The US Department of Health and Human Services (HHS) recently released a report linking “gender ideology” to leftwing authoritarianism and political violence – a study scientists say was poorly conducted and “nakedly political”, likely leading to greater politicization of science and health.
It follows attempts by the administration to limit access to gender-affirming care – including, on Friday, an agreement reached between the Department of Justice and a New York hospital to no longer offer pediatric gender-affirming care. Dozens of hospitals stopped offering gender-affirming care after the Trump administration began investigating them for offering the standard of care.
Patients on Medicaid and government insurance plans have also been blocked from accessing care, and a proposed rule would block any health system offering gender-affirming care from receiving federal funding.
The new report, which was not published by a scientific journal and did not undergo peer review, takes aim at medical organizations offering guidelines on gender-affirming care. It also links those who say they support trans individuals with supporting authoritarianism and political violence.
“It was a very poorly done piece of research,” said Gideon Meyerowitz-Katz, an epidemiologist from the University of Sydney, who highlighted several methodological failings. “It was nakedly political. I think this is probably the most obviously political study that I’ve come across.”
The report is “quite an abnormal document with a number of oddities,” said Daniel Aaron, an associate professor at the University of Utah’s SJ Quinney College of Law.
“It likely also violates federal law because it’s not peer-reviewed, and it’s essentially quite an influential dissemination of information,” which could mean it violates the Information Quality Bulletin, a federal regulation that requires peer review for influential scientific information from the US government, he said.
The HHS did not respond by press time to the Guardian’s questions about whether this report was commissioned by the agency and if it violated federal regulations.
Aaron believes the report would not survive peer review and wondered why a political science report was published by HHS.
“It’s actually not even health-related, so I don’t understand why this is related to HHS’s mission,” Aaron said.
Craig Konnoth, a professor at the University of Virginia School of Law who coauthored with Aaron a perspective on gender-affirming care policy for the New England Journal of Medicine, agreed. He sees the report as an attempt to undermine mainstream health and science organizations such as the American Psychological Association, American Psychiatric Association, the World Professional Association for Transgender Health, and the American Academy of Pediatrics, all named in the report.
“By that standard, any medical recommendation becomes ‘authoritarian’. Any standard set by any licensing board becomes ‘authoritarian’,” Konnoth said. “What we’re seeing is this broadside attack on the scientific establishment more generally, and trans rights are being used as the vehicle to do this.”
Colin Wright, an author of the report and a fellow at the conservative thinktank Manhattan Institute, said he believes the study was published by HHS quickly because a draft had been leaked to the public. He said the researchers are planning to release more information, including the numbers from the survey, and they are planning to submit the study to an unnamed journal for publication.
“It was kind of a surprise to us that it dropped when it did, and so we didn’t have plans beforehand,” Wright said. “We probably could have tightened the language a little bit more.”
Wright disputed that the study was an attempt to link support for trans people and political authoritarianism and violence, though the report itself says: “These findings suggest that gender ideology is associated with LWA [left-wing authoritarianism] and willingness to justify political violence.” Gender ideology was measured by statements such as: “People should be supported in expressing their transgender identity,” and “Parents should support their children’s transgender exploration.”
Wright suggested that the study is about the guidance offered by medical organizations and “in many ways geared to make people sort of have a more extreme reaction to it, and to kind of fuel somewhat authoritarian tendencies of trying to silence people” on gender-affirming care. He argued that the guidelines appear to push people toward ideological extremes.
“Sort of independently, it increased their willingness, at least correlationally, to their support for political violence,” Wright said. “There’s a lot of ideological content to it.”
In an online survey, 1,208 people ranked statements about support for trans people as well as about political ideology and political violence.
The political ideology questionnaire essentially measured whether someone was a Democrat, said Meyerowitz-Katz, who added: “I don’t think anyone would think this is a good measure of authoritarianism.”
One of the statements was about whether opposition to gay marriage is homophobic; another was a statement about whether the focus on terrorism should shift to the far right. “If you were a rational human being who understood the facts, you would agree with that,” said Meyerowitz-Katz. For instance, approximately 75-80% of deaths from terrorist attacks in the United States come from people on the far right, and rightwing attacks are more lethal than leftwing violence.
Similarly, the questions on political violence focused only on political violence against conservative figures or institutions, he said. If they’d included political violence against other actors, “you would almost certainly see the opposite correlation,” making the questionnaire an unreliable predictor of whether someone supports political violence, Meyerowitz-Katz said.
It was also difficult to parse these relationships, because the researchers haven’t yet released any numbers from the survey, Meyerowitz-Katz said: “The only thing they report in that paper is correlations.” But they don’t say, for instance, how many respondents supported actions like arson of US Immigration and Customs Enforcement (ICE) buildings.
“This is very silly,” said Meyerowitz-Katz. “They’re producing what I would describe as pseudoscience … It’s a bad, poorly done report.”
Konnoth, who studies the link between opposition to LGBT rights and authoritarianism, noted that the report overlooks significant research in the field. “They don’t cite and engage in the data that goes against that thesis,” he said.
Typically, HHS publishes issue briefs and synthesized information, but this is an “extremely weird” case of the HHS appearing to adopt a study as its own report, Aaron said.
The purpose of the report appears to be an attempt to correlate leftwing people, particularly those who support transgender people, with violence, said Meyerowitz-Katz. “The only possible outcome of this survey was to show a correlation between leftwing beliefs and support for transgender people and ‘political violence’, and so I think that was the aim. I don’t see another possible way to interpret this particular piece of research.”
Aaron said it appears to be “aimed to benefit a political group or demonize an opposing group and build political support,” he said. “It kind of builds this fake evidence base for transgender people as a political issue.”
HHS is tasked with protecting the health and wellbeing of all Americans, he said, noting: “It’s not happening here.” Aaron compared the report with recent actions on vaccines that depart from the scientific evidence and reshape the vaccine infrastructure – influencing those who make decisions on vaccines and fueling the anti-vaccine political movement.
“I think we can draw parallels with this consistent anti-science production of information by the federal government,” he said.
Konnoth called it an “attempt to create an alternate scientific narrative” that affects all Americans.
“There’s a targeting of these mainstream fundamental organizations that put out research that doesn’t just involve trans rights, but involves broader claims about science,” he said. “If we buy into their attempt to discredit the medical establishment, then we are in deep trouble … It’s life-and-death for massive swathes of the American population.”
