Misuse of the Johns Hopkins debacle

 

Springfield, VA, USA. Do people born transsexual have the same rights as other residents in Washington State? Faced with burgeoning Medicaid costs, the state imposed fiscal discipline by excluding a handful of residents simply because they are people born transsexual.

 

Washington has prohibited payments for Sex Reassignment Surgery (SRS). Douglas Porter, the Medicaid Director, endorsed the use of discredited research and religious bias when making public policy.

 

He used the infamous Johns Hopkins debacle as the basis for saying that SRS is "unnecessary".

 

Medicaid in Washington State funded a total of six sex reassignment surgeries over the past 15 years. But a recent refusal resulted in court action by two transsexuals seeking payments for their travel out of state to undergo SRS. A state Auditor's report resulted in Republican attempts to pass legislation that included an outright ban on Medicaid funding. The legislative initiative failed.

 

Douglas Porter, the State Medicaid Director, jumped in and declared that SRS is “unnecessary”. Mr. Porter cited the conclusions of Hayes Inc., an independent health technology assessment organization, that claimed sex-change surgery is no more effective than hormone treatment and psychotherapy. Porter and his consultants based their conclusions on discredited Johns Hopkins Research.

 

The Hopkins influence derives from Dr. Paul McHugh, who became chairperson of the psychiatric department at Johns Hopkins in 1979. McHugh is an influential conservative Catholic who has long campaigned to "stop sex changes". He has described women born transsexual as "... caricatures of women". As a consulting psychiatrist to the Vatican in 2000 on sexual matters, he influenced the declaration that transsexualism is a mental pathology and "doesn't exist" as a medical condition. He now serves as a member of the US President's Council for Bioethics.

 

Earlier, McHugh ordered follow-up evaluations on their former transsexual patients. The study found that most of the patients claimed happiness in their target sex. Nonetheless, department investigators concluded that the patients’ psychological functioning had not sufficiently improved. McHugh concluded that physical reassignment cooperated ". . . with a mental illness” rather than trying for a cure [of the “illness”]. Johns Hopkins closed its clinic and has not performed any SRS surgeries since that time.

 

There has been widespread criticism of McHugh's conclusions, noting that the purpose of reassignment is to help transsexual people become happy and content with their bodies. Improvements in psychological functioning are seen as a different issue.

 

The State of Washington has to decide how to spend their Medicaid funds, but should do so in a fair and enlightened manner. The cases of the transsexuals currently seeking SRS should be evaluated on the basis of their initial eligibility for Medicaid in the first place, followed by a careful adherence to contemporary medical protocols in evaluating the strength of their claims for treatment, including surgery.

 

We can only hope that public policy is based on sound principles of governance, science – not religious prejudice, a respect for facts, and an equitable distribution of resources.

 

For Washngton to base an important decision on the discredited Hopkins experience and ignore definitive scientific work is bad enough.

 

But there is another question: do people born transsexual have the same rights as other residents in Washington State?

 

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