The Present Illness

Forced Gene Testing and Surgery

• Alyssa Burgart & Arghavan Salles • Season 1 • Episode 27

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IOC resumes harmful sex gene testing; forced c-sections with zoom court rooms; The Lancet profiles our host!; A woman goes to the moon; Alyssa recommends bioethics books

The Lancet profiles Arghavan!

Sally Ride, 100 tampons (song)

IOC sex testing

Forced C-sections

Book recommendations

💊Take Two and Call Me in the Morning💊

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Credits

  • Production by Arghavan Salles & Alyssa Burgart
  • Editing by Alyssa Burgart
  • Theme Music by Joseph Uphoff
  • Social Media by Arghavan Salles

Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that's pretty febrile and definitely underdiagnosed. I'm Arghavan Sallas, a surgeon scientist and your friendly neighborhood doom scroller in residence. And I'm Alyssa Burgart an anesthesiologist and bioethicist who tracks news and health law like they're EKGs full of spikes and surprises. The present illness is where we dig into public health, politics, culture, and ethics with a scalpel in one hand and a meme in the other. Big thanks to everyone listening and extra love as always to our subscribers and those who follow us. A special warm thank you, or sorry, a special warm welcome to anyone who just stumbled in from the Artemis launch. Yeah, we're going to the moon again, I guess. Yeah, I had no idea this was coming. I'll just be honest. uh I just saw it all over my feed yesterday and I was like, oh, going to the moon. That seems cool. But I honestly like was surprised that people are very excited. Artemis is the first woman to go to the moon. So it only took 57 years. Yeah, you know better late than never. So who's the astronaut that's going to the moon? thank you for asking. Her name is Christina Koch. There are four astronauts as part of this mission, Reed Wiseman, Victor Glover, and Jeremy Hansen. And so they're doing um a path that is basically going around the Earth and then, um kind of getting slingshotted to the moon and then around the moon and then back to the earth. It's supposed to take roughly 10 days. here's the thing, there are some physicians who are astronauts, but I'm a little bit like low key scared every time a plane takes off. So it's really not the right fit for me, especially now when we don't have a functioning transportation safety board. we've seen enough things go wrong with these space flights that I would feel like I would have to be ready to never come back in order to get on one of these space flights. um And that gives me a lot of anxiety, that idea. So kudos to them for doing it. And I believe that this is being done. as a precursor to another mission to go land on the Yeah. you the other thing I was just thinking about it looks like it was 2019 there was finally an acknowledgement that it was harder for women to be astronauts because they didn't have any suits that could fit that could fit women astronaut sizes. And so this space launch I just looked up apparently is the was the impetus and they developed an adjustable space suit for this Artemis generation of launches. That's awesome. Well, if you remember, there was also that discussion, when was this, years ago, of a woman who was going, an astronaut who was going to space and they were trying to figure out how many tampons they should send up with her. Yeah, was like some absurd, for one cycle. Did you see the comedian who she had a song all about the astronauts? We're gonna find that for all of you listening at home because it's a hilarious song because this is how little some men know about women's basic bodily functions. well, folks, listen, we are so glad that you are here. We know that none of you are out in space today, so we're happy to have you listening. As a note to new listeners, we often talk about topics that can be intense, that can be a little difficult to listen to. If you've got little ones in the car, this is probably not the show for them. uh But really quick, before we get into this week's episode, I did want to highlight a little something about my co-host here, Arghavan. She's sort of a big deal, as many of you already know. And uh The Lancet, which is one of the most prestigious medical journals in the world, did a special interview with you. They had this lovely uh article about you, and it is called Argumon Salus, Seeing the Value of Diversity, Equity, and Inclusion. So I will make sure to put a link to that in the show notes, because I was so proud to see you in that. Aww, thank you so much. I appreciate that. Thank you for the shout out. so my understanding, and correct me if I'm wrong, is that you and I are going to talk about the Olympics. Yes, let's do talk about the Olympics. um Folks may know that there was an announcement several days ago that the IOC, the International Olympics Committee, has, it's been reported in a number of different ways. Like people have said that they have banned trans women from competing. What they've really done is announce a change in eligibility, basically, um where they want to go back in time, um because we're gonna make sports great again, I guess. Anyway, we're gonna go back in time to a policy they had in place in the 1990s, which was that every woman athlete, no men in the history of competitive sports, no one has tried to test men in this way, but that every woman who wants to compete will need to submit themselves to an SRY gene test. um can you tell people what the SRY test is? it's the sex determining region on the Y chromosome, S-R-Y, and it is, as it sounds, it's a region on the Y chromosome, it's a gene on the Y chromosome that lets you know, basically, according to the guy who discovered it, I think he's got it right, he goes, it just tells you whether that gene is there or not. It doesn't really tell you anything else. But the um sports world has, in the last several years, leaned more into misogyny and transphobia and they've decided that this is a way to make sure that we're going to, in their words, protect women's sports. It's important to recognize this is in the context of a long history of policing women's sports. In 1936, the International Amateur Athletic Federation, which was the precursor to the uh World Athletics, which is the current federation that rules over. everything that has to do with track and field sports. So there's all these different federations for different sports that kind of feed into the Olympics. Anyway, so that precursor of world athletics had a policy, again in 1936, that they could pull aside any woman athlete that they thought looked suspicious in any kind of way. And they could decide that she needed to prove that she's a woman by getting naked for them. So we're talking about, you know, almost a hundred years ago that this all started and actually the first time that I saw anyway and someone can let me know if they know something predating this but in 1928 was when women were first allowed to compete in track and field at the Olympics specifically and that is the first time that I'm aware of that people had these questions about whether a woman was womanly enough, whether she was female enough, feminine enough to be competing as a woman and then in 1930s and it's important to recognize that women were not allowed to compete at all before this because they were like, well, women are too weak. You know, they're going to hurt themselves. How would they possibly have babies? to 1928, women were allowed to compete in kind of more feminine considered sports, like they were allowed to swim and they were allowed to play tennis, but they weren't allowed to compete in track and field. And there was apparently, according to someone who was part of this podcast, which I really recommend called Tested, that was a collaboration between NPR and CDC, uh she had reported that, At that time, people thought you could become a man by doing manly things. So like if you competed in track and field, you would be more of a man and you could like slide toward being a man. This was apparently the idea. Anyway, so we're talking something that dates back many, many, many years. In 1966 and 1967, around that time, they started doing what they called nude parades of women where they required all women athletes competing in international games to um undress, to prove that they were a woman. um out of even attempting to perform in sports, because that's what it feels like. Right, so this is not only then, but also now, I think that's very front of mind for anyone who cares about women's sports, because what do you think is going to happen now if someone is not sure whether they may have an SRY gene, they look like a woman, they feel like a woman, they were assigned female at birth, and then they may have the, well, there's about, we don't really know the incidence, but it's about one to 2 % of women, which is, A lot of women, if you tested everybody, would have some differences of sexual development and many don't know until, let's say, they try to have a baby and that's when they find out that they have these differences of sexual development. intersex people have always existed, just like trans people have always existed. You know, this idea that sex is a binary characteristic has never once ever in the history of biology for any species been true. Absolutely. um And so I think at the origin of these kind of rules, was um the idea was not specifically to target trans people. I don't think there was such a movement around that at that time, but it was more to police women and make sure that you're womanly enough. In fact, they had to get a femininity certification. So what happened um in 1968 was they stopped the nude parades, which were also called"Peek and Poke." terrible. Yeah, terrible. God, no, we gotta pause for that, I'm sorry, what? Yeah, so one of the women um in the Tested podcast talks about how they were taken to a room underneath the stands and forced to pull down. I gotta pause you again. I gotta pause you again and I'm sorry, I'm sorry, but this podcast, not only do we obviously talk about lots of things that have to do with medicine and the ways that it impacts society. these peek and poke things, I just looked them up, it was they had to parade in front of a panel of doctors to prove that they were physiologically womanly. And so again, one of the many, many ways that medicine aggressively upholds misogyny, white supremacy, et cetera, et cetera. Absolutely. So in 1967, they discovered bar bodies. So the folks involved in international sports say, great, we can use this now. We don't have to do nude parades anymore. We can just have everybody tested for bar bodies. So from 1968 on, they started testing people for bar bodies. So there's a woman um in the podcast, and her name is Debbie Brill. She was a high jumper. and she talks about what that process was like and they literally gave women a female card. You know how they talk about like, don't play the female card. It was a card that apparently looked very much like a driver's license, but it was called a certificate of femininity. And they had to have that with them at every event they went to. And this is through 1999, mind you. This isn't just a thing that happened in 1960. So they have the bar bodies. Then the next thing is in 1990, the SRY gene that we're just talking about, the sex determinants on the Y chromosome is discovered. And then they're like, oh, this is great. We can start using this. So they use it for the 1992 Olympics and the 1996 Olympics. Now this is against the advice of one of the men who was involved in discovering. this, which is his name is Andrew Sinclair based in Australia, I believe. And he has talked about multiple times why this is inappropriate. And in fact, it was lobbying for the SRY gene, which was a practice that was ended in 1999. Now, a couple of things about the SRY gene and why it's inappropriate. One that we've talked about is that it will pick up a diagnosis of differences in sexual development in people who may not have known that they had that. Correct. And so you're forcing something onto people that can be very traumatizing. The harm definitely outweighs the benefit, whatever minimal benefit is seen to be there. It's also a test that's very sensitive to contamination. So in lower resource settings, one of the things that Andrew Sinclair talks about is that if it's a man who's handling the sample, then it could turn positive just because it was a man handling the sample. we don't have any problems with an over-representation of men in laboratories, so what could possibly go wrong? exactly. So it could be all these false positives. Importantly, as we mentioned, the presence of the SRY gene says nothing about sexual development and uh levels of hormones or the gender of anybody. It just tells you literally that this gene is present. It doesn't tell you the function of the gene and the receptivity of that body to hormones. So for example, there are people who have complete androgen insensitivity syndrome. And so they... their body does not respond to testosterone at all. And they will look like a woman and feel like a woman, feel they're a woman. And then you'll take this test and then they'll be like, you're a man, which is absurd. Cause they'll look like you or me or any other woman on the street. And they are women. It's not just that they look like, I mean, they are women. And then this test will tell them that they're a man. So. Well, so I want to take a moment here because this is very important and ties to this, which is that there's a really wonderful book that Dorothy Roberts published in 2011 called Fatal Invention, How Science, Politics, and Big Business Recreate Race in the 21st Century. And this is a prime example of how genetic conditions, genetic material are being used to impose racism. And so when you look at the percentage of women who are basically kicked or not allowed to participate in their Olympic sport despite qualifying, it disproportionately affects women who are from the global South and women who have darker skin tones. And so this is also a way that white supremacy is further upheld in the Olympics. Yes, and in addition, it is more likely if you're coming, if you're an athlete who grew up in a low resource setting, it's less likely that you would have been tested for this. It's more likely that it's people, women of color who will discover, unfortunately, this genetic difference when they're trying to just enter an athletic complex. it's just the trauma of finding it out in this way that I think is so harmful And so to make that point, in 1996 in the Olympics, they did use this SRY test and there were eight women athletes who were flagged. Seven of them had differences of sexual development uh involving androgen insensitivity. And one of them had five-alpha-steroid dehydrogenase deficiency and also had had their gonads removed previously. So it was a huge waste of time and money and traumatizing for everyone involved for nothing. they did not identify a single person who should have been excluded from the event. So that's part of and alongside uh evidence and science of coming from the scientific community, that's part of why they stopped using that test. Again, in 1999, it is now 2026 and the same body, the IOC has now decided that we should go back to using something that was already very costly and harmful and not effective. It's also worth noting, so back to this point of um the fact, and we can't deny it, that they're using this as a way to exclude trans women. There has been one trans woman who's competed in the Olympics ever, and it was in 2021 in Tokyo, and um it was a weightlifter who did not get a medal. And this is part of the transphobia that's driving this or the underlying assumption is that trans women have a physical advantage over other women because they have a Y chromosome and there's all sorts of assumptions that are made about testosterone levels and that connects back, I wanna tell you a story about this too, connects back to the SRY gene as well. People making lots of assumptions and inferences about what testosterone levels mean for performance that are not based in science and are not. backed by evidence. And there's so many examples, the swimmer who competed against Riley Gaines, right, when they tied. That swimmer, my understanding is their performance was much better, their athletic performance was much better prior to their transition. And that's an example of what is more typical, right? Because of the hormonal changes and then the body changes in response to that, which is not just testosterone. It's like, you know, the body is complex where human bodies are very complex organisms. um So that underlying assumption that trans women have some sort of unfair advantage is false to begin with. And even if it were true, even if it were true, the whole basis, you might say, of athletic competition is unfair advantages, right? That's how you get superstars. Well, and you have like Michael Phelps, an extraordinarily wide wingspan, which gives him an advantage that you could say, you could say it's an unfair advantage. Well, he shouldn't be allowed to swim. because it's not fair to everybody else, right? Or there's a guy who... the next version of the Olympics can just be that like, did you ever watch that movie Idiocracy? Okay, some parts of it have not held up and other parts of it remain very prescient. But it's all about like the most average man on earth is cryogenically frozen and then he gets forgotten and then the world moves on. And eventually, you know, he ends up being the smartest person because everyone's gotten so dumb. I mean, if you imagine like, if we use that example, right, we said, well, you know, if your arms are too long, that's gonna make you more likely to be an effective swimmer, so we shouldn't let you participate. So really what we're gonna say is we're gonna say, well, if your body proportions do not fit within the most average bell curve, then you shouldn't be able to compete. And what drives me bananas also is it's like, folks, This whole like sex essentialism thing is so dumb because it's like, listen, there are gonna be, there's overlap. There's a lot of overlap. There's more overlap between men and women and their abilities and like intersex people. like, it's just like, stop acting like these are dichotomous and as though there is no overlap. It's ridiculous. Yeah, no, it's definitely a spectrum. And there's a guy who I just learned about reading about this, Iro Montyrantha, who was a cross-country skiier, who had much higher oxygen carrying capacity because of a genetic mutation to his erythropoietin receptors, which meant like he could, had much higher exercise, naturally doped. And so that's another person who like, if you're gonna go down this, line, then you shouldn't let people like that compete. And where does that end? I mean, it's nonsense. But the reason I'm saying it that way is to highlight how absurd it is to say, trans women will have a physical advantage. That's the whole basis of sports. Like not everyone can play in the NBA. There's a reason that like, in general, taller people are playing professional basketball because the basketball hoop is at a specific height, right? Like it's you telling me that I don't have a right to be a professional basketball player? I am into things, you don't have that right, and nor do I, as much as I love basketball, but. this but this is the other thing and to your point about, you know, the swimmer who who's swimming actually was not as fast as when before they had transitioned. And the argument that that many people will make about the Olympics is that is that being trans simply having access to gender affirming hormones is the same is equivocal to doping, to using different, you know, these other medications that increase your oxygen carrying capacity. or taking uh certain types of hormones specifically in order to bulk up, for example, which is common in certain sports. And it's a ridiculous, unscientific belief. Yes, absolutely. it's also uh solving a problem that doesn't exist. mean, yeah. I wanna add. I want to share just a couple more stories here. One is that in 2024, folks may recall, a man named Stephen Vandevelde was allowed to compete in volleyball. He was convicted of raping a 12-year-old in, I believe, So sexual abusers are allowed to compete in the Olympics. Correct. Pedophiles. Thank you. Pedophiles are allowed to compete in the Olympics, but a woman with an SRY gene now cannot. I should acknowledge that the Olympics, the IOC has said that if somebody had an SRY gene and they thought they had a difference of sexual development, that they could ask for additional testing. They could ask to go through more trauma in order to be able to compete, which is not a solution. I understand why they think it is, but it is not a solution to a very terrible policy that you've created in the first place. There's also a lot of weird stuff that starts to happen when you try to, as you said, basically binarize something that isn't binary. So Castor Semenya is a runner who is from South Africa and won two Olympic gold medals in 2012 and 2016 and three world titles all in the 800 meter. has a difference in sexual development such that her testosterone level is higher than average for women. know, there's a range. Humanity is a range. For every single thing you want to measure, there's a range. But she has not been allowed to compete in the 800 meters since June, sorry, 2019 when they made rules about testosterone levels that anyone with a higher testosterone level needed to take medications to bring their testosterone level down. She has very publicly and proudly refused to do so. She says, I am a woman. I am a natural variation on the spectrum of what it is to be a woman. I will not alter m my woman body to meet some arbitrary, yeah, exactly, arbitrary standard. this is the other thing, right? Is that so many of these things, we're gonna, I mean, you look at Trump's executive order, know, we need to protect biological women, please. None of this is about protecting women. This is about protecting the ability to control women. It is about protecting the domination of men over any person of any other gender and any other sex. Castor Semenya's this case was a major turning point in these discussions around not only intersex women in sports, but trans women in sports. And this was part of the original sort of launching of what we've gotten to today. where we have all of these cases that are about preventing access to medical care, preventing access to gender-affirming care for children, preventing access to gender-affirming care for adults is the absolute next step. And Castor Semenya's case was one of the first to really launch this into a international dialogue, which continues to be incredibly dysfunctional and incredibly harmful. Yes, and in, I believe it was 2023, the European Court of Human Rights ruled that Castor Semenya had been discriminated against. And yet, because they don't have whatever jurisdiction or authority, it doesn't actually change anything. I mean, it's still an important ruling, and I'm glad that they made that ruling, but it has not allowed her to participate. And initially, in 2019, they had decided that any distance between 400 meters and a mile, Someone with elevated testosterone could not compete in, but they've since expanded it to no distances in which someone could be eligible to compete. Again, despite this finding in that court in 2023, it's also worth noting that the World Athletics Foundation or Federation, I'm sorry, I don't remember which it is, thank you. The World Athletics Federation last year already made the same decision that the IOC has announced this week to adopt the use of the SRY gene as a test. And folks may recall in the 2024 Olympics, there was a lot of really nasty stuff said about Imani Khalif, who is a boxer, a woman boxer from Africa. I think she's, Algerian. And she won. And she won her match. She won gold and People have really clung on to harassing her as though it's going to fix anything for anyone. And by people, mean, including JK Rowling. And also I've seen articles this past week talking about this IOC decision that included her picture. Now she is also a woman. Born a woman, assigned female at birth, raised a woman. At the time of the Olympics, it was unclear what kind of testing she had been forced to undergo. It's now known widely that she has an SRY gene. And so what, right? She is still a woman. She competed as a woman. She should continue to compete as a woman, but people have harassed her. I can't even imagine how hard it's been to be her and have people debating whether you're a human almost, right? again, It's not like humans are full of variations. We're full of variations that have nothing to do with sex. uh There's all sorts, you know, there's variations in like, you know, what blood vessels you have going through your liver. There's variation, you know, there's so many things about human beings that can just be a little bit different. And it doesn't Like, stop making a big deal out of it. Yeah, it's just natural. That's how we are. And that's part of the beauty of humanity. Anyway, so there's a runner, another runner named em Christina, they call her Mamba, but I think her last name is spelled M-B-O-M-A. And she is in a similar category where she was, she's phenomenally talented. And um people, as soon as she had success, started asking, well, is she really a woman enough? Does she deserve a female card? And she has taken a different approach from Caster in that she has actually tried to change her hormone levels. um And basically trying to play the game that's been laid out in front of her so that she can continue competing. um And I would really encourage folks to listen to the test of podcasts where they talk to her about how and her doctor about how very difficult it is Even if you're trying to comply to get your testosterone level artificially down to whatever number somebody somewhere in an office decided was like Low enough testosterone for you to count as a woman Because there's no protocol for this because it's a fucking stupid thing to do And so the doctor talks about like, we don't really know we're trying, you know, like, we're trying this, we're trying that. And it's actually agonizing as you listen to them talk about how much she's going through just to be able to run, just to be able to compete and represent her country, Namibia, she's from Namibia. I remember when I listened to that podcast came out in 2024, when I listened to that, was... just so harrowing to listen to them even trying to do the thing. So they're being asked to do something that is nearly impossible to do. And it's worth noting again, back to this point about testosterone, it's not true that more testosterone equals better performance. Like that's not a correlation that actually exists and it's not a causative relationship that anyone can prove. um And if you think about it like a more kind of extreme case thing about women's gymnastics. Mm-hmm. the amount of flexibility that's required for women is very different from what's required in men's gymnastics. So you could imagine that, you know, if a man, quote unquote man, tried to compete in women's gymnastics, they have a hard time with certain aspects of it. You know, would they maybe have an easier time getting up on the uneven bars? Maybe, but would they be able to do, you know, like it's just. it also depends on so many things. It's so silly. And for folks who really want to get in the weeds on testosterone, there's a wonderful book called Testosterone, An Unauthorized Biography from uh my former colleague Katrina Kisarkas and Rebecca Jordan Young. And it's all about testosterone. It's all about what does the science actually say about it versus What are all of the assumptions and myths and stereotypes about testosterone? um And so I highly recommend, I got a lot of book recommendations honestly for this episode. There's gonna be a lot. Well, we appreciate that. Anyway, so that's the bottom line for where we are now is that the IOC has said they're going to require this SRY testing. um It's really ultimately up to the federations to decide what exactly they're going to implement. But World Athletics has already implemented that. um Why in the world we're going backward to something that we already knew didn't work. I genuinely don't understand. Like, I understand transphobia and I understand those campaigns and I understand that J.K. Rowling is spending a lot of money on this. She sucks. I hate her so much. Don't watch this Harry Potter stuff, folks. Don't watch it. She sucks. no reason to support anything that she has anything to do with to be honest because any money that is going to her is going to Transfer white campaigns. I mean that is like how she is spending her time and her energy um it is vile and um Anyway, so there's a lot of people like her who are pushing so I understand that and I don't understand why we're going back to them. We already we already tried it We already tried it. It didn't work. We lived we lived and learned Why do we have to live and learn again? Just because as somebody said on Twitter, there's a new pedo in chief. You know, a lot, because a lot of people do think that it's caving to pressure from the US where transphobia is being made to alert the existence of trans people being made to be the biggest problem that could possibly exist. Meanwhile, people don't have healthcare. People can't afford to commute to work because gas is so expensive. People can't afford healthy food. unemployment rates are not great. We're losing so many opportunities, especially in the federal government with like 95,000 scientists having left the federal government in the last year. Anyway, all I'm saying is there are real problems that we have to address. anniversary of all those layoffs at the NIH. Anyway, we digress. instead of doing anything about any of that, we have a president who, last night, we're recording on Thursday, April 2nd, we a president who last night said, we can't afford daycare and Medicare and Medicaid. We have to pay for war. We actually don't, guys. We actually don't have to pay for war. Do know what we could do? We could just not do war. And instead, we could do public health. We could do feed people. We could do be kind. We could do basic human rights. We have a lot of options of things that we could do instead of war. I 100 % agree and I would vote for you. I would, well, yeah, anyway, I'd be a terrible politician because I would just be like, this is dumb. I have the same struggle, but anyway, I hope that's helpful for giving people some context as to like what the IOC is actually trying to do and why it's totally stupid and harmful. Well, thank you so much for that download. And it's just such a great example of how medicine and science are used in the oppression of marginalized people. And it is something that the culture of medicine must continue to dismantle. And we need to stop participating in these activities. I mean, you don't have to convince me. I know. I know. Wish that everyone else in our profession. But it is nice to preach to the choir. It's like, it's kind of fun. It's better than getting things thrown at you, that's for sure, when you preach to the not choir. Anyway, um what would she like to talk about today? Well, just onto another real light topic of also controlling other people's bodies, I thought we would talk about the recent cases in Florida of forced C-sections. I know, I know. It's terrible. So m I want to talk about this in the lead up to this. So I teach the basic ethics classes to all the medical students and all the PA students at our school. And one of the things that I have taught now for many years is right before the students go into their preclinical, right before they go into their first clinical rotations, we do a primer, a reminder of like, are the most important things that I want every student to take with them if they learn nothing else from us is I want them to have a deeper understanding of informed consent and why it's so important and a deeper understanding of like bodily autonomy and why when we violate somebody's autonomy, why it has all of these downstream implications and really trying to pull that together because we know that students get exposed as they're being indoctrinated into medicine, get exposed to some of the more toxic things about medicine, to the hidden curriculum in medicine. And so one of the things that uh I specifically talked to them about is decision-making. do a whole thing on deep dives into informed consent and then we do the second section. specifically on decision making for pregnant people. Because we know that I used to give a lecture called, I used to give a lecture called, it's like regular decision making, but with a uterus. And it was all about cases where pregnant people or people who have the capacity to become pregnant are not granted and do not have access to the same rights of autonomous decision making as other patients. And in particular, patients who do not have a uterus uh or patients who are assumed to not have a uterus, let's say. and all of that's to say that, so I've been giving this lecture for many years and there's a couple of cases, like I always talk about uh the Renat Dre case, which was a case in 2011 of a woman at a Staten Island hospital who had had, I believe two previous C-sections, wanted to have a VBAC, which is a vaginal birth after cesarean delivery. And the hospital had a, policy that allowed them to override her refusal of a cesarean section and they forced her to have a cesarean section. It's horrible case. She tried valiantly to fight it. Unfortunately, it's very difficult to win malpractice cases. uh So ultimately, I believe she ultimately lost that case, but it is a very major example. And it's been, I would say, the last time really in the national news media where there's been a big case that really caught the public attention. And so I always lecture about that case. And so I am giving that lecture again next week. And so I are not next week, the week after. And so I am now having to update all of my slides to talk about the new cases that have come out of Florida. And so there's two cases that both ProPublica, we're fan girls of ProPublica obviously, um and local reports of multiple women in Florida. The two that are most prominent right now in the news uh are Cherise Doyle and Breonna Bennett. Both of them were forced to have c-sections. uh They were subjected to court hearings while they were in active labor. These cases were where the hospital sought emergency orders to force these women to have c-sections after they refused. These women who are in active labor are being forced into these like Zoom court cases, em which is absurd. And there's some videos from those that we can put links to in the show notes. And thankfully, in at least one of these cases, the judge refused. And primarily because one of these women was a uh reproductive justice advocate and knew how to advocate for herself in a way that is just not typical. And so, This is infuriating. It is deeply upsetting. And it is way too common. I think it happens way more commonly than we know about Not all of these cases that make it to the courts make it into the national attention the way that these two cases have. And so I want to uh bring people's attention to the fact that this is a known problem. And it is a branch of something called obstetric violence, where Women's decision making, their ability to decide what is and is not going to happen to their body during uh maternity care is thwarted, is dismissed. Women are treated poorly. There's many, many reports of this. um While there are some people in the OB-GYN community who find the term obstetric violence offensive, I always encourage people to rather than focus on their feelings of offense, that we should focus on systemic changes that actually protect the health and wellbeing of our patients. And so I wanna tell people a little bit, tell our audience about the American College of uh Obstetricians and Gynecologists has all of these opinions that are meant to help guide practice. And so for example, there is an ACOG opinion. It's number 664. I'll put a link to it in the show notes. And it's called Refusal of Medically Recommended Treatment During Pregnancy. And it came out in 2016. And I legit, so in 2016, this is when I first got, I had finished my fellowship. And it was my first year of being the chair of the ethics committee for our hospital, which covers both children and. pregnant people, like things that are impacting folks in labor and delivery. And I remember being like, this new opinion came out. I'm really interested in refusal of treatment and how is it that we can make sure we're taking good care of people and not coercing people. And I remember reading this. I can't remember why. We were out on a hike with our kids. And I had it in my bag because I was like, I'll read it while the kids are eating their snacks or whatever. And I remember reading the opening statement. and my jaw dropping because I was like, finally, someone is saying what needs to be said. And they talk about how like you can have conversations where you support people in making informed decisions, but you cannot coerce people. cannot manipulate people. You cannot use threats of child protective services against people's uh children having access to their children in order to force people to make the decision that you want them to make. They're really open about the fact that like, listen, it is an incredibly morally distressing experience for an obstetrician and the nurses that are working in that area and the people who are trying to make sure that this person has a healthy birth and survives this delivery and survives this pregnancy. that is not your worry, is not an excuse to force someone to have a surgery that they do not Mm-hmm. Now, does that mean that one of the risks is that there may be harm to this fetus? It may be that there will be something bad that will happen. But the reality is that a lot of times it doesn't. They end up being able to deliver. They reach the decision on their own after having a little bit more time to make a decision. And absolutely, there may be cases where things don't work out as well. But us as health care workers forcing people to have surgery as though these patients are incapable of making a decision is infuriating. It's infantilizing and uh it's that paternalistic system of medicine that we've had for ever. uh But I was so shocked when I, and I haven't had a chance, unfortunately, to read the whole article from ProPublica but like they describe, you know, she's in labor and they're like, we're going to put a sheet over your legs so that you can get on this Zoom with this judge. mean, no. had no idea what was going on. She had no lawyer. I mean, anyone who just reading that opening of that article could be like, what? They did what? Like, it's not confusing. Like, it's very clear that this is messed up to do. And it is astounding that they felt they could override this woman's choice for, and not in just this case, obviously, but any woman's choice for what she wants to try. Like, if she understands that there's a risk, as you said, that things will go wrong, but she doesn't. want to have a c-section, who are we as healthcare workers to say no you don't get to decide that for yourself? Well, and C-sections are not the only arena in which this happens also. So for example, another case that I have used for many, many years uh when I'm working, especially with people in labor and delivery, I uh did a series for a year where we did simulations where somebody's refusing a blood transfusion. And so there was a terrible case in Chicago where a woman was a Jehovah's Witness. She did not want to have any blood transfusions. She needed to have some sort of uh I can't recall the details, but I believe she was having some sort of a urologic procedure where the risk of bleeding should have been very low, but there was some unexpected hemorrhaging. And she was very clear, this is getting a transfusion is not in alignment with my belief system. I do not want a blood transfusion. And they forced her to have a blood transfusion. And the hospital actually used a claim that her refusing to get a blood transfusion for herself was abuse and neglect of the unborn fetus who is not a person. It makes me so mad. It makes me so mad. And it's just the hoops, the hoops that people in medicine, in coercion with the law will use to force women to do what they're told. And that is what this is. Do what you're told. I know better than you. Your refusal doesn't count because you're too stupid to make your own decisions. And it is absurd. So I said I was going to do a bunch of book recs for my nerds out there, for my readers. And so there's several books I think are really, really helpful. If you are somebody who, like me, is like, holy moly, we are not good. We are not good to women. And we are not good, in particular, to Black women. We have talked before about this case, about the terrible, abysmal outcomes. of maternal mortality in this country, which are exceptionally worse for Black women in particular. And both of these cases that we're talking about in Florida, it is not a surprise that both of these women are Black. It is not a surprise. And so there's a couple of books I want to talk about. So this is Michelle Goodwin's Policing the Womb. This came out in 2020. Michelle Goodwin is a brilliant legal scholar and bioethicist. And this is all about criminalization around pregnancy. So this has to do with Not only cases like the ones that we're talking about here in terms of forced procedures, but additionally, for example, drug testing, forced drug testing of pregnant patients. for many, women are very highly likely to lose a child, not because the child has experienced any harm, not because there has been anything bad that has happened to that child. It is solely for the fact that the mother has positive drug test while pregnant. uh And you can hear the echoes of this, example, uh from this is from back in the 80s and early 90s that crack babies was really this idea that was saying, well, Black women are bad mothers and that's why these children should be taken away from them because they're being harmed because Black women are doing crack. Now, none of that was true because of course, white people use drugs far more often than Black people. uh And that is well documented in many studies, but If you are a Black person, you are far more likely to be criminalized for that behavior. And this is one of those examples. So Michelle Goodwin, brilliant. If you are not into, if you're not a reader, so many great YouTubes uh out there of lectures that she's given, highly recommend. And you know, I didn't pull it for this, but uh Dorothy Roberts' book, I just was talking about her book, Fatal Invention, but her book, Killing the Black Body, is an incredible also, em exploration that very much touches on on this issue as well as a lot of other forms of racism in relation to medicine. uh Medical bondage. This is medical bondage, race, gender and the origins of American gynecology. This is by Deirdre Cooper Owens. This is a history of Marion Sims and who is who is considered the founder of gynecology uh was incredibly famous. There were many statues of him. He is He was uh credited for opening the first women's hospital. However, what he really, the first, if you want to call it a women's hospital, was a hut in his backyard where he forced women who were enslaved to undergo unanesthetized surgeries uh in order to come up with the kinds of surgeries that he wanted to be able to perfect before offering them to white women. And uh as an anesthesiologist, one of the things to me that makes those stories even more traumatizing is that anesthesia existed. It was totally being used. It was something that he offered his white patients. And yet he did not anesthetize these women who were having these procedures that they definitely weren't consenting to because they were slaves. They didn't have the opportunity to consent and were not treated as human beings. But then he would dope them up with opium after that as a way to control them. He would purposefully get them addicted to opium so that they would then be more controllable. So thankfully, many of the statues of Marion Sims have been torn down. His role as a deep and terrible abuser of Black women in particular has been laid to bear. But the legacy persists. I think it's really important for people to understand that when we talk about forced surgeries, especially the forced surgeries of Black mothers, There is a direct line from Marion Sims to the cases that we're talking about today. And I want everyone to know. um This is one of my favorite books to recommend to medical students who are interested in reproductive justice. It's called Radical Reproductive Justice, Foundations, Theory, Practice, and Critique. I will say this is a more academic book than the other ones that I've just recommended. uh It's edited by Loretta Ross, who is really like the queen of reproductive justice. uh as well as Lynn Roberts, Erica Dirkus, Whitney Peoples, and Pamela Bridgewater-Touré. And the foreword is actually by Dorothy Roberts, so you can tell there's a lot of interest there as well. uh But it's a wonderful way to really more deeply understand feminist theory as it relates to reproductive justice and what we truly must demand. uh And then again, this is something I just recommend to all medical students also, um regardless of whether they want to hear about it or not. person in medicine should read this book, Medical Apartheid, which is by the brilliant Harriet Washington, the dark history of medical experimentation on Black Americans from colonial times to the present. so, for example, when we talk about Marion Sims, that was all terrible medical experimentation on human beings, totally dehumanizing without their consent. And there is a long, rich history that is like Tuskegee. The Tuskegee experiments were but a blip. They weren't even the worst thing. I it was a terrible, terrible thing that happened. Not close to the worst things that have happened. Part of a long history in America of the mistreatment in particular of of Black people. And. uh There is just no way to talk about medical justice without talking about medical racism, without talking about medical ableism and without talking about medical misogyny. And so, you know, intersectionality. I mean, this is just it is so part and parcel to everything that we're that we're talking about today in this episode. em So those are my book recs, folks. I'll put them in the show notes. Listen, my no, my poor my husband's like, I'm to read a novel. And I'm like, I'm going to read about terrible stuff. I was waiting for a medical apartheid. was like she has to get to medical apartheid Medical apartheid right and then of course you got it. Yeah. Yeah. Yeah. Well, thank you. Thank you for that Overview there's certainly plenty to keep us all busy and I do think especially for I don't know if there's any younger medical folks who listen to our podcast but No time like the present to start learning about the harms of our past because they don't usually get taught in medical school the way that they should be. I mean, I wish I had more time to teach in the medical school. I really make it my goal every time I teach to talk about these things because these are not things that were taught to me in medical school. I had to find these things out for myself. Yeah. Well, should we wrap up our super cheery episode just like all of our episodes and talk about what we recommend for folks? two and talk about Yeah, what do you recommend? Okay, uh so one of my kids turned me on to this creator named MiniMinuteman, He talks about history and like, why do we think things we think? like, and he's just kind of funny and he's got a compelling way of telling a story. He did a whole thing about how there was a type of goose that was going to go extinct. And so this like incredibly complicated process that people came up with in order to make these geese not extinct. But more importantly, because their numbers had gotten so small, they no longer could migrate the way that they used to because it's generational. And so once you have one generation that does not make the migration, that knowledge is lost. The geese don't know where to go. And so there is this absolutely bananas thing that happened where they had to like teach these baby ducks, baby geese to like match onto an airplane, like a little airplane. And then they had to basically convince it that the airplane was its mother or its leader or whatever. I don't know how the geese think of it. And then trained these geese to migrate on this historical ancestral pattern that geese used to migrate on all the time. So this plane had to fly like 35 miles an hour and all these geese were following it. And now they know how to do it. And so they just had to do it once, and now they do it. And it's bananas. So I enjoyed that very much. And the other thing that came across my feed is, um so we have California sea lions here, which I think are just, I think they're funny. I like to see them. They're huge. When I've gone scuba diving, when they swim past you, it's kind of scary. uh Because they're really big. Well, do know what's a lot bigger than a California sea lion? A whale? a stellar sea lion. So they're the descendants of bears, which I did not know. And there is this stellar sea lion, they're usually farther north. They're up by Alaska and Washington. And they're not supposed to be down here so much in California. But there's one of them that's wandered down here and like. I can't the the marine biology person that that made this video is like, yeah, I don't think that that guy's harassing these other smaller sea lions. Like he keeps jumping onto their platforms and they all like, like, boom, boom, boom, boom, boom. And they like leave. He's like, she's like, I think that that guy's just trying to make friends like he wants to cuddle and take a nap with them because that's how they like to sleep. So uh anyway, I'll put I'll put videos to both of these in the show notes because they're just, you know, we love an animal situation. What about you, Arghavan What's your take two and call me in the morning? Okay, one that I really, so I hope that people know about the WeRateDogs account. um So I love the WeRateDogs account. They're always highlighting very interesting dogs, usually funny and very sweet. So they did this week the worst dogs. Usually they say the dogs were good again this week and then they have a series of clips of dogs being funny and sweet. And this week they were like, the dogs were bad this week and. um Like naughty, like doing bad things. okay. like a compilation of these dogs doing silly things. This one I had seen before, but it's still funny every time this dog is playing with another dog in looks like a living room, whatever, and is so like worked up that he accidentally with his bum punches a hole in the wall and then he like turns around and he looks at it. I had a friend that did that in high school. It was not great. A human with their human butt. with their butt! There's like a series, I think it's 10 of them. And one of them is this dog, I believe the name was Stevie. And Stevie, I forget exactly what kind of chaos Stevie caused, but there's like a mess on the floor. And the human is like, what did you do? And he's he's squinting his eyes like he can't see it. Like nothing happened. Nothing, I don't know. That was my interpretation. I don't know why the dog was squinting, but I was like, maybe he thought if he doesn't see it, it didn't happen. I don't know, it so cute. who did that. It wasn't Stevie as far as I'm concerned it wasn't Stevie. But anyway, it's lovely and I will put a link. There's more examples. uh It's excellent. Anyway, I think that was their April Fool's uh effort there to do bad dogs. But anyway, I'll put a link to that video in the show notes. And then the other thing that was interesting that happened this week that's kind of launched some internet humor is the heist of KitKat. So about 12 tons of KitKat bars were stolen in Europe this week. I'm sorry, you just said 12 tons. That's a lot of KitKats. Right? Like you could do a lot with 12 tons of KitKats and in fact... So basically there's been a lot of um brands who have taken up this uh KitKat heist, like Denny says, official statement, we would like to make one thing clear. Whatever happened to those KitKats happened between 1.30 a.m. and 4 a.m. and we were very busy. No further questions. And some of them are like, like this is from the city of Montreal as far as I can tell. Official statement, we would like to share our thoughts and our thoughts and condolences with KitKat following their recent sad news. On a completely unrelated note, we're pleased to announce a new KitKat flavored bagel. You know, there's a lot of these. Omnom, which I don't even know what that is, but they have official statement. We can confirm that Omnom had nothing to do with this. Yeah, sure. Sounds convincing. Anyway, there's a lot of them. I don't know if I any good ones. really readily available. TGI Friday is sending our deepest condolences to KitKat during this difficult time on a completely unrelated note. If you're in need of a break, we make a pretty great chocolate espresso martini. um There was one, I didn't take a screenshot of this, should have. There was one where there's like a chocolatey finger, like three or four fingerprints, like it's somebody's palm or just their finger, and then some chocolate at the top. And then it's like, we don't know what, we have nothing to do with the KitKats. It would feel really bad for the KitKat company. uh And then now KitKat has launched a stolen KitKat tracker. So can go on their web site and enter. There's like a, they even show you how to do it. There's like a barcode number on the package and then like you can enter your barcode and see if you have, if you're consuming a stolen KitKat bar. um Anyway. my gosh, please put a link to that in the show notes. Well, I think that's it for this week's episode. um If you didn't like what you heard, this has been the Alex Jones Show. If you liked it, don't forget to subscribe to The Present Illness and leave us a review, maybe a rating, and tell other folks to take a listen as well. We know that you don't listen to the Alex Jones show and that's how you've made it this far. Please follow us on TikTok, Instagram and YouTube. We're at the present illness and stay on top of all of our TPI related news. We will be back next week with more headlines, hot takes, and doom scrolling, hopefully wrapped in some laughs. Until then, agitate, hydrate, and take a nap. We'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Burgart editing by Alyssa Burgart, social media by Arghavan Salles, original music by Joseph Uphoff. Don't take medical advice from random people on a podcast. This shows for informational purposes. It's meant to be fun, and it's certainly not medical advice. Take your medical questions to a qualified professional. You had so many good recommendations for medical. recommendation. I love to read. Yeah, I can tell.

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Alyssa Burgart, MD, MA

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Arghavan Salles, MD, PhD

Host