Decoding the Misinformation-Legislation Pipeline: an analysis of Florida Medicaid and the current state of transgender healthcare
DOI:
https://doi.org/10.5195/jmla.2023.1724Keywords:
transgender healthcare, critical librarianship, misinformationAbstract
Background: The state of evidence-based transgender healthcare in the United States has been put at risk by the spread of misinformation harmful to transgender people. Health science librarians can alleviate the spread of misinformation by identifying and analyzing its flow through systems that affect access to healthcare.
Discussion: The author developed the theory of the Misinformation - Legislation Pipeline by studying the flow of anti-transgender misinformation from online echo chambers through a peer-reviewed article and into policy enacted to ban medical treatments for transgender people in the state of Florida. The analysis is precluded with a literature review of currently accepted best practices in transgender healthcare, after which, the author analyzes the key report leveraged by Florida’s Department of Health in its ban. A critical analysis of the report is followed by a secondary analysis of the key peer-reviewed article upon which the Florida Medicaid authors relied to make the decision. The paper culminates with a summation of the trajectory of anti-transgender misinformation.
Conclusion: Misinformation plays a key role in producing legislation harmful to transgender people. Health science librarians have a role to play in identifying misinformation as it flows through the Misinformation - Legislation Pipeline and enacting key practices to identify, analyze, and oppose the spread of harmful misinformation.
References
Medical Library Association. Code of Ethics for Health Sciences Librarianship: Goals and Principles for Ethical Conduct [Internet]. Medical Library Association. Medical Library Association; 2010. Available from: https://www.mlanet.org/p/cm/ld/fid=160.
Ashley F. The Misuse of Gender Dysphoria: Toward Greater Conceptual Clarity in Transgender Health. Perspect Psychol Sci. 2021 Nov;16(6):1159-1164. DOI: 10.1177/1745691619872987. Epub 2019 Nov 20. PMID: 31747342.
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
Lepore C, Alstott A, McNamara M. Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth. JAMA Pediatr. 2022 Oct 1;176(10):965-966. DOI: 10.1001/jamapediatrics.2022.2959. PMID: 35994256.
Call DC, Challa M, Telingator CJ. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Curr Psychiatry Rep. 2021 Apr 13;23(6):33. DOI: 10.1007/s11920-021-01245-9. PMID: 33851310.
Feldman JL, Luhur WE, Herman JL, Poteat T, Meyer IH. Health and health care access in the US transgender population health (TransPop) survey. Andrology. 2021 Nov;9(6):1707-1718. DOI: 10.1111/andr.13052. Epub 2021 Jun 10. PMID: 34080788; PMCID: PMC8613303.
Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021 May-Jun;8(4):273-280. DOI: 10.1089/lgbt.2020.0437. Epub 2021 Mar 31. PMID: 33794108; PMCID: PMC8213007.
Velasco RAF, Slusser K, Coats H. Stigma and healthcare access among transgender and gender-diverse people: A qualitative meta-synthesis. J Adv Nurs. 2022 Oct;78(10):3083-3100. DOI: 10.1111/jan.15323. Epub 2022 Jun 10. PMID: 35689393.
Bockting WO, Miner MH, Swinburne Romine RE, Dolezal C, Robinson BBE, Rosser BRS, Coleman E. The Transgender Identity Survey: A Measure of Internalized Transphobia. LGBT Health. 2020 Jan;7(1):15-27. DOI: 10.1089/lgbt.2018.0265. Epub 2019 Dec 24. PMID: 31880493; PMCID: PMC6983734.
English D, Carter JA, Boone CA, Forbes N, Bowleg L, Malebranche DJ, Talan AJ, Rendina HJ. Intersecting Structural Oppression and Black Sexual Minority Men's Health. Am J Prev Med. 2021 Jun;60(6):781-791. DOI: 10.1016/j.amepre.2020.12.022. Epub 2021 Apr 8. PMID: 33840546; PMCID: PMC8274250.
Naz Khan F (2022). A history of transgender and gender diverse health care: from medical mistreatment to gender-affirmative health care. Keuroghlian A.S., & Potter J, & Reisner S.L.(Eds.), Transgender and Gender Diverse Health Care: The Fenway Guide. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=3104§ionid=259324704
Stryker S. Transgender history: the roots of today’s revolution. Second edition. Berkeley: Seal Press; 2017. 301 p.
Frey JD, Poudrier G, Thomson JE, Hazen A. A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. J Sex Med. 2017 Aug;14(8):991-1002. DOI: 10.1016/j.jsxm.2017.06.007. PMID: 28760257.
Siotos C, Neira PM, Lau BD, Stone JP, Page J, Rosson GD, Coon D. Origins of Gender Affirmation Surgery: The History of the First Gender Identity Clinic in the United States at Johns Hopkins. Ann Plast Surg. 2019 Aug;83(2):132-136. DOI: 10.1097/SAP.0000000000001684. PMID: 30557186.
Amengual T, Kunstman K, Lloyd RB, Janssen A, Wescott AB. Readiness assessments for gender-affirming surgical treatments: A systematic scoping review of historical practices and changing ethical considerations. Front Psychiatry. 2022 Oct 20;13:1006024. DOI: 10.3389/fpsyt.2022.1006024. PMID: 36339880; PMCID: PMC9630738.
Coleman, E., Radix, A. E., Bouman, W.P., Brown, G.R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F.L., Monstrey, S. J., Motmans, J., Nahata, L., ... Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1), S1-S260. https://doi.org/10.1080/26895269.2022.2100644.
Rafferty J; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH; COMMITTEE ON ADOLESCENCE; SECTION ON LESBIAN, GAY, BISEXUAL, AND TRANSGENDER HEALTH AND WELLNESS. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics. 2018 Oct;142(4):e20182162. DOI: 10.1542/peds.2018-2162. Epub 2018 Sep 17. PMID: 30224363.
Klein DA, Paradise SL, Goodwin ET. Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know. Am Fam Physician. 2018 Dec 1;98(11):645-653. PMID: 30485050. https://pubmed.ncbi.nlm.nih.gov/30485050/.
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869-3903. DOI: 10.1210/jc.2017-01658. Erratum in: J Clin Endocrinol Metab. 2018 Feb 1;103(2):699. Erratum in: J Clin Endocrinol Metab. 2018 Jul 1;103(7):2758-2759. PMID: 28945902.
Madara J. AMA to states: Stop interfering in health care of transgender children [Internet]. 2021. Available from: https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children.
Florida Health. Treatment of Gender Dysphoria for Children and Adolescents [Internet]. Florida Health. Florida Department of Health; 2022. Available from: https://www.floridahealth.gov/newsroom/2022/04/20220420-gender-dysphoria-guidance.pr.html.
David Schwartz (2021) Clinical and Ethical Considerations in the Treatment of Gender Dysphoric Children and Adolescents: When Doing Less Is Helping More, Journal of Infant, Child, and Adolescent Psychotherapy, 20:4, 439-449, DOI: 10.1080/15289168.2021.1997344
Wallace T. Generally Accepted Professional Medical Standards Determination on the Treatment of Gender Dysphoria [Internet]. Tallahassee, FL: Agency for Health Care Administration; 2022 Apr. Available from: https://ahca.myflorida.com/letkidsbekids/docs/AHCA_GAPMS_June_2022_Report.pdf.
Davy Z, Toze M. What Is Gender Dysphoria? A Critical Systematic Narrative Review. Transgend Health. 2018 Nov 1;3(1):159-169. DOI: 10.1089/trgh.2018.0014. PMID: 30426079; PMCID: PMC6225591.
Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One. 2018 Aug 16;13(8):e0202330. DOI: 10.1371/journal.pone.0202330. Erratum in: PLoS One. 2019 Mar 19;14(3):e0214157. PMID: 30114286; PMCID: PMC6095578.
Littman L. Saying that Bauer et al studied rapid onset gender dysphoria is inaccurate and misleading. J Pediatr. 2022 Jun;245:250. DOI: 10.1016/j.jpeds.2022.03.003. Epub 2022 Mar 8. PMID: 35276124.
Sinai J. Rapid onset gender dysphoria as a distinct clinical phenomenon. J Pediatr. 2022 Jun;245:250. DOI: 10.1016/j.jpeds.2022.03.005. Epub 2022 Mar 8. PMID: 35276122.
Hutchinson A, Midgen M, Spiliadis A. In Support of Research Into Rapid-Onset Gender Dysphoria. Arch Sex Behav. 2020 Jan;49(1):79-80. DOI: 10.1007/s10508-019-01517-9. Epub 2019 Jul 17. PMID: 31317286.
Bauer GR, Lawson ML, Metzger DL; Trans Youth CAN! Research Team. Do Clinical Data from Transgender Adolescents Support the Phenomenon of "Rapid Onset Gender Dysphoria"? J Pediatr. 2022 Apr;243:224-227.e2. DOI: 10.1016/j.jpeds.2021.11.020. Epub 2021 Nov 16. PMID: 34793826.
Restar AJ. Methodological Critique of Littman's (2018) Parental-Respondents Accounts of "Rapid-Onset Gender Dysphoria". Arch Sex Behav. 2020 Jan;49(1):61-66. DOI: 10.1007/s10508-019-1453-2. Epub 2019 Apr 22. PMID: 31011991; PMCID: PMC7012957.
Tiffany K. The secret internet of terfs [Internet]. The Atlantic. 2020 [cited 2023 Feb 24]. Available from: https://www.theatlantic.com/technology/archive/2020/12/reddit-ovarit-the-donald/617320/.
Törnberg P. Echo chambers and viral misinformation: Modeling fake news as complex contagion. Bauch CT, editor. PLoS ONE [Internet]. 2018 Sep 20 [cited 2023 Feb 24];13(9):e0203958. Available from: https://dx.plos.org/10.1371/journal.pone.0203958.
Törnberg P, Törnberg A. Inside a White Power echo chamber: Why fringe digital spaces are polarizing politics. New Media & Society [Internet]. 2022 Sep 20 [cited 2023 Feb 24];146144482211229. Available from: http://journals.sagepub.com/doi/10.1177/14614448221122915.
Serena Bassi, Greta LaFleur; Introduction: TERFs, Gender-Critical Movements, and Postfascist Feminisms. TSQ 1 August 2022; 9 (3): 311–333. DOI: https://doi.org/10.1215/23289252-9836008.
Gina Gwenffrewi; J. K. Rowling and the Echo Chamber of Secrets. TSQ 1 August 2022; 9 (3): 507–516. DOI: https://doi.org/10.1215/23289252-9836176.
Paceley MS, Dikitsas ZA, Greenwood E, McInroy LB, Fish JN, Williams N, et al. The perceived health implications of policies and rhetoric targeting transgender and gender diverse youth: a community-based qualitative study. Transgender Health [Internet]. 2023 Feb 1 [cited 2023 Feb 24];8(1):100–3. Available from: https://www.liebertpub.com/doi/10.1089/trgh.2021.0125.
Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Factors Leading to "Detransition" Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT Health. 2021 May-Jun;8(4):273-280. DOI: 10.1089/lgbt.2020.0437. Epub 2021 Mar 31. PMID: 33794108; PMCID: PMC8213007.
Durwood L, McLaughlin KA, Olson KR. Mental Health and Self-Worth in Socially Transitioned Transgender Youth. J Am Acad Child Adolesc Psychiatry. 2017 Feb;56(2):116-123.e2. DOI: 10.1016/j.jaac.2016.10.016. Epub 2016 Nov 27. Erratum in: J Am Acad Child Adolesc Psychiatry. 2018 Nov;57(11):899. PMID: 28117057; PMCID: PMC5302003.
Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics. 2016 Mar;137(3):e20153223. DOI: 10.1542/peds.2015-3223. Epub 2016 Feb 26. Erratum in: Pediatrics. 2018 Aug;142(2): PMID: 26921285; PMCID: PMC4771131.
Cook CE, Thigpen CA. Five good reasons to be disappointed with randomized trials. J Man Manip Ther. 2019 May;27(2):63-65. DOI: 10.1080/10669817.2019.1589697. Epub 2019 Mar 14. PMID: 30935322; PMCID: PMC6484499.
Ground. News [Internet]. Ground News; Available from: https://ground.news.
Media Bias/Fact Check [Internet]. Media Bias/Fact Check. Media Bias Fact Check; Available from: https://mediabiasfactcheck.com/.
All Sides [Internet]. All Sides. AllSides Technologies, Inc; Available from: https://www.allsides.com/.
Shrier A. Irreversible damage: the transgender craze seducing our daughters. Washington, DC: Regnery Publishing, a division of Salem Media Group; 2020. 264 p.
Herman, J.L., Flores, A.R., O’Neill, K.K. (2022). How Many Adults and Youth Identify as Transgender in the United States? The Williams Institute, UCLA School of Law. Available from: https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/.
Newcomb ME, Hill R, Buehler K, Ryan DT, Whitton SW, Mustanski B. High Burden of Mental Health Problems, Substance Use, Violence, and Related Psychosocial Factors in Transgender, Non-Binary, and Gender Diverse Youth and Young Adults. Arch Sex Behav. 2020 Feb;49(2):645-659. DOI: 10.1007/s10508-019-01533-9. Epub 2019 Aug 14. PMID: 31485801; PMCID: PMC7018588.
Howell JD, Maguire R. Factors associated with experiences of gender-affirming health care: a systematic review. Transgender Health [Internet]. 2023 Feb 1 [cited 2023 Feb 24];8(1):22–44. Available from: https://www.liebertpub.com/doi/10.1089/trgh.2021.0033.
Van Leerdam TR, Zajac JD, Cheung AS. The effect of gender-affirming hormones on gender dysphoria, quality of life, and psychological functioning in transgender individuals: a systematic review. Transgender Health [Internet]. 2023 Feb 1 [cited 2023 Feb 24];8(1):6–21. Available from: https://www.liebertpub.com/doi/10.1089/trgh.2020.0094.
Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2020 Feb;145(2):e20191725. DOI: 10.1542/peds.2019-1725. Erratum in: Pediatrics. 2021 Apr;147(4): PMID: 31974216; PMCID: PMC7073269.
Turban JL, King D, Kobe J, Reisner SL, Keuroghlian AS. Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLoS One. 2022 Jan 12;17(1):e0261039. DOI: 10.1371/journal.pone.0261039. PMID: 35020719; PMCID: PMC8754307.
Trans Legislation Tracker. Anti-trans Bills Tracker [Internet]. Trans Legislation Tracker; 2023. Available from: https://translegislation.com/.
Blume R, Roylance A. Decolonization in collection development: Developing an authentic authorship workflow. The Journal of Academic Librarianship [Internet]. 2020 Sep [cited 2023 May 12];46(5):102175. DOI: 10.1016/j.acalib.2020.102175.
Popowich S. The antinomies of academic freedom: reason, trans rights, and constituent power. Can J Acad Lib [Internet]. 2020 Dec 18 [cited 2023 May 12];6:1–28. DOI: 10.33137/cjal-rcbu.v6.33980.
American college of pediatricians [Internet]. Southern Poverty Law Center. [cited 2023 May 12]. Available from: https://www.splcenter.org/fighting-hate/extremist-files/group/american-college-pediatricians.
Henderson S, Wells R. Environmental racism and the contamination of black lives: a literature review. J Afr Am St [Internet]. 2021 Mar [cited 2023 May 12];25(1):134–51. DOI: 10.1007/s12111-020-09511-5.
Ornelas C, Torres JM, Torres JR, Alter H, Taira BR, Rodriguez RM. Anti-immigrant Rhetoric and the Experiences of Latino Immigrants in the Emergency Department. West J Emerg Med. 2021 May 7;22(3):660-666. DOI: 10.5811/westjem.2021.2.50189. PMID: 34125043; PMCID: PMC8203025.
McNamara M, Lepore C, Alstott A, Kamody R, Kuper L, Szilagyi N, Boulware S, Olezeski C. Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines. J Adolesc Health. 2022 Sep;71(3):251-253. DOI: 10.1016/j.jadohealth.2022.06.008. Epub 2022 Jul 2. PMID: 35787819.
Skidmore MJ. The affordable care act: dispersing the fog of misinformation. Poverty & Public Policy [Internet]. 2012 Jan 21 [cited 2023 May 12];4(1):1–6. DOI: 10.1515/1944-2858.1239.
Pagoto SL, Palmer L, Horwitz-Willis N. The Next Infodemic: Abortion Misinformation. J Med Internet Res. 2023 May 4;25:e42582. DOI: 10.2196/42582. PMID: 37140975.
Pauly M. Inside the secret working group that helped push anti-trans laws across the country [Internet]. Mother Jones. [cited 2023 May 12]. Available from: https://www.motherjones.com/politics/2023/03/anti-trans-transgender-health-care-ban-legislation-bill-minors-children-lgbtq/.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Catherine Lockmiller
This work is licensed under a Creative Commons Attribution 4.0 International License.
