The destruction of our public health infrastructure has continued mercilessly in the last several weeks (alongside the destruction of our foreign policy, our economy, our civil rights, our democracy, and our humanity as the case may be). RFK’s obsession with beef tallow feels so small in contrast to the invasion of Minneapolis by our own government, but his anti-science dictums are going to kill people. The decisions his department has announced in the last several weeks have been a strange combination of comical, cruel, and dangerous. The government’s new non-guidance on alcohol—which just says “consume less alcohol for better overall health”—is pretty much useless. When asked for clarification, Dr. Oz glibly said, “Don’t have it for breakfast.” (Umm, mimosas?) He went on to praise alcohol’s role as a social lubricant that “brings people together.” I’m not a psychologist (though neither is he), but I’m pretty sure the goal is to be able to have healthy relationships without the use of alcohol as a social lubricant. I also know that people are often on their worst behavior when alcohol is involved. One study found that approximately 69% of rapists on college campuses were drunk at the time, and another estimated that 3 out of 4 incidents of domestic abuse involve alcohol. Maybe exalting alcohol for its relationship benefits is not the way to go. Next, they’re going to take the black box warning off tobacco products so that we can all enjoy a cigar with our 48 oz. porterhouse and pitcher of Michelob Ultra. That ought to Make America Healthy Again.
Dr. Oz was also chosen to announce the administration’s newest idea for picking on trans kids. The first of the new rules HHS is proposing prohibits Medicaid and CHIP (Children’s Health Insurance Program) from paying for any gender-affirming care for minors. The second says that any hospital that receives Medicaid and Medicare cannot provide gender-affirming health care to trans youth. Or in the reverse, that any hospital that does provide such care can’t be in the Medicaid/Medicare program. It’s not so much a ban as it is a threat. According to the proposed rules—which are currently in their 60 day public comment period—gender-affirming care includes puberty blockers, hormones, and surgery which they refer to as “sex-rejecting surgery.” Dr. Oz got pretty fired up about that last part during his press conference. He ranted about the outrageous cost of vaginoplasty and phalloplasty (creating vaginas and penises). He explained, “A vaginoplasty, a procedure a child does not need, costs $60,000. Shockingly, a phalloplasty, the creation of a penis, costs, on average, in America… $150,000 per child... A scrotoplasty, where you add testicles? That’s extra.” Mehmet would like us to believe that the government is wasting billions on making penises that it could be using on more marble for the Lincoln bathroom. The truth, however, is that gender-affirming surgery for minors is exceedingly rare, and most of it involves neither genitals nor trans children. A 2024 study out of Harvard’s T.H. Chan School of Public Health found that only 85 minors underwent gender-affirming surgery in the U.S. in 2019; 82 of those procedures were chest-related surgeries. Far from sweeping the nation, the rate of gender-affirming surgery for minors who have a transgender or gender diverse diagnosis (TGD) was 2.1 per 100,000 15-to-17-year-olds, 0.1 per 100,000 13-to-14-year-olds, and 0 for anyone 12 years or younger. The researchers suggest that the numbers might seem inflated because they often include cisgender males who undergo breast reduction surgery. Of 151 breast reductions among cisgender male and TGD minors, 97% were performed on cisgender males. I’d bet anything that Dr. Oz is in favor of a cis guy in high school not getting teased in the locker room over having man boobs and that he’d be just fine with that kid getting surgery during his summer break. Whether Oz likes it or not, that is gender-affirming surgery. Unfortunately, HHS is also going after a much more common form of gender- affirming care—chest binders. The FDA’s Center for Devices and Radiological Health issued warning letters to 12 manufacturers and retailers of breast binders. The letters claim that because companies marketed their products as alleviating gender dysphoria, the binders are considered medical devices. As such the companies needed to register the devices with the FDA. The letters went on to say the companies were now in violation of the Federal Food, Drug, and Cosmetics Act. Legal experts characterized this as an overreaction and said letters like this are pretty much unheard of. It’s not surprising. The endless attack by this administration on the trans community as a whole—and trans kids in particular—is deliberate and shameful. Wrapping it in the language of health care and protecting children makes it even worse. And, while I know math is hard, if you’re going to complain about how much something costs, try getting accurate numbers first. The Gender Confirmation Center reports that a vaginoplasty costs about $24,000 and a phalloplasty can range from $35,000 to $50,000. Sorry, Dr. Oz, but the only $150,000 dick in the room is you. Okay, maybe not because RFK, Jr. was standing next to you, and he had a banner couple of weeks as well. As promised, Kennedy changed the whole f**king childhood vaccine schedule. Instead of basing the changes on the decades of research we have telling us how well vaccines have worked in this country and how many lives have been saved, Kennedy compared the number of shots given in the United States to the number in other developed countries like Denmark. (I’ll give you one guess about why Donald Trump is so obsessed with Denmark. Hint: It’s not Greenland, but it does have to do with color.) This comparison to other countries is complete bulls**t. First of all, many of those countries now recommend vaccines Kennedy is taking off of our list. But also—and this is a biggie—all of those countries have some form of universal health care. Until you get us that Bobby, you know where you can shove your comparison. According to the new schedule, the CDC will continue to recommend that all children are vaccinated against diphtheria, tetanus, acellular pertussis (whooping cough), Haemophilus influenzae type b (Hib), Pneumococcal conjugate, polio, measles, mumps, rubella, chickenpox, and HPV. Other shots which used to be included in the recommendations for all children will now only be recommended to those considered high risk. These included RSV, hepatitis A, hepatitis B, dengue, meningococcal ACWY, and meningococcal B. For people who are not high risk, the CDC is now recommending a shared decision-making model in which parents and pediatricians decide together. This model also applies to the rotavirus vaccine, the seasonal flu shot, and Covid-19 boosters. It may sound empowering, but it’s just meant to sow more confusion and further discredit vaccines. We’ve been promised that these changes will not affect availability. We can still get the vaccines we want. Kennedy has promised that insurance coverage won’t change nor will the what’s available through the Vaccines of Children’s Fund. The best case scenario is that nothing changes because pediatricians tell the parents they’re sharing decision making with to get the damn shots. More likely, vaccination rates will continue to drop and measles and whooping cough continue to spread. Along with these changes, the CDC announced that young people only need to get one HPV shot. This feels like a big deal. When the vaccine first came out, it was a three-dose regimen. A few years ago, the CDC changed its recommendations to say that anyone who got the shot before 15 only needed two shots. Anyone who got it after that, still needed three. Now it appears to be going down to one shot for all ages. As someone who writes about HPV all the time, I’m familiar with the research both here and internationally. I know that there’s evidence to suggest that one shot is enough. In fact, just a few weeks ago a study came out in the New England Journal of Medicine supporting a one-shot regimen. (In true public health fashion, it was titled, “Noninferiority of One HPV Vaccine Dose to Two Doses.”) But I have some questions because the World Health Organization still says people 14-20 should get one or two doses. Specifically, it says people should get one dose when getting two isn’t practical. Normally, I would go to the CDC for answers, but this time I’m just not sure whether to trust what it says. That makes me sad and more than a little scared. I guess this is what happens when you put the fox in charge of the hen house (or a brain worm in charge of our public health infrastructure). Stay tuned for the Audio version of today’s Sex On Wednesday.
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Dr. Oz is a $150,000 Dick
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