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Incoming AMA president: ‘We simply will not stand’ for anti-trans healthcare restrictions

Org will use ‘every avenue available’ to push back

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Incoming American Medical Association Jesse Ehrenfeld at the AMA's Washington, D.C. office. (Washington Blade photo by Michael Key)

Doctor Jesse Ehrenfeld sat down with the Washington Blade on Tuesday, weeks ahead of the start of his tenure as the American Medical Association’s first openly gay president and amid an onslaught of legislative attacks targeting trans Americans’ access to healthcare.

“We see the attack on reproductive care, reproductive access, and transgender healthcare as a continuum of government overreach into patient-physician decision making,” Ehrenfeld said.

“We simply will not stand for the government coming in to interfere with the doctor-patient relationship,” such as by passing these laws that “outlaw what we know to be appropriate, evidence-based clinical guidelines-based care,” he said.

An anesthesiologist who served as the Joseph A. Johnson Jr. Distinguished Leadership Professor of anesthesiology, surgery, biomedical informatics & health policy at Vanderbilt University’s School of Medicine, much of Ehrenfeld’s professional background has been focused on matters of healthcare access, particularly for LGBTQ patients.

Ehrenfeld directs a $560 million philanthropic organization, Advancing a Healthier Wisconsin Endowment, while also serving as a consultant for the World Health Organization’s Digital Health Technical Advisory Group. He was special adviser to former U.S. Surgeon General Jerome Adams, who served during the Trump administration.

For his research on “understanding how can we use technology to work better for LGBTQ people,” in 2018 Ehrenfeld became the inaugural recipient of the NIHā€™s Sexual and Gender Minority Research Investigator Award.

He and his team did much of the work for that project at Vanderbilt’s Program for LGBTQ Health, which he co-founded and led for several years “before I took on my current clinical role in Wisconsin.”

“At the end of the day,” Ehrenfeld said, “we’re really about improving access to health care for LGBTQ people, which is a lot of the work that I have been involved in at the AMA and is a core piece of what we’re trying to do nationally through our policy activities.”

In testimony before the U.S. House Armed Services Committee in 2019, Ehrenfeld told lawmakers: “I would like to state unequivocally that there is no medically valid reasonā€”including a diagnosis of gender dysphoriaā€”to exclude transgender individuals from military service.”

Last year, far-right anti-trans pundit Matt Walsh targeted Vanderbilt’s Transgender Health Clinic on his podcast, leading conservative lawmakers in Tennessee to call for investigations of the institution based on information the university claims was “misrepresented” or taken out of context.

“It’s deeply personal for me,” Ehrenfeld said. “Almost everybody that I helped recruit and hire at Vanderbilt, their personal information was shared online. Their names were on TV. And that has had a chilling effect [both] there and in many places across the country, as there have been attempts to intimidate and threaten practitioners who are providing what we know is evidence based appropriate care.”

A big moment for Ehrenfeld and the AMA

Ehrenfeld will be inaugurated as AMA president on June 13, midway through Pride month. It will be an exciting time, he said. “The AMA will have our first contingent walking in the Chicago Pride Parade…so, my husband and the family and the kids will all be there with a bunch of AMA colleagues celebrating at the end of June.”

“It’s an exciting moment for the organization, but I think also for the community for a bunch of reasons,” Ehrenfeld said. “One is, you know, to be an out person in a very visible role, I think sends a message to patients in the community as well as LGBTQ physicians and other healthcare workers, that their needs are being heard in a way that hasn’t always happened,” notwithstanding “challenges that are happening in many places on the legislative level.”

On a personal level, he said, “growing up, I didn’t have a lot of LGBTQ role models in college and medical school who I saw as defining a career pathway for me.” This meant “I would often question, ‘would I have a role? Was there a place for me as an out person in medicine, in leadership, doing policy work, trying to make the community healthier and improve access to health care?'”

Ehrenfeld said his leadership of the AMA marks an “important moment” in the organization’s history, demonstrating what is now possible for LGBTQ people who historically were denied these types of opportunities.

Jesse Ehrenfeld (Washington Blade photo by Michael Key)

Anti-trans laws worsen systemic issues in healthcare

“The AMA opposes any policy “that creates a barrier between a patient and their doctor making a decision that’s in the patient’s best interests,” Ehrenfeld said, which includes “efforts to ban care for transgender people” at the state and federal level. “We stand for the science, the evidence, [and] the clinical guidelines that we know lead to better outcomes for patients.”

Even beyond healthcare restrictions that are passed legislatively, “we have a lot of backseat drivers trying to tell doctors what to do,” Ehrenfeld said, like “insurance companies who put up barriers around prior authorization for getting approval for care and services.”

“Those things are real and they cause people to give up trying to get the care they need,” he said.

Six states have passed laws criminalizing certain healthcare interventions for the treatment of gender dysphoria, which carry the specter of felony charges for healthcare providers. These, Ehrenfeld said, are the most “heartbreaking” for him personally.

Survey data says one in five physicians is experiencing signs of burnout, with an increase beginning with the COVID-19 pandemic, Ehrenfeld said. “That burnout is only exacerbated when you find yourself practicing in a place where a law is passed that tells you how to practice or [tells you] that you can’t practice.”

“That causes moral injury to a physician who finds an untenable choice: provide the care that they know is in the patient’s best interests, or break the law and [potentially] go to jail,” Ehrenfeld said. “And that stress is real. There’s not a week that goes by that I don’t hear from a colleague who says I can’t take it anymore.”

Beyond impacts felt by individual healthcare workers, “we’ve seen a drop in the number of physicians who are applying for training positions in states where care is being restricted,” he said. “When, suddenly, you don’t have specialists and internists and primary care providers working in a state, that impacts care for everybody.”

Anti-trans legislative restrictions on healthcare are increasingly targeting adults, too. Florida’s S.B. 254, which would allow the state to take children away from parents who facilitate their access to best-practices treatments for gender dysphoria, would also bar all Floridians from accessing gender affirming care via telehealth, or that which is administered by nurse practitioners and physicians’ assistants.

“Telehealth is particularly important for a lot of LGBTQ people because of access distance challenges and the need to seek care in places that often is not immediately local,” Ehrenfeld said.

“There’s this cascading effect of, unfortunately reducing access to care that’s very concerning to me and to the AMA,” he said.

When laws proscribe healthcare interventions that “we know to be appropriate,” Ehrenfeld said, “we use every avenue available” – from pressuring the National Governors Association to filing lawsuits and amicus briefs in coordination with other stakeholders as well as “work on the policy side at the federal level and with our state partners.”

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Health

UNAIDS to commemorate Zero Discrimination Dayā€™s 10th anniversary

UN agency urges global action to protect human rights

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A UNAIDS anti-discrimination exhibit at Tocumen International Airport in Panama in 2018. (Washington Blade photo by Michael K. Lavers)

As the world marks the 10th anniversary of Zero Discrimination Day; UNAIDS is sounding the alarm on the increasing threats to human rights, calling for renewed efforts to protect the rights of all individuals as a fundamental step towards ensuring health for everyone.

Established by UNAIDS a decade ago, Zero Discrimination Day aims to promote equality and fairness regardless of gender, age, sexuality, ethnicity or HIV status. The progress achieved over the past years is now in jeopardy, however, due to rising attacks on the rights of women, LGBTQ people and other marginalized communities.

UNAIDS Executive Director Winnie Byanyima emphasized the critical link between protecting human rights and safeguarding public health. 

“The attacks on rights are a threat to freedom and democracy and are harmful to health,ā€ she said in a press release. ā€œStigma and discrimination obstruct HIV prevention, testing, treatment and care and hold back progress towards ending AIDS by 2030. It is only by protecting everyoneā€™s rights that we can protect everyoneā€™s health.”

Despite challenges, there has been notable progress. 

At the onset of the AIDS pandemic more than 40 years ago, two-thirds of countries criminalized consensual same-sex sexual relations. They are now decriminalized in two-thirds of countries. An additional 38 countries around the world have pledged to end HIV-related stigma and discrimination, contributing to positive changes that include 50 million more girls attending school compared to 2015.

To sustain and enhance these advancements; UNAIDS urges global support for womenā€™s rights movements, LGBTQ rights, racial justice, economic justice, climate justice and peace initiatives. By standing with communities advocating for their rights, the U.N. aims to reinforce the collective effort towards a more inclusive and equitable world.

Zero Discrimination Day is observed on March 1.

Events and activities that will take place around the world throughout the month will serve as reminders of the essential lesson and call to action: Protecting everyoneā€™s health is synonymous with protecting everyoneā€™s rights.

“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals and secure a safer, fairer, kinder and happier world ā€” for everyone,” said Byanyima.

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Health

New CDC report finds transgender women at higher risk for HIV

More than 1,600 people in seven cities surveyed

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The Centers for Disease Control and Prevention in Atlanta (Photo courtesy of the CDC)

The Centers for Disease Control and Prevention issued a new study report this week that revealed that restricted by employment and housing discrimination and lack of access to needed gender-affirming healthcare for transgender women increasing the risk of contracting HIV. 

Researchers reviewed data from a 2019-2020 survey, theĀ National HIV Behavioral Surveillance Among Transgender Women, which found that the demographics of HIV/AIDS have been disproportionally high, especially among Black and Latina trans women, who had experienced employment and housing discrimination coupled with lack of access to gender-affirming healthcare.

The Jan. 25Ā Morbidity and Mortality Weekly Report was based on data studies of more than 1,600 trans women in seven major urban locales. Participants from Atlanta, Los Angeles, New Orleans, New York, Philadelphia, San Francisco and Seattle were chosen by referrals from people and community-based organizations who knew or were part of the local population of trans women.

The studyā€™s researchers noted: ā€œEmployment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity and survival sex work. These issues are interconnected.ā€

The study stated that trans womenā€™s inability to access quality healthcare, including gender-affirming treatment or access to PrEP, and can expose them to potential incarceration as many turn to ā€œsurvival sex workā€ and violence, which increases the risk of contracting HIV. 

The studyā€™s authorā€™s pointed out: ā€œWhen economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships. This analysis ā€¦demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment.ā€

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Health

A Whole New Perspective on Well-Being

The Matherā€™s team recognizes that everyoneā€™s wellness journey is completely unique to their life experiences and influences.

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The Mather is incorporating biophilic designā€”a design approach to facilitate access to nature or things that replicate natural patterns.

Itā€™s easy to spot the distinctive, elegant silhouette of The Mather, a Life Plan Community for those 62+ opening this spring in Tysons, Virginia. What is not apparent to the naked eye is The Matherā€™s unique wellness philosophy, which is literally built into the community.Ā 

The Matherā€™s team recognizes that everyoneā€™s wellness journey is completely unique to their life experiences and influences.

Nature is one of the important factors that contribute to well-being. So The Mather is incorporating biophilic designā€”a design approach to facilitate access to nature or things that replicate natural patterns. This can include interior spaces with sightlines to a garden, choosing natural wood and stone as interior materials, or incorporating fragrant flowers and plants indoors to spark memories and provide tactile opportunities such as gardening.Ā 

Residents of The Mather will be able to select from plentiful amenities, programs, and other offerings to target their personal wellness goals and preferences.

ā€œProviding biophilic design within interior settings connects residents to the natural world,ā€ says Mary Leary, CEO and President of Mather, the organization behind The Mather. ā€œResearch shows that a connection to nature provides positive benefits to mental states and overall well-being. At The Mather, biophilic design is the intersection of buildings and programs with nature in an urban setting.ā€

ā€œThe Mather is attracting a diverse group of older adults,ā€ says Mary. ā€œAs a result, we aim to incorporate wellness practices from around the world, including Wyda movement theory of the Celtic Druids, which helps people achieve harmony with nature and contentment through mindfulness.ā€ This holistic regenerative approach is similar to Qi Gong and yoga, while born in a different part of the world. Mather Institute has a special focus on mindfulness to support older adultsā€™ practice of present moment awareness, which can lead to increased overall well-being, compassion, and joy.

A very different example of a wellness offering at The Mather is the Gharieni Welnamis spa wave bed, which uses computer-controlled vibrational therapy and audio frequencies to train the brain to relax. ā€œThe bed increases mindfulness, concentration, and creativityā€”all of which support our mission of creating Ways to Age Well,SMā€ says Mary.

These and other personalized ways to wellness will ensure that residents of The Mather can choose from seemingly countless ways to focus on their well-being. In other words, the skyā€™s the limit!

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