and refuse to immunize their children. Immunization rates are dropping.  The incidence of the disease increased 1000% from 2013 to 2014.

The recent outbreak traced to Disneyland illustrates the seriousness of the disease. At least 12 cases were traced back to visits to the theme park in mid December. 11 of the cases were in non-immunized individuals. Two of the children were too young to be immunized, the rest were unprotected due to a foolish parental decision. It is deeply troubling to consider how babies were put at risk by another person’s decision.

It is this Disneyland story that took me back the 25 years to the day I saw that child die. The feelings of anger and helplessness came rushing back. These feelings are intensified when I think of the increasing number of parents who are refusing to vaccinate their children. As someone who took an oath to help people I cannot comprehend the arrogance and foolishness that leads to these decisions.

As a doctor I have spent hours upon hours trying to convince such parents of the importance of protecting their children. The years have proven that such efforts by me are futile. As these are emotional and irrational decisions, rational arguments have no effect. I have reached a place where I don’t argue anymore. I tell parents that vaccines have been proven safe and that if they refuse to vaccinate their children that I will not provide care for their family. I will not stand by while they risk the health of their child and I do not want my other patients placed at risk. There is no negotiation. Their position need not be heard, tolerated or respected.

It is time that society take a similarly firm stance. There is no duty to respect a foolish position.

-          Bart

If you found this post valuable, please consider sharing it with others. Readers typically learn of the blog from their friends. The follow up to this post, "Autism, Measles, Vaccines and Truth. Protecting the Lives of Innocent Children" addresses the reasons parents refuse to immunize their children.  I blog on multiple topics including faith, family and culture with new posts every few days. You can search the archives for a listing of posts. Follow Doctor Barrett on Twitter @bartbarrettmd for blog updates. You can subscribe to the blog to have future posts delivered to your inbox. Dr. Barrett's book, Life Medicine, is available at Amazon.com.

Update- The Disneyland Data is evolving. The post reflects the data that was available at the time of writing. The post has been edited to clarify the reasons for parents not immunizing children in the late 1980s. 

References-

http://jid.oxfordjournals.org/content/189/Supplement_1/S1.long

http://www.historyofvaccines.org/content/graph-us-measles-cases

http://www.latimes.com/business/hiltzik/la-fi-mh-antivaccination-update-the-measles-crisis-strikes-disneyland-20150108-column.html

Falling from Grace

He was one of my heroes. He was a gifted writer and speaker; I purchased his books and listened to his sermons. He was gentle in his demeanor and delivery, but powerful in his arguments. His defenses of the Christian faith were eloquent, articulate, and persuasive. I wished I could be like him, that I could make a lasting impact with my life and words.

I was not alone in my admiration. He was incredibly respected in the Christian community, a much sought after speaker and teacher. He traveled around the world, lecturing and debating at the most prestigious universities. He consistently held his own against the most brilliant secular minds and as a result inspired many to follow Christ.   When he died earlier this year I felt like the Christian faith had lost a great mind and a great warrior, one who would be very difficult to replace.

Then the accusations came.

They seemed ludicrous at first, descriptions of grossly immoral behavior that seemed out of character and clearly beneath the man. I was surprised to learn that he was a part owner in a health spa that offered massage services and shocked to read of the multiple female employees who accused him of sexually abusive behavior. Some of them went on the record,  claiming that he had repeatedly revealed himself to them during massage sessions, had touched them inappropriately and gone so far as to regularly masturbate in their presence. According to the women, the reason he gave for his egregious behavior was that he “needed to release stress.”

I read the words of the women with a mixture of shock, disgust and anger. I wanted to dismiss the accusations, to write them off as false and malicious, but I couldn’t. The women were not seeking any damages and their stories corroborated one another. They seemed true. Sadly, they were. The organization he founded hired a private investigative firm to research the claims and this week they released the preliminary findings of the investigation- all of the initial accusations were confirmed as true, and many more episodes of abuse were uncovered. He was a fraud.

In the wake of his death his family must now grieve more than his passing. His daughter, the chairman of the board of the ministry organization that bears his name, is left to mourn not just the loss of her father but also the loss of his reputation. Instead of celebrating his life she must now give answers to donors and supporters about his behavior. I cannot begin to imagine the pain his widow must feel as she deals with the reality that he frequently sought sexual pleasure outside of their marriage

How could this happen? How could he betray his message, his ministry and his marriage in such a way?

As I reflect on his story, one thought repeatedly comes to my mind. He was not content with the life and the blessings that God had given him. Consumed with pride, he thought he deserved more.

He was not content with his $500,000 a year salary. He was not content with the love of his wife and children. He was not content with the admiration and praise he got for his ministry. He thought he was special, that he deserved more.

His was not a sin that blossomed overnight. He did not wake up one morning and say, "today is the day I am going to reveal myself to the massage therapist." His symptoms began in his mind, with the thoughts that he needed and deserved more. Even in his 70s, he felt he needed and deserved the touch of younger women, to touch younger women, to be sexually desired by women other than his wife.

More tragically, he quit believing that God was enough. The hope for eternal life, the belief that wonderful blessing awaits those who are faithful, had somehow dimmed in his mind. He turned away from that eternal focus and instead focused on momentary pleasure. This desire so consumed him that he irrationally convinced himself that it was acceptable and appropriate to pleasure himself in the presence of women who were his employees, women who feared for their jobs, and that they would not be believed if they spoke up.

It is easy to shake our heads at such a story, to say that we would never do such a thing. I am not so sure. I have seen too many similar stories in my lifetime, stories of men, Christian leaders, who used their positions of authority to feed their desires. I have seen pastors consumed and addicted to admiration, who have sought praise and attention from women other than their wife. I have cared for pastors who felt there gifts entitled them to material wealth. I have seen other Christian leaders verbally abuse and demean those are served under them.

The Bible is filled with details of leaders who abused their power. The most famous examples are king David, whose lust so consumed him that he murdered a faithful friend so he could bed his wife, and David’s son Solomon who had 700 wives and 300 concubines. As king Solomon built the first temple in Jerusalem and was blessed beyond measure. Sadly, he eventually abandoned his faith to worship the false Gods of his pagan wives.

These stories are a warning to us all. We need to remember who we are and what God has given us. We need to remember that we are wretched sinners, saved by Grace and entitled to nothing. We need to continually remind ourselves that our spouses are gifts to be treasured, honored, and adored. We need to focus on the truth that nothing this life has to offer compares to the blessings that await us in heaven. We need to be content and happy with the lives that God has given us.

Perhaps most importantly, churches need to cast away the culture of celebrity that has invaded our congregations. We need to quit looking for charisma and start emphasizing character. We need to hold our leaders accountable, and set up structures where accountability can happen. If we don’t, we should not be surprised when we see our leaders fail.

 Bart 

PS: I wrote this post 7 months ago. I decided to share it after listening to the story about the disgrace of another man of faith. Christianity Today has a podcast about the fall of another Christian leader, “The rise and fall of Mars Hill”. It is a sobering cautionary tale of what can happen when churches elevate talent over character. It should be required listening for all church leaders.