American Thought Leaders - How DEI and Gender Ideology in Medicine Is Harming Patients: Dr. Stanley Goldfarb

Episode Date: January 1, 2025

More than 5,000 minors in the United States underwent transgender surgeries between 2019 and 2023 and nearly 14,000 had transgender-related treatments, according to research into insurance billing codes conducted by the advocacy organization Do No Harm. In total, these treatments and procedures cost at least $119 million.Dr. Stanley Goldfarb is a board-certified kidney specialist and the board chairman of Do No Harm, which recently released a national database on transgender-related services at medical facilities across America.The “gender-affirming” treatment model is based on flimsy evidence and has, in many cases, robbed children of normal lives, he says.Dr. Goldfarb says social justice ideology and diversity, equity, and inclusion standards have taken over medical education, to the detriment of patients. Students are no longer taught to think critically and to properly evaluate medical research and statistics for weaknesses and flaws, he says.Views expressed in this video are opinions of the host and the guest and do not necessarily reflect the views of The Epoch Times.

I thought we had an innovative curriculum, but a new vice dean for medical education came in and she said, your curriculum is way out of date and we need to be teaching the students to understand community issues. They need to understand social justice issues. And I became very concerned because to me, the purpose of the medical school was to teach them to take care of sick people. It wasn't to cure the community. That's an important job. It's just not the job of the practicing physician. Dr. Stanley Goldfarb is the board chairman of Do No Harm, which has been fighting to remove DEI ideology in health care and stop the use of the gender-affirming care treatment method for minors. It's a procedure that's being done without evidence that it's

beneficial. It really is an experimental procedure. He is a board-certified kidney specialist and professor emeritus and former associate dean of curriculum at the University of Pennsylvania School of Medicine. Physicians are not being taught to be contrarian about these things. It's just not taught in medical school. This is American Thought Leaders, and I'm Jan Jekielek. Dr. Stan Goldfarb, such a pleasure to have you on American Thought Leaders. Jan, it's great to be with you today.

We're interviewing at an interesting time. There's going to be a new Trump administration. This probably has a significant impact on federal policy when it comes to the issues that do no harm covers. So why don't we just dive into that? What jumps to your mind immediately here? Well, it does suddenly raise the opportunity to have national policy. Up until this time, we've very much focused on states

that have a Republican governor, a Republican legislature, because those were the only places that we could sort of get our policies enacted. And that's been one of our approaches is to use the legislative tools that are at our disposal in order to make change. And, you know, our main issue has been two themes. One is DEI in health care, and it's really corrosive characteristics. And the other has been to combat gender-affirming care in children only. Adults are adults.

They can do what they like. But children should not be exposed to these treatments. And we've been successful having passed laws in part in 26 states now that have prevented children from getting some levels of these therapies applied to them, as well as some issues with DEI. But it's been a state-by-state, difficult, slow process. Suddenly there's the opportunity to have some national impact.

And I think President Trump has made statements about, particularly about gender care, saying that this should not be done on a national basis and that there ought to be laws that prevent children from being treated this way. And children should have the opportunity to go through puberty and they should not have their puberty interrupted. So I think that the biggest opportunity that we see right off the bat is to have some sort of national program that prevents this gender affirming care from being instituted in children. And I think we're trying to determine how we can best go about doing that. But it's going to take some congressional cooperation here,

and it's going to be a tough fight. But I think it's really important to save children from something that's been often mutilating and certainly has robbed many children of having normal lives. Whether they be gay or not gay is sort of irrelevant. The question is can they live their lives without being under lifelong medications or even surgical procedures that are really quite mutilating. Let's dig into that for those that might be uninitiated in this.

We're talking about gender-framing care. That's an approach to medical care. Just very briefly kind of frame what your understanding of this is and why it's such an issue. Well, this all began in Europe in the 1980s. And the notion was, since there were transgender adults that felt like part of their difficulties in life was that they didn't look like the gender that they were interested in really pursuing. That if children who were going to be transgender individuals would have this opportunity to have changes made while they're going through puberty, before they go through puberty, that they would look much more like the sex that they were interested in being.

So the impulse was to do something that was beneficial for people that seemed to be struggling with their identities in this way. And it was realized that there were medications that were available at that time that would prevent children from going through puberty and at the same time sex altering hormones such as estrogen or testosterone depending on the sex could be applied so that the end of puberty the children would look much more like the gender that they supposedly wanted to be in that would make their lives better and this was begun in the Netherlands they initially did studies to suggest that when children went through this, it was typically children that were otherwise seemed to be pretty high functioning in terms of their psychological profiles.

They weren't depressed, supposedly. They were relatively high functioning individuals who had always, through their childhood years, felt like they needed to be in a different body and so these children were put on these medications and supposedly they did well with this new approach. This led a number of European countries to begin this process and this was going on around Europe and then a physician from the United States saw this and brought it to Boston Children's Hospital and it became something that was pursued in the United States saw this and brought it to Boston Children's Hospital and it became something that was that was pursued in the United States and that was I think in around 2008 and after that this exploded and it exploded

in the United States for a couple of reasons one was there were a bunch of physicians who rapidly adopted this approach. And the second thing was social media. So these children started to communicate. There were peer groups that developed. And then there was a great movement by certain activists to sort of push this idea that children would benefit from this, that children knew what gender they needed to be in, that children would benefit from this, that children knew what gender they needed to be in, that children were born in the wrong body, and that this whole process took off.

It took off to the point where there are now today over 100 gender clinics in the United States that are treating these children in this fashion. Now the problem here was twofold. One is the notion that children know what they should be doing when they're going through their childhood, adolescence. Anyone who has children, who knows children, when they're going through early puberty, it's a time of great discomfort for many children and a time of really personal unrest, if you will.

So the idea that children could give informed consent on an issue like this seemed really sort of unlikely. I mean, it's a confusing time, I remember, basically. Very confusing. The other problem was that these physicians, there were some transgender individuals who became very, very active in pushing this idea and trying to convert children down this path. The problem was that nobody really did the research to show what the real consequences

of this treatment would be, whether it would be beneficial, whether these children that had this idea that they could change their genders, change their sexual characteristics, that this would make them happy. And it became sort of something that was an example of medicine that was looking for the evidence to support it, and yet these experimental approaches were being pursued in young children. And then people started to ask the question, you know, is this really beneficial? Is this helping or hurting children?

And research started to come out. And the first thing that the research showed was this initial experience that was in Netherlands where these children seemed to benefit could not be reproduced. The other thing that was found was that many of the children that were started down these paths in Europe and then in the United States had a lot of psychological problems to begin with. It was a very high rate of autism, there was a high rate of depression, many of these children have been abused. So suddenly the picture became not of children that had some biological basis for feeling that they were in the wrong gender, the wrong sex,

but rather very vulnerable children that were struggling with psychological problems. And this change, this medical change, was held out to be a cure for their psychological problems when there really wasn't evidence that, in fact, that would be the case. And since that time, studies have just not supported that this treatment really helps children. And we do know that it changes children. And we know that in some cases it really hurts children, particularly children that have had surgical procedures. They've had their genitals altered. They've had new genitals created. It's really an attempt to use plastic surgery to change someone's external appearance,

as if that really changes their basic biological characteristics. It's turned out that the European countries, where all these ideas began, have now looked after they have a 20 or so year experience and have done evaluations and have found, you know, we've made a big mistake here. We should not have been pushing this on children. It isn't clear that we've benefited children. And in fact, many of them have shown quite clearly that children are harmed by this. Finland, the head of the psychiatric program for these children in Finland came out very strongly as one of the early individuals who was an expert in this area treated hundreds and hundreds of

these children said you know it turns out we've harmed these children. The notion that led to so much of this support in the United States was an idea that if these children were not allowed to go through these procedures that they would commit suicide. That's turned out not to be the case. It's turned out that there's no higher rate of suicide in these children than any other groups of children who have such severe psychological problems but don't feel like gender dysphoria, which is the medical name for this condition, was part of their problem. They were depressed, what have you. These groups of children have what's called gender dysphoria, where they have this really unhappiness with the gender that they find themselves in. But their suicide rate is no different than any other troubled

child. So to treat them with these approaches has not been shown to be beneficial. And in fact, a large study that's underway in the United States was recently published in the New England Journal. It started out with 300 children in this study. It was done in California as well as in a few other centers around the country. They reported on about 150 of these children, and they had two suicides in the group that were getting this gender affirmation. So it clearly doesn't prevent

suicides to put children through this. And the last part of the story is that now there's been a cohort of individuals, children who have gone through this process and realized they made a terrible mistake. They're called detransitioners. They're children who have decided they want to go back and live their lives as they were originally intended as God's children to live their lives either as men or as women. And yet now they're left with the residue of the treatments that they got. In case of children that had surgical procedures, there are young women who have lost their breasts, their breasts were removed.

There are men who have lost their genitalia. And they're left with all of the residue that is associated with having taken these hormones and taken these puberty blockers, which prevented them from going through puberty. And there are complications associated with these medications as well. I think there are now five European countries that have said, we're not going to expose children to these treatments, except under very specific research protocols. It's not going to be something that's automatically allowed on children. They're not going to be affirmed if they come in and say that they want to have such treatments.

In the United States, we're still fighting this battle because there is no central authority. So many of these clinics are continuing to process children through these pathways. And our organization very recently released a database called Stop the Harm database. And we were able to have this database because whenever a procedure is done on a child or on an adult, there's a billing code that's generated. And these billing codes are sent into the insurance companies or sent into Medicare or other payers in health care. And databases containing all these codes are available. They're used by insurance companies for actuarial processes and so on.

So it's become a business too in the United States, unfortunately, as well as a medical problem. And again, the medical side, the difficulty there is that it's a procedure that's being done without evidence that it's beneficial. It really is an experimental procedure. And we know from other studies in the past that when these children who have expressed these desires to change their young boys to wear dresses, for example, if they're allowed to go through puberty, the vast majority of them, over 85 to 90 percent of them, will then go on to live a normal life. They may be gay

individuals, whatever, but they haven't had to be exposed to all these medications, surgical procedures, and they generally come to grips with the life that they really were intended to have if they're allowed to go through puberty. So this issue of stopping puberty and changing children at that point prevents a normal part of development and produces some of the psychological problems that we're now starting to see in these detransitioners. And we think the number may be as high as 30 to 50 percent of children who start down this path determine that they're not going to take the medications at some point, determine that the surgeries were a mistake.

And that's a terrible tragedy that this cohort of children now exists. You mentioned the lack of centralization as one of the reasons why there's some certain places where these things are being performed. You mentioned a financial motive potentially as well. At the same time, there are all these studies that are done out there. Presumably, people would be reading this literature. I guess I just want to kind of expand a little more on why this would continue given, as I understand, quite a bit of literature now, including the whole CAST review in the UK, for example, that really says this gender-affirming care approach is destructive, really, or not helpful at best, right? Let me describe one study that's sort of repeated over and over again because it's one of the few examples of a study in which they actually did a control group.

A lot of the literature, the vast majority of it is they take a group of kids, they see what they were like before they start the transition, and they transition them and they measure some aspect of their psychological situation after. But unless you have a control group, you really don't know whether any change that you might see represents getting better, getting worse, or staying the same because you have to have something to compare it to. So there is one study in which there was a control group. This was a study done at the University of Washington.

Really it's about the only one. They took two groups of children. There were about something on the order of 30 to 50 children in each group. One group got gender affirming care, medications, and one group didn't. It wasn't clear why groups did or didn't, but both groups of children came with the same desire when they first appeared at the clinic. There was absolutely no change in their psychological parameters. The ones who were depressed were still depressed. The group that didn't get

the care, didn't get the medications, at the end was much worse. And this was felt to indicate that the treatment was beneficial because the children didn't deteriorate. Here was the problem though. In the group, the control group, 85% of the subjects dropped out before the end of the study. So what was being compared was a residue

of a few children that remained in the study, whereas the vast majority of the children that left the study, we have no idea. They may have gotten better, that's why they left the study. Whereas the children that actually got the treatment had absolutely no change. So it wasn't a therapy that benefited the children

that got the therapy, but compared to this group, which had this enormously high dropout rate, they seemed to do better. I think anybody who has basic scientific principles in hand would say, well, you can't really make that statement. You can't say the children that didn't change were 79% better when they weren't better. And comparing it to a group in which you had such a high dropout rate, the study becomes uninterpretable. This study has been held up as the proof that psychological well-being is generated by going through gender affirming care.

And the practitioners of the field look at these data and I think have convinced themselves, almost in cult-like fashion, that this particular study, again done at the University of Washington, was a study that proves the benefit of their treatment. And they quote this study. But when they quote this study, they don't describe the study. They simply quote the conclusions of the study, which were not valid conclusions. You could not conclude from that study that children should go through this treatment. The only conclusion was we had an incomplete study because we lost so many of the control

group. So that's an example of the kind of literature that's out there. And that's the kind of literature that Dr. Cass in England looked at and said, this is a treatment pathway that really has no proof that it is benefiting human beings. And that's why we shouldn't be doing it anymore. And that's why she has determined that puberty blockers are banned in England. The hormone therapies are only given to a very small, select group of people in research studies. That's the only way they can receive these treatments. So, you know, this database that, first of all, absolutely fascinating and frankly really disturbing to hear this. What has been the impact of having that information available? We've seen two things. One is the Catholic Church has become involved in this because there were several Catholic hospitals that were performing these procedures.

And one of the bishops, as written in the Catholic literature now, there's a journal about Catholic ethics, and, you know, saying that this was terrible, that the Catholic Church should not be doing this, this is against Church teaching. And so it's created, I think, a great deal of discomfort amongst Catholic hospitals, the bishops. There was a sense by some of them that this was something that should not have been discussed, that they were very upset that this came out.

I think the Catholic Church has had a history of suppressing some bad information in the past, so that may be a manifestation of it. In terms of the other hospitals, what we really tend to see is that people in the field tend to not engage when information like this comes out. And the other thing we know is that other physicians who are not involved in this gender-affirming care kind of put their heads in the sand over this. They don't want to hear about it. And the Supreme Court case is Scermetti versus the United States. Department of Justice, I think, has sued the state of Tennessee because Tennessee has a law preventing gender-affirming care being administered to children under the age of 18.

The government, the administration, the Biden-Harris administration has been four square behind gender-affirming care in children. And they're attempting to overturn this law based on the fact that there's some sort of sex discrimination going on here. And we'll see, you know, what the Supreme Court thinks about this. So I think between waiting for the results of that and also attempting to ignore any sort of press or information that counters the idea that gender affirming care should be provided to any child that that is vaguely interested in this, even to the

point where very recently Boston Children's Hospital said that their treatment protocol would be two hours of psychological counseling before a child was allowed to enter into their protocols for gender-affirming care. Two hours to have a child go through a change that will be a lifelong impact on their ability to have sexual pleasure, on their ability to have children, on their ability to have intact bodies. So this seems on the surface to be absurd, but that's what's going on in the United States. And I think they're hoping that the Supreme Court will throw out this law and that this whole process will continue, because the people that support it, I think, have really closed their minds to the possibility

that this is a great mistake. And it's sort of understandable, because if it is a terrible mistake, they have been involved in something that's hurt a lot of children. It's a very painful thing for people to contemplate. There's no question that many of them think they're doing the right thing. But I always say it's almost like the famous movie, The Bridge on the River Kwai, where Alec Guinness, at the end of the movie, looks and realizes that he's done this horrendous thing in building this bridge that's allowed the Japanese to move their troops in Burma.

And he stands and looks at the camera and he says, what have I done? And I think that's what's going to happen to these people. Someday they're going to say, what have I done? When the whole realization of what the impact of this has been. But they're very rigid in their support of this idea. And they refuse to back off. How much of it is based on monetary issues and on financial issues? I don't know. And I hate to ascribe the worst impulses to people in this. I think they

think they're helping children. The problem is when you look at the literature carefully, as Cass did in England, as the head of program in Finland, as Norway has done, as Denmark has done, they realize we're hurting children. We're not helping children. And we've got to stop doing this. You're a nephrologist, and you, of course, have a, you know, a lot of knowledge in this area. How is it that you kind of fell into this? Yes, this all started, Do No Harm, the organization that I helped found back in April of 2022. This all started in my role as the associate dean for curriculum in Penn's medical school. I had a career as an academic physician.

I had done research and I spent the last 13 years of my career there as running the medical school curriculum and meeting with the students and developing courses and making sure that they were learning what they should be learning. I thought we had a pretty good medical school. It was highly ranked, number two in the country, behind Johns Hopkins or Harvard. Everybody, there was sort of musical chairs about which was the top few medical schools in the country. I thought we had an innovative curriculum, but a new vice dean for medical education came in, the one who I had worked with for many years, retired from her post, and a new one came in,

and she said, your curriculum is way out of date and we need to be teaching the students to understand community issues, they need to understand social justice issues, they need to have a very, very different orientation than you have. There's too much science in the curriculum. She actually made that statement to me. At that point I became very concerned because to me, you know, the purpose of the medical school was to teach them to take care of sick people. It wasn't to cure the community. That is an important job. It's just not the job of the practicing physician. It's public health workers

jobs and politicians jobs. Physicians need to really focus on caring for people, preventing illness but also treating illness when they find it. I was kind of the heterodox person in the group. I was eventually forced out. And then one day I saw that an article in The Wall Street Journal that there was 40 medical schools had courses in climate change. And I became more aware that these social issues were being presented in medical schools around the country through her forcing me to interact with other medical schools around the country.

And I wrote a letter to the editor of the Wall Street Journal, and the editor said, I don't know about this article, but I pointed out there was such an article. And he said, why don't you write an op-ed about it, because you're an insider, really, and you know what's going on there. And I wrote this op-ed. It was called, by the Wall Street Journal, Take Two Aspirins and Call Me By My Pronouns. Now the article had nothing to do with gender issues at that point. It had to do with the fact that I thought the medical school curriculum had not become rigorous enough and that there was too much time spent on these social issues to the

harm of learning about surgical issues, medical issues, and so on. There was a huge uproar over this. Medical Twitter, there's something called Med Twitter, it went crazy and it said that, you know, I didn't know what I was talking about and these social issues were what drove healthcare. The school then denounced me

and then the Wall Street Journal wrote an op-ed, wrote an editorial about my op-ed saying I guess he was right because the outpouring of criticism suggested that I really had hit a nerve. So at that point, you know, then I went on to write a book about this because I was really annoyed about all this. But the same title, yeah, I didn't like the first title. I didn't, it wasn't my title. It had nothing to do with gender at that point. But the Wall Street Journal gets to write the title to the op-eds and that's what they used. And I think actually the title was so provocative that it was part of the reason there was such a response to it. But then the question was what can we do about

these issues and should I just sit back and I had the opportunity through some friends and some philanthropists that were interested in some of these issues to start an organization, Do No Harm, that would sort of fight back against some of this and point out how the curriculum in medical school had deteriorated and point out how identity politics were starting to produce real harm in health care. We can talk about some examples of that. I must say many of our donors said to me, what about this gender stuff?

Why are children being put through this? And I frankly, like many physicians, I wasn't really that aware of what was going on. So that led us to look into the issue. And it became quite clear that there was a great harmony between the issues about DEI and identity politics in health care. This was another example of identity politics.

These children were put into this category of trans kids. Whether or not they had individual characteristics that suggested that their treatment ought to be very different than getting put on puberty blockers or sex-changing hormones, but they were put in this group. And it became quite clear that there needed to be sort of this legislative effort that we talked about earlier in this way, because there was just no way to control the whole process unless there were laws that were going to stop it. I'm very much against governmental laws intervening in health care and the way health care is practiced, but sometimes you have to step up when you find that there really are

problems and the problems are not being dealt with by the medical community but they're being there they're just going on and on and we have unfortunately over the years many examples of the medical community adopting procedures and practices that turn out to be terrible the great example of this is lobotomies for children that had psychological problems. A man won the Nobel Prize in medicine for lobotomies and it turned out to be a catastrophe.

And there are many other examples like this. Marty McCary, who's a well-known physician at Johns Hopkins, just written a book where he goes through many examples. He called it, the book is called Blind Spot, about how physicians have a blind spot about many issues. And he goes through many examples of medical conditions that have been really handled very poorly by the medical establishment and need to be treated

and have been treated very differently. Do No Harm started, and we've had this tripartite approach to things. One has been the legislative one we talked about. We've tried to inform the public. I've been in interviews like this with some leading organizations. And finally, we've instituted a bunch of lawsuits,

typically in the area of identity politics where organizations, medical schools, and even companies have programs that excluded white and Asian students from participating, for example, in the description of the program. These are frankly illegal. They go against civil rights laws. They go against the 14th Amendment. And so we've instituted lawsuits, and we have 11 lawsuits now and three others pending. And I can describe some of the details of those.

And we've sent about 150 letters to the Office of Civil Rights because of programs in various medical schools. If you send letters to the Office of Civil Rights, they will do, in the Department of Education, they will do investigations even if you don't have standing. The lawsuits that we filed, our members, we have, it's a membership organization, we have 15,000 members. And our members, if they would want to apply to such a program and are excluded, it conveys to us to be able to support them and sue on their behalf organizations that have been engaged in practices. We've sued Pfizer, had an employment program that excluded whites and Asians from a very rich program of mentoring and employment and supporting further education.

And again, in the program description, whites and Asians should not apply. You know, Marty McCary, I'll just tell our viewers that a fairly recent guest on the show about this amazing book, Blind Spots. So I'll encourage people to watch after they watch this interview. Also on the point of the Nobel Prize winning researcher who created the lobotomy, as I understood, and this is another guest I had on the show, I can't remember who right now, but explained to me that subsequent to everything happening, the researcher who invented the lobot body went out and actually looked to try to see the impacts of his work. And in many cases, you know, a lot of harm had been done to the people, but he was unable to recognize it in people. I guess this is a common known story in medical schools. I don't know, I hadn't heard it, but to the point of people maybe not being able to say,

what have I done in this type of a context. Yes, unfortunately, groupthink is a very powerful kind of phenomenon where it's very hard to go against the tide of opinion. And in medicine, there aren't that many things that we really know based on hard science. There's an awful lot of opinion that's present as the way people should be treated. And it often takes some sort of pivotal study to make the change. And pivotal studies are hard to do, they're expensive to do, and there needs to be sponsors that are willing

to take them on. So unfortunately, and I think one of the problems in medical education that I'm particularly concerned about is that physicians are not being taught to be contrarian about these things. You know, we've just come through a pandemic where recommendations were made. Take for example, masks. You know, we have multiple studies now that show that masks simply do not work in the COVID pandemic. And the literature is quite clear on this, yet we still have recommendations being

made about masks. Because while it makes sense, the mask recovery, but it doesn't work. And so it doesn't matter what makes sense. What unfortunately, in medical education now, I think there's a real deficit of training young physicians to think critically this way. I think they need to learn much more about psychology, how people develop these false ideas and refuse to confront reality. And they don't learn enough about the scientific method. They don't learn enough about how you evaluate statistics. They don't learn enough about how you evaluate statistics. They don't learn

enough about how to evaluate a medical study. What are the weaknesses in the study? In a particular question, what's the best experimental design? It's just not taught in medical school. And yet physicians need to be able to do that. And that was, again, my concern about the way the medical school curriculum was being designed, because it focused on getting students out in the community so they could deal with some of the social problems in the community. Their time needed to be spent on learning how to evaluate the medical literature.

And that's not an easy thing to do. And the students, in fact, are not that interested. They want to go and I keep saying they want to play doctor. They want to go out and act like physicians when, in in fact they need to sit in the classroom and learn things that are maybe even boring but crucial if they're going to be a successful cohort of health care workers as physicians in the United States. And I think that's part of the lesson of McCary's book is that physicians need to know when the literature comes out and a new idea appears, to look at it critically, to be open-minded and not

closed-minded about it, and to think critically about these issues. One particular, actually in your field of study in nephrology, looking at kidney function, how kidney function is assessed, that you've kind of been championing, I guess, a return to the traditional way of doing it. Maybe if you could flesh out this example of how these types of DEI policies could go awry, potentially. When George Floyd was killed, there was this revolt in American society. It really was. It's the only way to think about it. It was a revolutionary effect.

And medicine was not despaired from all this. One of the things that came about was that there were a bunch of physician activists that decided that racism was embedded in American medicine. Really no evidence for it, just an idea, a theory that racism defines American life. And despite the absence of evidence, that doesn't mean that it wasn't the case as far as they were concerned. And they identified the fact that there were certain medical algorithms that had a race basis to them and one important one was in kidney disease. So in kidney disease one of the important things we need to assess is

how well the kidneys are functioning. It's a very difficult issue to study and over the years there was a factor in the blood called creatinine which is a breakdown product of muscle that's only excreted via the kidney. So when the level of this substance rises in the blood, that's an indicator that there's kidney damage. I've used the analogy of a reservoir. If the water flows into the reservoir and flows out at the same rate, the level of the

reservoir stays the same. Let's say there's a problem with water egressing through the dam that's allowed the reservoir to be created. The levels in the reservoir will rise. However, if the inflow to the reservoir is reduced at the same time as the level as the excretion pathway from the reservoir is reduced, the levels might stay the same. So if you really want to know about the function of the reservoir and the dam, you need to know both input and output. Well, with kidney function, this measurement that we use, creatinine, its input comes from muscle and its output is through the kidneys. If someone has

very small body mass, very little amount of muscle, their creatinine level might be quite low, even if their excretion of creatinine through the kidney is impaired. And conversely, someone might have a very high production of creatinine because they have a lot of muscle, and their level may be high, even if the outflow is perfectly fine because so much is being produced, so much water is entering the reservoir, that if the outflow is fine, there's nothing wrong with the outflow. The problem is there's a lot of input to the reservoir.

Well because of the fact that you could have a basketball player who's 6'7'' and is very muscular and a little old lady who weighs 80 pounds and has very small muscle mass and we use creatinine to measure in both cases. Let's say the normal value is 1. One in the basketball player might be 0.1 in the little old lady because her production of creatinine is so low. And in order to compensate for the fact that people have such different muscle masses and of different sizes.

A formula was created where the kidney function was actually measured using a radioactive isotope and then their serum creatinine was taken and a whole bunch of numbers were multiplied by the serum creatinine to come out with a number that equaled the actual measured kidney function with the radioactive isotope. And when this was done, it turned out that over and over again, in many hundreds of patients, black individuals had a higher level of serum creatinine for a given level of outflow than white individuals.

They both could have the same level of actual kidney function. The black people had a bigger input of creatinine into their blood. So because of that, it turns out that you had to multiply the value that you got in this formula for kidney function by 20% higher number in order to get an accurate value in black individuals compared to white individuals. Two hundred and fifty million times a year in the United States, the serum creatinine value is measured because it's a very common parameter.

And in order to make sure that we know how it reflects kidney function, this formula is applied. And the laboratory would report the value as two separate numbers. One number was a white person, and one number was a black person. And the black value for that same level of creatinine in blood would be 20% higher than the white patient. This was

determined empirically. This was not somebody trying to be racist. This was somebody trying to play games with the values. This was the data. Right after George Floyd was killed, some activist physicians, and they typically were young black physicians, decided that this was something that had to be rejected. That this was race-based and there is no biological basis for race. It's all socially determined and there's no reason we should have two different sets of values for whites versus blacks. Except the problem was that was determined empirically.

It wasn't somebody's ideology that produced the two values. It was an empirical observation. And they pushed to get rid of this formula and to come up with a new formula that would not have, would not be different, that whites and blacks would be measured by the same formula. The only trouble was to do that you had to create a formula that gave you a result that was really wrong. The new formula overestimated kidney function in white people and underestimated kidney function in black people. Now, why did they pick that formula?

They could have picked hundreds of different formulas. They picked that formula because if your kidney function is felt to be below a certain level, that qualifies you to get referral to a kidney specialist. And if the kidney function is too low, it qualifies you to be put on a waiting list for a kidney transplant, if that's the approach that you're willing to take. So they decided to change this whole system by having this one formula. And because they overestimated kidney function in white people, white people were denied access to referral for kidney care or access

to go on the kidney transplant list, whereas black people were sent to referrals to the nephrologist, the kidney specialist, and were placed on the transplant wait list even though they did not need it for their level of kidney function and did not deserve it, if you will, for their level of kidney function and did not deserve it, if you will, for their level of kidney function. To get put on the kidney transplant list is a very highly desired result. And often, it's a two to three year wait before a kidney is available. So as soon as you get on the kidney transplant list, the sooner you get on it, the more likely you're going to be able to get a kidney transplant. But you shouldn't go on the list unless you have kidney function that's declined to a certain level. That's been a sort of a governmental rule. Because of the ideology about this, the proper correct two formulas were thrown out by labs and the labs

started reporting one formula. The governmental agency that determines who gets to be on kidney transplant wait lists and kidneys get a portion, they decided that you had to use this single formula that now overestimated the number of black patients that needed kidney treatment and underestimated the number of white patients. Because there are so many more white people in Blackpool in the country, it turns out that four million white people are denied access to kidney referrals, based on the criteria that are there for kidney referrals, so that 180,000 black people get referred for kidney referrals too soon. The transplant wait list has changed dramatically because this formula was applied retroactively,

and black people that shouldn't have been put on the transplant waitlist let's say a year or two before were now put back into the queue as if they had kidney declines at this earlier point in time and something like 4,000 black kidney transplants were done and that had displaced 4,000 white people from the kidney transplant wait list, and those people had to wait longer. The longer you wait for a kidney transplant, the greater likelihood that you're going to die. So it turns out that people died.

And they died because these two formulas were thrown out for the sake of one formula, and the one formula that's used is inaccurate. But yet it solves a political problem, which was to have a race-based algorithm for determining kidney function. One of our coworkers, Dr. Paul Williams, who was an epidemiologist and scientist at the Lawrence Livermore Lab, one of the famous governmental labs, was part of the Manhattan Project, for example. He's sort of devoted himself,

he's now retired from that position, and he's devoted himself to uncovering this issue and putting the quantitative aspects on it that I've just mentioned. We've even produced a CME course on Do No Harm's website that anybody could take. Anybody could listen to Dr. Williams go through all of the data that I've just described and counter all of the data that I've just described and counter all of the arguments that have been raised about why this was a valid thing to do and shown that the arguments were totally invalid that argued against his position and that his position is that we have hurt patients in the name of some sort of poorly thought

out misguided issue of trying to create health equity, so-called health equity, when in fact what's been created is inequity through this kind of process. So I'm very, as you can tell, I'm quite animated about this because it's in my field. People in my field know this, but no one's willing to speak up because the professional societies have deemed this, this is the way we should do things. And professional societies have deemed that the children should get gender-affirming care. The American Academy of Pediatrics and the Endocrine Society have all supported that idea, even though the literature doesn't support it. And now the American Society of Nephrology and the National Kidney Foundation have supported this idea of this single algorithm for determining kidney function,

even though they know that the data has actually harmed people and that the data are wrong. Do you expect to see any change in this? I'm an optimist. I think we're going to, our organization has the resources to make this point. I'm in the process of sending this CME course to every medical organization in the country to ask them to examine this. I have friends that were part of the American Society of Nephrology, one of whom is going to be president. I'm going to send it to him and challenge him to face reality, face the data here. This is an example of individuals not willing to face reality, face the data here. This is an example of individuals not willing to

face reality and it's really quite disturbing. We've tried to explain this to the public. It's obviously a highly technical complex issue. It doesn't lend itself to a two-minute discussion, but people in the field know that this is reality and hopefully we'll start to teach medical students about this and ultimately it'll be reversed because it's just wrong. It's a terrible mistake that this is reality. And hopefully we'll start to teach medical students about this, and ultimately it'll be reversed, because it's just wrong. It's a terrible mistake, and it's harmful. So I understand that Do You Know Harm actually has a number of reports that are going to be coming out in the not-too-distant future, like new developments, new research. If you could kind

of let me know what you're working on. Again, going back to this issue of the medical societies, you know, the way medicine in the United States is practiced, yes, you go to medical school and you learn, you go through a residency program, but then the professional education that goes on really derives from professional societies like the American Academy of Pediatrics, like the American College of Physicians. They provide continuing medical education and all. And so they really are influential in each of the fields in which they have, you know, their specific subject material. What we've done recently is to do a study to look at how

often they've strayed into social issues and political issues. How much of their efforts are devoted in their ways, and there's a report coming out to show that this is very, very extensive. They've adopted the diversity, equity, and inclusion issue. They've pushed very hard for their idea of how social determinants of health influence health, again, despite no real evidence and no real data to understand how living in a neighborhood that's violent, for example, leads to particular medical problems. No one understands what the link is there,

how one could even begin to understand that and deconstruct it. And so we're gonna be able to report to the public how these organizations are so invested in all of these social issues to the point where it detracts from their main purpose, which ought to be to improve the health of the American people. The American Society of Nephrology should spend all of its efforts, all of its time, all of its money on improving kidney health in the United States

and not on arguing for treating one group of people differently than another group of people as they've done with these formulas for understanding kidney function. So we're going to be presenting that report. Another important report that we have written about in the past, I think it's been the main argument against undermining the meritocratic basis for admission to medical school. And this is, I think, a really important issue for the public. There are two applicants for every spot in medical school in the United States. And of course, everyone's aware of the fact that it's very hard to get an appointment with a physician. We really have a deficit of physicians in this country.

The reason for that is complicated, and we rely to a great extent on foreign-trained doctors in the United States as well. But to get into medical school is really quite difficult. And unfortunately, the idea has been that we should take a certain number of minority individuals, particularly black students, into medical school because of the idea, the theory, that black patients need black doctors to have optimum health outcomes. We've issued a report on this in the past. In fact, there's a huge medical literature on this. There are over 60 studies of this question. Most of the studies

involve how well do patients communicate with their physicians. They may do studies like record patient interviews with their doctors and then assess them afterwards. And the interesting thing is that there have been systematic reviews of the studies that have been done. There are five systematic reviews of this question. Is there a benefit to concordance between patients

and physicians based on race? And the answer is no. Four of the studies absolutely find no benefit whatsoever. One study does find a benefit, but it excludes a lot of the studies that found no benefit. So it was an incomplete study itself. One example of this is the question of, do black patients communicate better with black physicians than with white physicians. In one particular study, there were eight examples where black patients communicated better with black doctors. There were 12 examples where black patients communicated worse with black doctors. And there were 80 examples in the various studies to show that it made no difference.

And this is what you find over and over again. There just is no evidence that this is true. And when you sort of think about it, why should it be true? What you really want is the best doctor. And the patients want the best doctor. They don't want somebody that looks like themselves. And there are studies that have shown this. When black patients are given the opportunity

to pick a doctor based on just a photograph, which one would you like? They don't pick the black doctor over the white doctor. There's no difference between their choices. are given the opportunity to pick a doctor based on just a photograph, which one would you like? They don't pick the black doctor over the white doctor. There's no difference between their choices. And when studies have been done where there are real surveys done of black patients asking them this question, do you want the best doctor, do you want a doctor that looks like you? They always opt in over 80% of the time for the best doctor.

And yet this has become the rationale for schools like the University of Toronto. 75% of the students in the medical school were going to be based on identity politics and weren't going to be based on merit. Insane. And in the United States, the achievement test for medical school has been changed. Many schools forego the achievement test for medical school if they are recruiting students from historically black colleges and universities. There are some brilliant black doctors. That's fine. I couldn't care if the entire medical school class were black doctors, as long as they were the most qualified people. And that's what my organization has been asking

for. So we'll be putting out a report into a peer-reviewed journal on this issue to be able to go back to the public and say, and to these medical societies that claim this, they make this claim that they support diversity because health outcomes are going to be improved, and they don't have any data to support that notion at all. A lot to digest from our discussion. Any final thoughts as we finish? No, I'd just like to say that we want individuals, whether they be healthcare workers or concerned people, doesn't matter what their political persuasion is. We have many Democrats, we have Republicans, we have about half of our 15,000 membership are healthcare workers. We're interested in people joining us. There's no cost to joining our organization, do-no-harm-medicine.org. And again, the purpose of

joining is to be able to tell the rest of the world about some of the issues that I've talked about. And also, if people have experienced discriminatory practices in their institutions, particularly healthcare workers, we can help with that. And we have helped with that. And it can be the basis for us moving forward with legislative or legal actions to try to eliminate discrimination. So I really would encourage every interested person

to join us. They also will be fighting against the so-called gender affirming care in children by supporting us that way. Well, Dr. Stan Goldfarb, it's such a pleasure to have had you on. Dr. Thank you so much. I really enjoyed it. Thank you all for joining Dr. Stan Goldfarb and me on this episode of American Thought Leaders. I'm your host, Jan Jekielek.