Sports, Leibowitz, and Adults?!?
Updates from Ohio
Ohio is a known swing state, and targeted by both major party campaigns for presidential elections. It is also known as a bellwether. The evolving situation over House Bill 68 in Ohio impacts the national discourse and is important to watch.
House Bill 68 would have done the following:
restricted puberty blockers, cross sex hormones, and surgery for trans related care from those under the age 18
limit participation in women’s sports categories to women
The bill was passed with 62 representatives and 24 senators voting for it, all Republicans. It was then sent to Governor Mike DeWine’s desk over the holidays. Governor DeWine is a Republican, he vetoed the bill. He announced his veto in a 26 minute press conference.
On January 10, 2024 a vote will be taken to attempt to override the veto. They will need 3/5th of the vote. That means that 59 representatives and 20 senators are needed to override the veto.
The Veto
The press conference on December 29th announcing the veto was both predictable and yet wildly unexpected. It became clear quite quickly in the announcement that the veto was imminent.
DeWine spoke about the deep dive that he took looking at the issue and acknowledged that the legislature was seeking to address issues that were in fact valid and needed a response. DeWine had traveled the state and visited the 5 pediatric gender centers in Ohio. He said, “all the children’s hospitals say, look we don’t do surgery.”
Although it was never directly stated in sources reviewed, it is widely believed that one of the providers that DeWine met was Dr. Scott Leibowitz. Leibowitz is the medical director of behavioral health in the THRIVE program at Nationwide Children’s Hospital. Leibowitz has been called a pioneer in pediatric transgender care, and he was an author of the WPATH SOC 8 Adolescent Chapter.
Leibowitz has his critics on both sides. He has a page on the infamous Transgender Map, a website recently written about by Jesse Singal here. The critics have claimed that he has worked with ‘anti-trans journalists’ and also that he promotes comprehensive psychological assessments which some refer to negatively as ‘gatekeeping’.
Listening to the press conference given by DeWine, it sounded as if DeWine had been influenced by the Leibowitz’s type of argument. This argument promotes that a small number of children and adolescents can benefit from puberty blockers and cross sex hormones but only after comprehensive mental health assessment and care. Leibowitz is not alone in this worldview, and many who hold these views agree with many of the criticisms of pediatric gender medicines’ current practices. However those with these views do not support legislative bans and they hold out the belief that: not only is there a group of children and adolescents who can benefit- but that they can correctly identify them and screen out those that should be diverted from these treatments.
DeWine acknowledge that he is not an expert in this field and that he learned what he could. The press conference sounded like he was heavily influenced by the, “yes something has gone seriously wrong but we can fix it group.” Good intentioned, but without ever really explaining how they can somehow exert any influence or control over the vast majority of the providers who just give hormones to everyone.
According to the Time article about the veto, “multiple young people who have pending gender surgeries scheduled, and as they wait for the governor’s decision, they worried.” The article did not identify the ages of those waiting for surgery but just because the children’s hospitals were not admitting that they were completing surgeries does not mean that surgeries have not happened to minors in the state.
His veto was based on the fear of suicide. He cited a number of parents who told him that their children, “would not have survived, would be dead today” and that they had, “real concerns their child will not survive until adulthood.”
Sports
DeWine admits in the press conference he didn’t even really consider the issue of sports, after he began the press conference with a shout out to the local home team. It was a men’s team so it’s fine.
Apparently it is a job well done to be Governor and veto a bill completely and ignore a significant part of it. If a Governor can do it we should all just feel free to ignore a significant part of our own work today, fingers crossed you are not performing surgery or driving the school bus.
Adults
At the end of the 7th minute of DeWine’s press conference he first mentions adults. Adult care was not a part of the bill that he vetoed. He explained that although he had vetoed the bill he was going to immediately seek to have administrative rules created that would address the following:
Ban any surgical treatments for those under the age of 18 (which would have happened with the bill).
Create rules to require data to be reported every six months and reported to the general assembly and the public, “we will do this not only when the patients are minors but also when the patients are adults.” He acknowledged that no comprehensive data today exists regarding persons who receive this care, nor independent analysis of any such data.
Restrict ‘pop up clinics’ and require significant counseling and therapy. Restrictions for children and adults from pop up clinics that do not provide significant counseling and therapy.
DeWine stated:
“everybody agrees that their needs to be a process and it needs to be a focus on mental health and there needs to be a team behind that and if you don’t have adequate mental health counseling you’re not getting what you should be getting as a patient, the parents are not getting what they should get, adults are not getting what they should get. The idea that someone can walk in and just you known without psychological counseling without mental health counseling and start down the road with taking these drugs virtually everyone that I have talked to said that is not the way to do it”
Let’s remember, DeWine acknowledge that he is not an expert in this field and that he learned what he could. He did not apparently get the 15 minute crash course on the history of WPATH guidelines, or that hormones are suppose to be available in vending machines. According to activists on X:
The Purple Way
DeWine suggested that he was proposing a unique way forward. He called it the Ohio way. For the sake of political argument let’s call it the purple way.
Everyone- children and adults- are required to have multidisciplinary comprehensive care, including mental health counseling that is extensive and is done by professionals before any medical transition is begun.
Surgery is limited to only those who are adults.
Data for all medically transitioning individuals, regardless of age is widely collected, public, and independently analyzed.
If a poll was conducted tomorrow asking if the three above proposals should be enacted; it would be a safe bet that the vast majority of American’s from all political parties would agree with these proposals.
Some might even argue that 1 and 2 are already reality, unfortunately that is not the case. If these three proposals were enacted tomorrow on a federal level then the discussion would be radically shifted.
Perhaps in 2024 the purple way could be the starting point, at least it would stop the bleeding. Then we can get back to really attending to the patient and see if the treatments proposed have real long term benefit.
What do you think?
Is there a purple way?
Override the veto? Administrative Rules? Both?
In the short term, it's vital to override the veto. Executive officeholders must feel the burn and our momentum must be seen overcoming all resistance. To settle for less would be political malpractice, a different problem than medical malpractice. Longer term, it's better to say that the "purple way" is the zone of acceptability where we can call the result a victory. One of the worst habits of Democrats is that they propose seemingly-reasonable half-measures and then lose ground to their opponents inch by policy inch. Instead, start by asking for a full ban or something near, settle for middle ground that resembles the purple way.
Three cheers for the purple way! Three cheers for attempts at evidence-based care! There is tons of room for discussion on what the purple way would look like, but neither the red or blue way is looking all that appealing to me. Thanks for reporting on some of these important details of the governor’s position.