In the weeks since Jake Tapper and Alex Thompson’s “Original Sin” came out, there has been so much speculation about Joe Biden’s cognitive health that feels so pointlessly retrospective to me, or conveniently certain — even though I wouldn’t say I disagree fundamentally with what seems to have emerged as the consensus view.

Writing in POLITICO, James Kirchick took the Beltway reporters to task for what he argued was their (our) failure to investigate and cover the “truth” about the president’s mental acuity, as if the truth were a simple binary (is he okay?) and as if the answer was as evident at the time as it now appears with the benefit of hindsight.

“Lack of access is no excuse,” he wrote. I happen to disagree: Not only is that an excuse but it’s also a perfectly serviceable explanation.

We can report only what we know, and we can know only what we can observe with our own eyes and ears. If you happened to catch a White House press briefing in 2023 or 2024, there’s a pretty good chance you heard difficult questions about Biden’s health. When we don’t have much time with the president, we rely on the testimony of those in his inner circle who did.

And at this point I become agnostic on the question of whether there was a coverup by those closest to him or an effort to obfuscate the truth. Because even now the reality looks murky to me, and I was fortunate enough to spend more time with Biden than many of my colleagues near the end of his tenure in the White House.

As many of our readers will know, in September 2024 I had the great privilege of interviewing the president one on one across the Resolute Desk in the Oval Office.

Biden was as attentive and engaged as anyone I’ve spoken with. When I reflect on the experience, I remember how blue his eyes looked and how electrifying it felt to have his gaze and focus fixed on me.

Part of that is charm and charisma, but I also think he took very seriously the opportunity to talk about his legacy of helping to advance the equality of queer people in America. He wanted to be there. He spoke clearly and from the heart.

The president came with a binder of talking points prepared by the press secretary and the communications director, but he barely glanced at the notes and needed assistance from his top aides only very briefly — on two moments when he stumbled over the name of the Heritage Foundation’s Project 2025 (specifically the “2025” part) and Karine Jean-Pierre spoke up to help him.

On the one hand, Project 2025 was a critical part of the messaging strategy of his and then his vice president’s 2024 campaign, and our conversation came at the tail end of the election cycle last year. On the other hand, considering the totality of my experience talking with Biden, looking back it doesn’t seem like those lapses were that big of a deal.

I guess what I am ultimately trying to say is this: I think we should extend some grace to the former president and those closest to him, and we should also have some humility because a lot of these questions about Biden’s cognitive health are unclear, unsettled, and even to some extent unknowable.

And another thing. I am grateful for the opportunity to interview him, for his years of public service, and for his unwavering defense of my community and commitment to making our lives better, safer, richer, healthier, happier. I pray for his recovery such that these words might come to describe not only his legacy in public life, but also his years beyond it. 

Christopher Kane is the Blade’s White House correspondent. Reach him at [email protected].

Pride month feels different this year. There is a simmering fear beneath all the glitter. Of course, Pride has always been a festivity interwoven with a certain amount of unease. Our rainbow parades were forged from protest marches, demonstrations that erupted from a community under the searing fire of violence and humiliation. Accordingly, our rhinestone costumes and glimmering disco balls have always held an element of precarity, though that edge may have felt less present recently. Nevertheless, Pride is a holiday in active conversation with our communities’ place in society. At once, it is a moment of radical celebration while also an act of resolute defiance. 

However, Pride month feels different this year because that conversation has shifted. The discourse around our communities carries a renewed threat of violence: systemic, political, and physical. In just six months since the inauguration, the Trump administration has worked swiftly to strip protections from LGBTQ+ communities, erase our histories, and demonize us in the public imagination. The vitriol that Trump and his lackeys have spewed against the trans community specifically is completely baseless and profoundly dangerous. Although our communities have long weathered such abuse, the return of such bigoted ideology at the highest levels of power is alarming, to say the least. 

One of the key ways Trump has attacked LGBTQ+ communities is by targeting our access to healthcare. While healthcare is essential for anyone, for LGBTQ+ people, it can mean life or death. Our medical needs are unique and complex, often compounded by intersecting identities of race, ethnicity, gender, and sexual orientation. Denying us affirming, equitable care is not just negligent, it’s dangerous. By enacting barriers to gender affirming care, slashing tens of millions of dollars in grants for LGBTQ+ medical research, and stripping away essential protections, the current federal administration is carrying out a calculated assault with catastrophic consequences.

As a queer, nonbinary person and practicing psychiatrist, I have an intimate, visceral understanding of these issues. Even before Trump ever set foot in the Oval Office, the medical disparities affecting my LGBTQ+ friends, colleagues, and patients were obvious to me. As a young medical student in Indiana, I quickly became aware of the substantial gaps in access to healthcare for LGBTQ+ communities. At a base level, there is already significant distrust between LGBTQ+ patients and their providers, stemming from a long history of mistreatment and, in many cases, outright gaslighting, abuse, and trauma. This distrust can prevent patients from seeking care, and even when they do, providers often lack the training to deliver the affirming care they need. 

This lack of equitable and affirming healthcare led me to found OutCare Health. OutCare started with a carefully curated list of medical professionals with the knowledge, training, and experience to provide LGBTQ+ people with the care they desperately need and deserve. That list has since blossomed to more than 6,000 providers and has become a vital resource for LGBTQ+ communities, their families, and allies. Over the last decade, our grassroots efforts have grown into a national force, and our programming has expanded to include health equity training, care navigation, and public education. That early momentum gave me hope that we were making headway in the fight to ensure that LGBTQ+ communities have access to the care they deserve. 

However, with the return of Trump to the White House, it feels like everything has changed. We endured his first administration, bolstered by what felt like a nationwide resistance to his presidency, but this time, something is different. Instead of resistance, the air feels thick with despair, lulling the country into a doleful acceptance of our fate. Moreover, there is a pervasive sense of fear. Some providers have asked to have their names removed from our OutList of affirming providers, not out of a desire to stop helping our community, but out of a legitimate fear of retribution, professional retaliation, and even their own safety. This is a request I completely understand. There is nothing wrong with protecting yourself, your livelihood, and your family, but the need to do so speaks volumes about the political climate in which we find ourselves. 

What has been truly demoralizing has been the behavior of the healthcare field at large. The willingness to grovel to the unscientific, harmful, and ignorant policies of the Trump administration is not just disappointing, it’s disgraceful. Even more disturbing is the speed and enthusiasm with which some health systems and organizations have preemptively distanced themselves from LGBTQ+ equity work, as if racing to prove their compliance with regressive ideology. Many of our past partners have vanished, most without a last goodbye. To those outside our communities, this quiet retreat from providing life-saving care to those of us who are being vilified may seem unfortunate yet pragmatic. But let me be clear: if you abandon your values in moments of inconvenience, you never really held them in the first place. 

Nevertheless, I do not believe we can resign ourselves to walking despondently into the future being laid out for us. Although we are seeing an attempt to systematically dismantle many of the structures that we have put in place to help ensure health equity for LGBTQ+ communities, it is worth remembering that it was we who built those structures. Fifty or even 25 years ago, we had so much less than we do now, even after these attacks. Today, we have life-saving medications and therapies that we used to only dream of. We have networks and coalitions with deep knowledge and formidable strength. They may force us to take a step backward, but they cannot and will not make us turn around. 

Most importantly, we have each other, and we have the wisdom of those who came before to guide us. From the Stonewall Riots to seizing control of the FDA, the LGBTQ+ community has shown a staunch resilience and strength of spirit that has always been one of our greatest assets. Although we are a broad and diverse banner and may not always agree, we must remember that our sense of community and our ability to organize are what have gotten us where we are today. We must stand shoulder to shoulder, hand in hand. The echoes of our footsteps drumming the streets can cause even the most unyielding enemy to cower. These are lessons we cannot afford to forget. Our survival depends on it. 

So yes, Pride month does feel different this year. There is indeed a simmering fear beneath the glitter, but deeper than that fear, more enduring and infinitely stronger, there is grit—grit forged in fire and defiance. We are vibrant, colorful, and unapologetically queer, but do not mistake our joy for weakness. We’re loud, we’re resilient, and we’re holding the damn line. 

In this spirit, let me make one thing abundantly clear: OutCare Health is not going anywhere. When I founded this organization 10 years ago, I knew it wouldn’t be easy, but I didn’t do it because it would be easy. I did it because it was necessary. Because it was right. Because it was my life. Your life. Our lives. We will not back down, and we will not be erased. We will continue to uplift our communities and fight for truth, equity, and democracy—no matter what the bigots throw at us. 

To my OutCare family and all LGBTQ+ families, know that we are here for you, and we will not stop. To our allies, now is the time to show up—loudly, proudly, and relentlessly. To those who fear our freedom, despise our joy, and resent our very existence: our glitter may catch your eye, but don’t underestimate the strength burning beneath it. We will not break. We will not be silent. We’re not going anywhere. 

Happy Pride!

Dustin Nowaskie, MD is founder and chief medical officer of OutCare Health.

Tomoya Asanuma, a prominent transgender activist in Tokyo, faced the triple abuses of Japan’s “hostage justice” system, hostile detention conditions, and mistreatment trans people face in the absence of meaningful legal protections. 

For Asanuma, March 14, 2024, was supposed to be another Thursday at work. At around 7 a.m., he woke up to the sound of someone repeatedly ringing his doorbell. Through the intercom, Asanuma saw three men wearing dark-colored clothes, this time pounding his front door. When he opened the door, the men identified themselves as police officers and showed him an arrest warrant.

This was the beginning of what Asanuma recently described to Human Rights Watch as being “difficult to put into words.” After Japanese police arrested him for sexual assault for allegedly hugging an acquaintance from behind, the authorities held him for months at a pre-trial detention center. 

During this time, they mocked his transgender identity during interrogation, denied him access to medical services such as dental care, and initially denied hormone treatment until he obtained a recommendation from a doctor.

While some authorities showed a level of consideration for Asanuma, including letting him shower away from other detained men, the abusive treatment he faced led him to attempt suicide twice.

Trans people in Japan are in legal limbo. Historically, they have faced outright discrimination — including a law compelling them to be surgically sterilized for legal gender recognition — and barriers to accessing education, employment, and health care. A landmark Supreme Court decision in 2023 declared the sterilization requirement unconstitutional, but reform has stalled in parliament — leaving trans people’s basic rights in limbo.

The courts finally granted bail to Asanuma in July 2024 and found him not guilty in January 2025. But in a country with a 99.8 percent conviction rate for indicted cases, Asanuma had to live through acute fear as authorities forcibly tried to obtain a confession from him during interrogations without the presence of his lawyer.

His fears are grounded in a justice system with a well-earned reputation for abuse and arbitrariness. His experience is part of systemic treatment in Japan called “hostage justice,” under which criminal suspects are detained for prolonged periods, sometimes months or years, unless they confess to the charges. This denies them the rights to due process and a fair trial. 

The authorities ultimately dropped the sexual assault allegations, but charged Asanuma with assault, which is punishable by up to two years in prison or up to a 300,000 yen fine ($2,000.) Prosecutors sought a 200,000 yen fine. Despite this, because he pleaded not guilty, a court rejected his request for bail four times and detained him for more than 100 days in pre-trial detention, punishing him disproportionately since the prosecutors did not even seek imprisonment for his alleged crime.

In Japan’s hostage justice system, authorities frequently subject suspects to harsh interrogations to coerce confessions from them during pre-indictment detention. Defense lawyers are not permitted to be present, and the questioning does not stop even when a suspect invokes their constitutional right to remain silent. Indeed, Asanuma invoked his right to remain silent, but authorities interrogated him for hours on 13 occasions. 

The case of Iwao Hakamata highlights the dangers of this practice. Hakamata, a former professional boxer, was arrested on Aug. 18, 1966, for murdering a family of four. Following harsh interrogations by the police and prosecutors, he confessed nearly a month later. Based on this coerced confession, Hakamata was indicted and subsequently convicted and sentenced to death. He maintained his innocence and was eventually acquitted — 58 years after his arrest — on Sept. 26, 2024, following a retrial.

To prevent further abuses and wrongful convictions spurred by the “hostage justice” system, the Japanese government should not as a general rule deny bail to suspects in pretrial detention, and should end interrogations without legal counsel that often involve coerced confessions through manipulation and intimidation.

The Japanese government should also improve the conditions under which suspects are being held, including by ensuring adequate access to all medical services, and revising the Notice Regarding Treatment Guidelines for Detainees with Gender Identity Disorder by specifying that hormone replacement therapy and other gender-affirming medical interventions are medically necessary and should be made available to all imprisoned people who want them.

“My case is just the tip of the iceberg, as there are others who are detained much longer,” Asanuma said. “I think this experience gave me a good reason to speak up even more for the rights of suspects going forward,” he added.

Teppei Kasai is a program officer for Japan at Human Rights Watch.