Affirming Care with Dr. Kellan Baker

The F.D.A. approves the country's first over-the-counter oral contraceptive pill. Johnson Johnson bows to public pressure over access to a critical tuberculosis medication. The state of Indiana, a red state, just increased its public health funding 15-fold. This is America dissected.

Today, we're talking about gender-affirming care, what it is and what it's not. I've been wanting to do this episode for a while now. In large part because the question of healthcare for trans kids has emerged as one of the most pressing political lightning rods among the MAGA movement. I have to put my cards on the table here. I'm a cis, straight man. I've never had to worry about violence directed at me because of my gender or sexual orientation.

And I'll admit at times that's left me with a bit of a blind spot. When it comes to the climate of hate and marginalization LGBTQ plus people so often face, though I have known my fair share of hate for other reasons. There's absolutely no way to ignore the white hot rage coming off the far right in this country. The clip I'm about to share could be triggering, but I'm sharing it. Because in some ways, it's precisely why this episode is so important. For the good of society, and especially for the good of the poor people who have fallen prey to this confusion, transgenderism must be eradicated from public life entirely, the whole preposterous ideology at every level.

That was Michael Knowles, a proto-fascist political activist, calling for the eradication, yes, eradication of a whole group of people. That is nothing short of a call to violence, genocide. Even when political activists say things like this from a microphone at a political conference, all of us should take heed. Because the attention over transgender healthcare is bigger than the 1.4 million Americans who identify as trans.

It's about the kind of America we all of us want to live in. The first step of political violence is dehumanization. It's an attempt to flatten the inherent complexity of human beings into attributes that are then mercilessly targeted. That dehumanization is intended to do two things first, it creates a permission structure that validates interpersonal hatred.

It's a call for a climate of open discrimination intended to terrorize people simply because of who they are, but it's also a call to drive public policy that sanctions those people. Anti-trans laws targeting healthcare have already passed in 20 states. These two, discrimination through hate and discrimination through public policy, are meant to feed off each other, to validate each other one creating a justification for the other. And at the core of it all, is a blatant misrepresentation of a basic set of facts.

Which is why we're talking about gender-affirming care today, what is, at its core, individualized, age-specific, multi-modal healthcare delivered by licensed experts has been deliberately mischaracterized by those seeking to hate and marginalize to justify that cycle of discrimination they're perpetrating. So today, I wanted to talk to someone who's been studying gender-affirming care for decades. Dr. Kellen Baker is the executive director of the Whitman-Walker Institute, the research, advocacy, and policy arm of Whitman-Walker. A system of clinics serving the LGBTQ Plus communities in the D.C. area.

We discuss what gender-affirming care is and is not, why the far right is demonizing it, and how we address the misinformation about it in our networks. Here's my conversation with Dr. Kellen Baker. All right, um, I am recording. Are you recording?

So there's a variety of considerations that go into that individualized and age-appropriate determination. That doctors, in conjunction with patients, and for young people, with their parents, have a lot of conversations to make sure that that pathway is individualized. And there's a lot of misinformation out there about exactly what gender-affirming care is, to your point? And it really is based on nothing but fear-mongering. And really an exploitation of the fact that relatively few people in the U..S. at least until recently, I think, knew a transgender person or could say they knew much about transgender issues. And so unfortunately, what we're seeing now is this really poisonous politics, kind of rushing in to fill that gap.

Two, it is age-appropriate, and three, it is individualized, and that is entirely the opposite of how the conversation tends to collapse. This very broad, individualized, long-practiced space in healthcare. And oftentimes, when you see a one-size-fits-all conversation for a individualized, very specific, highly tailored practice. It is intended to fear-monger about that, as you discussed. So I want to walk through the age-appropriate piece, as you talked about thinking about what gender-affirming care means across the life course.

So what do we think about when we think about gender-affirming care pre-puberty?

When young people do reach puberty, that's a really scary and difficult time for transgender young people. Because you're talking about irreversible physical changes that are really at odds with who these young people know themselves to be. And that's exactly why puberty delay medications are the standard of care. These medications are safe and effective. They've been used for transgender young people for many, many years, and also for cisgender young people. The idea is to do exactly what the name says to pause puberty, to temporarily hit a pause button. To say we need to make sure that this young person has the time that they need without the ticking clock of puberty. Of these irreversible physical changes. That can be a real source of intense distress for transgender young people who are watching their bodies change in ways, again, that don't align with who they are.

So at puberty, that's when puberty delay. Medications are the standard of care to allow young people, their parents, their doctors, that time to make the right decisions. And that they're not being pressed by a ticking clock.

And there's absolutely no other medical intervention that happens before puberty at all.

And people said something like 23, which would mean that one in four people were trans, but most of these people had never met a trans person. So how would it be that a quarter of the population is trans and you never met one, right?

There simply aren't that many transgender people. And when you look at the amount of vitriol and the amount of political harassment and outright attacks that are being targeted at this really small population, to what end? Why are we terrorizing children?

Circumstance where there is this somehow imagined sense that the world is not really as it is. And it's that ability to imagine the world as being this place that literally contradicts itself. In the sense that people have that create this almost like emotional pearling effect, where people create a circumstance intended to fear monger over circumstances that do not exist. And what's forgotten is that the real people you're talking about are a tiny minority who, by definition, because of the lack of numbers, are very much put on the back foot and are children. So they don't even have the capacity, by law, to fully and 100 advocate for themselves. They can't vote, just the basic entry point into our politics that doesn't exist for them.

The second point I wanted to bring out here was the conversation about puberty blockers, and you said something that's really important here, which is that puberty blockers.

In medicine, in pediatrics, even in circumstances when you're not talking about gender-affirming care, can you expound a bit on how they're used?

So, puberty delay medications were originally developed and used in order to appropriately time puberty for cisgender presumed cisgender young people. To make sure that typically you're looking at an age of around 11, 12, 13 years old. That's the sort of standard time, if you will, when young people tend to go through puberty. And so making sure that that is what's actually happening for young people, making sure that they're not going through puberty too early. So it's a totally standard intervention that has been used safely and effectively with cisgender children for decades, and also has been used with transgender children for a long time. And there's no reason to believe, and there's no evidence at all, that these medications work differently in cisgender versus transgender young people. Because all you're doing again is hitting pause on that process of the beginning of puberty.

Once you go off these medications, puberty starts, and so for cisgender young people, it's timed. They get to the age 11, 12, 13, and they go off these medications and puberty resumes. And there are no ill effects, there are no side effects that are unknown about these medications. Puberty does induce a lot of changes around, for example, bone density, and so it's a standard practice to monitor bone density.

It's a standard practice for cisgender young people on these medications, and it's a standard practice for transgender young people on these medications. And another one of the uses is when.

And all of this is to say that when you actually step in and think critically about what you're talking about. When you talk about gender-affirming care, you start to appreciate that. A lot of this is built out on a preexisting sense of whose medical care is allowed to be censored and whose medical care is not. And that introduces a tremendous space where all of us should be worried about the politicization of health care. Even if you or someone you love does not identify as trans.

The last thing that you need, and I would hope the last thing that you want, is. Some politician who has no idea who your kid is, has no idea what their medical needs are, is not your child's doctor saying from some distant state capital. Well, you can have access to this care, but you can't have access to that care. You can support your kid in this way, but if you support your kid in this way, that is in accordance with expert standards of care, that's under the guidance of a clinician. There are states that are calling this child abuse.

Child abuse for taking care of their kids and wanting to make sure that they get the health care that they need. And that's something that should scare everyone. The last place that politicians and politics really belong is between a parent and their child, or between a patient and their doctor. These are relationships that we hold sacred. These are sacrosanct places where we as Americans are accustomed to freedom and privacy. And the ability to make the decisions that we as parents need to make for our kids. Where we trust doctors to operate according to expert, evidence-based standards of care. And the last thing that we need in the middle of those sacrosanct relationships is politics.

We'll be back.

American Dissected is brought to you by article. Look, we all know that the best thing about summer is getting to do all your favorite things indoors, outdoors, sharing meals, watching movies, falling asleep on the sofa accidentally, everything's better. Alfresco Article's curated catalog of outdoor furniture is here to help you do all your favorite things this summer.

They've got everything you need to really make things your own, from outdoor sofas to dining sets to decor. Article believes in delightful design for every home, and thanks to their online-only model, they have some delightful prices too. Their curated assortment of mid-century modern, coastal, industrial Scandian Boho designs make furniture shopping simple. Article offers fast, affordable shipping across the U.S and Canada.

Plus, they won't leave you waiting around, you pick the delivery time and they'll send you updates every step of the way. Look, I love the combination that article offers between thoughtfully curated design, fast, affordable shipping and, well, you know, prices that don't break the bank. And their stuff lasts a long time. I can tell you this as a father of two article is offering American dissected listeners $50 off your first purchase of $100 or more.

To claim, visit article.

Com Slash ad, and the discount will be automatically applied at checkout That's Article..com Slash ad for $50 off your first purchase of $100 or more. Support for this podcast comes from Marguerite Casey Foundation. Students suffered nearly 1500 book bans, targeting books featuring LGBTQ plus themes, characters of color, and books on race and racism during the first half of the school year. Now, fascist forces are escalating this assault by threatening to remove library funding altogether as a way to control what books communities can access.

These book bans are a threat to democracy, but there is a growing movement of young people and educators fighting back in an effort to support the movement. Our sponsor, Marguerite Casey Foundation, is helping to get the newly released book. Our History has always been Contraband in defense of Black studies out as widely as possible. So it can serve as a resource to all working to protect the freedom to learn and ensure the accurate teaching of Black history. Co-edited by Colin Kaepernick and Marguerite Casey Foundation.

And Keong Yamada-taylor? Our history has always been contraband. Brings together more than 50 incredible authors in Black studies, many of whose work has been banned. Are you ready to launch your Book Ban Club? Get your free ebook today at kcgrants..org slash Freebook.

I want to ask now about gender affirming care after puberty, what does that look like, how does that manifest? And what do we understand about the long-term implications across the board, frankly, of gender affirming care for physical and mental health? The overall outcome?

Improves life satisfaction, quality of life, it improves what's called gender. There are various terms for it. But gender dysphoria, which is the clinical term that describes the distress and impairment associated with a difference between someone's gender and the sex that they were assigned at birth. Gender dysphoria is a serious medical condition. It's recognized as such by every major U.S medical association, including the American Medical Association, as well as the World Health Organization.

When you treat gender dysphoria, when you provide gender affirming care, then people's overall health and well-being improves. When you're talking about young people who are on puberty delay medications, so what that does, as we've discussed, is it buys time. It gives the young person an opportunity to work with their providers, with mental health providers, as well as their pediatricians. To talk with their parents and to make sure that they're on the right path, that this is something that they need in order to be authentically themselves. And so for those who are transgender, then the next step after puberty delay medications is hormone therapy, gender affirming hormone therapy, and what that does is it starts puberty.

So transgender young people who begin taking testosterone go through, quote-unquote, male puberty, what we think of as male puberty, and transgender young people who take estrogen go through female puberty. And that is a major contributor to overall health and well-being and quality of life for these young people. Because they're seeing their bodies change in ways that make sense to them. So hormone therapy is really the next step after puberty delay medications, and that typically begins, it varies how long young people are on puberty delay medications.

Again, as you were mentioning earlier, it's very individualized. And so the young person works with their provider, works with their parents to identify when is the right time to stop puberty, delay, medications, and.

Hormone therapy? The other type of gender-affirming care that people frequently think about is gender-affirming surgeries. And it's really important to know that gender-affirming surgeries are not part of the standard of care for minors. For people before they become adults. There are very, very, very rare cases in which somebody who is younger than age 18 might have gender-affirming surgery. For example, top surgery for a transgender boy who has grown breasts.

That's incredibly rare and is only done on a case-by-case basis when there's no other solution, no other treatment that has been effective for the young person's gender dysphoria. So it's not something that the standards of care recommend, because typically you're waiting until the young person is an adult. And any instances when young people, adolescents, have had gender-affirming surgery is incredibly, incredibly rare. And done in very close and intense consultation with mental health providers, with parents, and with other clinicians who are experts in treating gender dysphoria. I'm asking this because it is a common.

And by comparison, if you look at other types of medical interventions that we routinely provide support, consider to be really important. For example, I had a hip replacement surgery last summer because apparently I'm not 41, I'm 81..

But the regret rate for some of these orthopedic procedures knee replacement, hip replacement, lower back surgeries. regret rates for those procedures can range anywhere from 15 to upwards of 30. In fact, there was an investigation a couple of years ago that looked at regret rates for knee replacements and found that fully about.

Regretting having the procedure? And when we look at regret rates for gender-affirming care, for any type of gender-affirming care, it is in the very low single digits, if even that high.

For other forms of elective, procedures are substantially higher, order of magnitude higher than regret for gender-affirming care. Yeah, and I really think in terms of elective.

My hip replacement surgery was unfortunately medically necessary. It was elective in the sense that I could have tried to make it another couple of years with the original hardware. But my quality of life was so low that I elected to have a hip replacement surgery earlier than I might otherwise. And I would put gender-affirming care, I would define it similarly in relation to the word elective. That it's medically necessary. Treatment for gender dysphoria is medically necessary, it is life-saving.

And gender dysphoria, if left untreated, can progress to really intense rates of psychological distress, depression, anxiety, and even suicide, suicidal ideation, suicide attempts. So it's not elective in the sense that people are choosing whether or not to get it at all, it's elective in the sense that. Making sure that the timing is right, that the person, whatever age they are, has the support that they need in place. To make sure that they are surrounded by love, that they are surrounded by people who support them, that they have the financial means they have, for example, good insurance coverage that covers the care that they need. That's the sense that gender-affirming care is elective, in the sense that you want to make sure that you're accessing it at the time when.

Set up. But it does not mean that it's not medically necessary, it's every bit as medically necessary as my hip replacement was. Yeah, and I appreciate that clarification.

It's very difficult to be trans in a society where so many politicians have apparently dedicated their careers to taking away your access to medically necessary, life-saving health care. The way that trans people get treated in school, sometimes at home, on the job, while walking down the street, while trying to play on a sports team, while trying to go to the restroom. In a public place. Trans people are often subject to really vicious and intense discrimination in the United States today, discrimination, no matter who you are, has mental health consequences. The framework that we use for describing that in public health and medicine is the minority stress framework. Which is that the experience of being treated poorly, the experience of being subject to stigma, prejudice and discrimination has health impacts.

It's not just sticks and stones may break my bones, but words will never hurt me. No words hurt words. Get under the skin. Treatment that is discriminatory, that tells you that you're less than that, you're not worth it, not worthy of love, protection, safety, dignity. That hurts. And that is directly related to higher rates of mental health concerns, depression, anxiety again for transgender people.

Even sometimes, when they're able to access gender-affirming care, it can alleviate that experience of gender dysphoria. But unfortunately, there are times when it can't alleviate. The experience of being trans in America and being treated the way transgender people are being treated right now, which is as a political football.

That treats the specific challenge at the core. We're talking about a form of mental health intervention. And when we talk about mental health, the challenge is that sometimes we don't appreciate that mental health or mental illness kills. And so if we are taking away people's access to a form of healthcare that will protect their mental health, we are talking about life-saving care, we are.

And the problem is that when we forget that, that is life-saving care, when we treat it as being entirely capricious. In the way, that is implicit, in the way that the right talks about this, we forget the fact that there are a lot of people whose lives we are putting at profound risk.

Ban a certain kind of healthcare.

I want to jump now to that question, exactly the degree to which this issue has been politicized. Because it seems like over the past two years, we've just seen this epidemic of politicization and anti-trans bills. Can you tell us how many states have passed anti-trans bills that specifically target gender-affirming care?

People are panicking, people are terrorized, parents are terrorized. They're being told that they're committing child abuse by supporting their kids, and kids are being told. Young people, adolescents, for example, on puberty delay medications, who are thriving, who are doing well, who are under the care of their clinician.

They're being told that they have to stop, that they cannot have access to this care that for them is lifesaving and so important. So what we're seeing again is panic, we're seeing terror. We're seeing people who have the means to do so, picking up and leaving these states. We're seeing families being made into refugees in the United States, having to flee these states. Where state governments have decided that parents who love and support their kids are child abusers.

We're also seeing providers leave these states. This is not just about criminalizing parents, this is also a campaign of terror that is criminalizing providers for upholding their oath to provide evidence-based, ethical, best practice health care to their patients. They are being told that they are criminals, and they're increasingly picking up and leaving those states that have signaled clearly that they are prioritizing politics over the practice of good medicine. And, over again, the sanctity of that patient-provider relationship.

So this has effects not just on transgender people, but on everyone who needs health care. Because, for example, if you're a pediatrician who works with trans adolescents, you help them with puberty delay medications, maybe you help them transition to gender-affirming hormone therapy. Then you're also doing a lot of other health care for cisgender adolescents with a lot of different complex conditions. And when you pack up and you leave the state because that state is criminalizing you for the care that you provide. According to the evidence and according to the best practice standards in.

The state that leaves those kids, those cisgender kids, out of luck. And that is, I think, a particularly untold piece of this, or something that not a lot of people are thinking about or talking about that. This isn't just about terrorizing trans kids and depriving them of access to really important health care services. it's also depriving cisgender kids of access to health care providers.

Really important health care for a variety of conditions. And so this idea that we can just sort of surgically target transgender people and no one else will be hurt, that's not true. It's having knock-on effects again, not just on trans people and their families, but on cisgender.

And the consequences can be profound because at the end of the day, we tend to isolate ourselves from those assaults on rights that don't directly affect us. And when we do that, we don't realize that we're stepping into a future where we may be setting ourselves up for a target. And I say this because I know that the vast majority of our listeners here are supporting trans rights, but may not appreciate the implications that personalize them to them as well. It's one thing to say I support this and I really wish the world would be better. But ah, is the world a terrible place? Versus saying actually an assault on a set of rights?

Is an assault on all of our rights to make our own health care decisions? That in a circumstance, of course, in a country where we haven't even guaranteed the basic right to health care in the first place, right? But that question of targeting any particular form of health care itself opens up a set of doors that I really want folks to think a bit about. Yes, I mean, this is, you know?

And I would unfortunately say that. It's part of a coordinated strategy, which is to push huge swaths of the U.S. population out of public life. To make it impossible for so many people, not just trans people or not just women, but so many people, to make fundamental personal decisions about what happens to our bodies. And what that does is it makes it impossible for us to participate in public life. It makes it such that we are off to the side that we are excluded from this fundamental human right. And human need really, to be able to make these really intensely personal decisions about our own bodies. And again, it's not just about trans people. It is a coordinated effort to strip whole huge groups of us, whole huge groups of Americans, of the ability to make those personal, private decisions for ourselves. And to not have the government intervening, not have the government coming in and trying to make those decisions for us.

And so that point that you're making is one. It's not just that they're taking away trans healthcare, it's that they're giving.

A society the permission to dog and discriminate trans people in daily life in ways that are really intended, as you said, to exclude people from public life. But that's even a sterile way of saying it. It's about terrorizing you into shutting up, being quiet and not showing up, right? That's that's really what it's about.

And that piece of it, where we assent to the targeting of of any group of people, whether we may identify with them or not, should force us to be asking. Do I assent to a society where my government, in theory, for the people and by the people, targets a particular group of people? To open and sanction, in effect, civic terrorism against them? Because, because that's that's how that shows up, you know, I think about my wife Sarah, who's a mental health professional who wears a hijab. And I never really appreciated the degree to which she has to be asking when she goes into public, there's some piece of her mind.

In a certain set of ways that, you know, I become very aware of when we're together, that I can forget in some respects when I'm alone. And, and you know, that's not to say that I don't get targeted racially, but that is to say that I don't stand out as fast as easily. And because of that, um, you know, cishet privilege, I am not as targeted in terms of my own physical safety in the same way. And so that question about what kind of society we want to live in is one that all of us ought to be invested in. And then, beyond that, what kills me, really grinds my soul is that folks who pursue this kind of politics pursued in the name of freedom. Which is to say, you want the freedom to be able to target and demonize anyone you want.

It's not about whether or not we have personal freedom, about autonomy of our own bodies. No, it's about whether or not you have the freedom to aggress against a particular group of people. Or in ways that allow you to irrigate yourselves over others. Like, it's, it's what they're talking about, is the freedom to think yourself better than someone else, yeah.

And that seems to me a really bastardized sense of freedom. And it's a campaign.

And it's not going to stop with transgender people. Transgender people are in many ways kind of just a convenient target for the moment, because there are relatively few transgender people. Because, as we've talked about earlier, a lot of Americans aren't very familiar with transgender people or transgender issues. Which makes it possible for this sort of hugely distorted, demonized idea of who transgender people are to be projected into people's minds. And then the call comes, that has to be eradicated, we have to stamp that out, we have to stamp it out.

We have to eradicate transgender people, these are people that we're talking about here. And, to your point, there are so many elements of America's history where we have demonized, targeted and tried, in some cases, to eradicate groups of people. And it is a danger that we all need to be aware of. Because the purpose of our government needs to be about protecting each and every one of us in our ability to live freely and safely and authentically as who we are. Whether we're transgender or not, whether we're white, Black, brown, whether we're men or women, or whether we're non-binary people, we don't have to understand each other perfectly. In order to, I would hope, accept the premise that every single one of us is human, and every single one of us deserves.

To be loved and to be able to move through the world without constantly doing that calculus that you were mentioning. That sense of am I visible today to someone who wants to hurt me because of who I am? And that is a terrible way to have to go through life. And that is exactly what we're doing to transgender people, and, worse, we're doing it to transgender young people. We're telling young people that we hate them for who they are.

And that has really serious impacts all the way through someone's life. To be told that who you are is wrong, to be told that who you are is so bad. That the government is going to try to step in and call your parents, child abusers, is going to step in and try to arrest your healthcare provider. Just for listening to you, just for believing you when you tell them who you are. That's a terrible thing to do, a terrible message to send to anybody, but especially to kids. We are in a moment, right?

I think two.

A lot of us, like, we're living in a post-fact world where there's so much misinformation out there about, just look at Covid, for example. So much misinformation about Covid. And this idea that all of a sudden facts don't matter, but facts do matter, and facts are real. And you can follow the science, you can actually look at the expert standards of care, you can look at if it's your jam. You can read the journal articles that will tell you the incredibly positive impact that gender-affirming care has on transgender people. So the idea that we have so often, I think in our society these days, that on one side there's a fact and on the other side is an opinion. And these things are so often presented these days as if they're the same thing.

They're not the same.

Not the same, so sorry.

So that's one thing I think is following the science, following the facts. And there are a number of articles out there, you know, in various media outlets that will walk through the facts of what do we know? How long has gender-affirming care been being provided in the United States again? more than 50 years? Are there expert standards of care? Yes.

Is there a substantial body of scientific evidence that shows that care benefits the health and well-being of transgender people? Yes, so we can stand on that, we can stand on that foundation of facts, not that shifting sea, if you will, of opinions. Another thing that I think is particularly important is elevating and listening to the voices of transgender people themselves.

We are so often arguing about people and people's lives that they don't exist. But transgender people do exist, and transgender people have the actual experience of being trans, of needing health care. And for those who are fortunate and don't live in. Some of these states that are criminalizing the provision of care have the experience of getting gender-affirming care. So we can listen to the voices of transgender people of any age who are telling us, this is what it's like to be trans. This is who I am, this is what I need, this is what has helped me, and this is what has hurt me. We can listen to those voices, and we can listen to the voices of parents and doctors as well. Talking about, you know, I think some of the most powerful stories come from parents who, of course, had no. I don't think most parents expect a young person to come out as transgender, but when they do. There are so many parents who are loving and supportive. And listen to that young person when they're saying who they are.

And so we can listen to the stories of those parents. That you don't have to get it right the first time, you don't have to get it right every single time. You don't have to know everything about gender and gender theory and medicine and all of this, that and the other. All you have to do is be willing to listen. And to ground your response to what somebody is telling you about who they are, ground your response in love. And I think that remembering that there are so many parents who just want the best for their kids, whether they're cisgender, whether they're transgender, parents just want the best for their kids.

And so taking the public policy steps that support those parents and being able to do what every parent wants to do support and love their child.

Thank you so much for having me.

As usual, here's what I'm watching right now. A friend of mine got on me this week for always ending the show with tough news. It's a public health podcast there's not that much to be positive about, but hey, in honor of said friend, I hope you're listening.

It's all good news today. The first ever over-the-counter birth control pill in the U.S has just been approved by the FDA OTC OCP. I love it.

Let me decode over-the-counter oral contraceptive pills. That is what the F.D.A. approved this week and one of the most important wins for reproductive justice in. Well, let's just say it a while. For far too long, oral contraceptives have been hostage behind the pad of a physician, meaning that's been incredibly difficult for folks with limited health access to get them. That inaccessibility has led to unwanted pregnancies that could have been prevented.

And now, with this new medication called OPIL, anyone can get access to safe, effective oral contraceptives by walking into a pharmacy. That's particularly important in a post-Dob's world. But as if to tell on themselves, the same folks who architected the fall of Roe are up in arms over this new over-the-counter contraceptive. I mean, you would think that people who hate abortion would also love a pill that stopped unwanted pregnancies, right? No, because it was never about abortion itself.

It always has been about control. A few weeks ago, John Green of YouTube Fame posted a critical video sounding the alarm over how pharma giant Johnson Johnson was attempting to use patent rights to keep profiteering off.

What will actually happen next Tuesday is that the company Johnson Johnson will begin enforcing a secondary patent, thus denying access to Bedaquiline to around 6 million people over.

Turns out that 3.

7 million YouTube subscribers can get shit done. Finally, the state of Indiana, a red state, just increased its public health funding 1500, that's right, a 15x increase in public health funding. Wait in a red state, yep.

Indiana had been one of the states with the lowest public health funding in the country. And they had some of the worst health statistics on smoking, obesity and mental health to show for it. But with this new budget, that's all changed. The state is making a $225 million investment in local health departments over the next two years. How'd it happen? Strong gubernatorial leadership, albeit from a Republican, and a recognition that all health is local.

And strong local government had traditionally been a conservative idea. Well, traditionally. This is unequivocally a win, but you know what?

I'd love to get back where public health was nonpartisan again. That's it for today. On your way out, don't forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, I hope you'll drop by the Crooked store for some America, dissected Merch.

America dissected is a product of crooked media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emma Illich-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Takai Suzawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

The show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host. And views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services. It is not intended to present the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.

It is not intended to present the views.