Stanley Goldfarb and his group, Do No Harm, say Republicans need new advisers because major medical groups have embraced progressive ideology.

By Daniel Payne

07/21/2024 07:00 AM EDT

A retired kidney doctor has become Republicans’ go-to source for medical expertise in making the case to ban gender-affirming care for kids.

Twenty-five states led by Republicans have enacted laws banning or restricting that care for kids with gender dysphoria. They’ve often relied on nephrologist Stanley Goldfarb and his organization, Do No Harm, to argue that hormone treatments, puberty blockers and rare surgeries to change physical characteristics are medically harmful.

Goldfarb, a former dean at the University of Pennsylvania’s medical school, and Do No Harm have staked out a position on gender care opposite to that of mainstream doctors’ groups including the American Medical Association and the American Academy of Pediatrics. And Republicans, who increasingly view those groups as filled with progressive ideologues, are happy to use him as a legislative strategist.

“Our goal right from the beginning was to have an effect,” Goldfarb told POLITICO. “We’ve done that.”

Goldfarb has also raised millions of dollars for his cause since he founded Do No Harm in 2022, capitalizing on the polarization that has gripped health care since public health officials warred with then-President Donald Trump and GOP governors over how to handle Covid-19. Those feuds coincided with major medical groups’ decisions to weigh in on thorny cultural debates, backing abortion rights after the Supreme Court’s 2022 decision to rescind constitutional protection for the procedure, and LGBTQ+ rights, including access to gender-affirming care.

Goldfarb, who acknowledges his training as a kidney doctor means he’s no expert in gender care, accuses the medical establishment of putting ideology over good medicine. He said Republicans need to seek out new sources of medical advice — and has been quick to offer his own.

Children and their parents “don’t understand the lifetime implications of some of these treatments,” Goldfarb said. “The government has to step in.”

His inroads on the right have caught the attention of doctors who lead the established groups. Dr. Marci Bowers, president of the World Professional Association for Transgender Health who provides gender-affirming care to others, calls Goldfarb “pompous” and compares his crusade against the care to Nazi eugenics experiments.

“I think this is nothing short of that,” she said. “I do feel it’s the same kind of force.”

Goldfarb called Bowers’ broadside, or any name-calling in the debate over transgender care, “the last refuge of the scoundrel.”

But mainstream medical groups are doing more than name-calling, publishing policies backed with research to show that gender-affirming care is both safe and necessary for patients’ health.

Even so, Goldfarb has moved aggressively to prove that groups like Bowers’ are infected by ideology and shouldn’t be trusted. Do No Harm has an anonymous tip line for people who have evidence of ideologically driven care and publicizes leaked documents in an effort to prove the point, including social justice-focused curricula at medical schools and emails from researchers involved in gender care research.

Goldfarb’s ambitions go beyond gender-affirming care.

Earlier this year, Republican lawmakers gathered outside the Capitol to tout a new bill that would eradicate diversity, equity and inclusion efforts in medical education — and thanked Goldfarb for his help.

Without Goldfarb, Rep. Greg Murphy (R-N.C.) said, the lawmakers “would not have made any significant progress” on the bill, which is now pending before the House Committee on Education and the Workforce.

Whether Congress passes a bill or not, Goldfarb sees DEI as a vulnerable target after the Supreme Court banned affirmative action in college admissions last year.

Do No Harm’s success has lobbyists who represent mainstream health organizations concerned about the group’s influence among Republicans and how that could change the standing — and budgets — of their own groups.

They also say his lobbying on gender-affirming care is putting patients at risk.

“Banning things rarely ends well,” said Dr. Deborah Greenhouse, a pediatrician who works in South Carolina, which has barred patients under 18 from getting medical care for gender transition. “They’ve given us no path forward.”

Nearly all of her patients with gender dysphoria have moved from the state or are making arrangements to do so.
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Goldfarb acknowledged the stakes — and even that these policies could, in his view rarely, do harm to some kids. But he said his larger concern is that missteps in treatment could mean suffering for adolescents as they move into adulthood.

“We’re trying to do the right thing. That’s it,” he said.

An awakening at Penn

Goldfarb, a wiry, soft-spoken octogenarian with a penchant for recalling research papers, stands out as an academic among politicians — even as he lobbies them, testifies before their committees and makes his case on Fox News.

His policy concerns began years ago at the University of Pennsylvania, the Ivy League school he joined in 1969.

He worked on the medical school curriculum as an associate dean until 2018, when his colleagues and the school’s leadership began to push coursework on “climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness,” he wrote in a Wall Street Journal op-ed in 2019, shortly after retiring.

Goldfarb turned that article, “Take Two Aspirin and Call Me by My Pronouns,” into a book and founded Do No Harm in 2022.

“There was such an uproar about it,” he recalled of the op-ed. “This really was touching a nerve. And I thought that nerve needed to be touched.”

Nearly 8,000 people have since joined Do No Harm, and Goldfarb expects to raise $10 million by the end of the year.

That’s still a pittance compared to his rivals — the AMA had nearly $450 million in revenue in 2022, according to its most recent tax filing — but “we’ve proven we can win with so much less,” Do No Harm’s executive director, Kristina Rasmussen, said in a statement.

A significant portion of the group’s budget has come from a few donors, such as the Project on Fair Representation, a conservative legal group, and the Edelman Family Foundation, which is bankrolled by billionaire financier Joseph Edelman.

Both gave more than a million dollars according to 2022 tax filings.

Goldfarb said people in GOP presidential candidate Donald Trump’s orbit have reached out to him for advice on potential appointees to administration jobs in a second Trump term.

Do No Harm’s formation was in part fueled by the aftermath of the death of George Floyd, when health institutions pledged to take on the racism within their organizations and the wider health system. Their statements struck Goldfarb as “bizarre” and far from his own experiences in health care.

It’s not just medical education that worries Goldfarb now — it’s the changes in how race is factored into health systems and patient care across the country. That includes equity efforts, like the formula that’s used to distribute organs to people who need transplants. In Goldfarb’s view, it unfairly disadvantages white patients.

Leaders of major medical institutions point to disparities in health outcomes among racial groups to bolster their argument that they need to do more: the wide gaps in maternal mortality or life expectancy at birth.

Goldfarb doesn’t deny there are disparities but argues that medical institutions are too eager to address them through “diversity, equity and inclusion” initiatives that, he said, aren’t based on evidence, inflame racial divisions and discourage disadvantaged patients from getting care.

He came later to gender-affirming care, concerned that ideology and the vehemence of the care’s proponents was getting in the way of debate over whether the evidence supports it.

Still, he acknowledges some worries that a small minority of children may need the care he’s working to ban.

“You should always be questioning what you’re doing and why you’re doing it,” he said. “I’ve always been sort of contrarian.”

Despite that opposition to the American medical establishment’s consensus, some colleagues from his years at Penn say they admire his introspection.

“I respect his ability to form his own opinion about what he thinks is right or wrong,” said Dr. Eric Neilson, dean at Northwestern’s medical school.

Neilson disagrees with Goldfarb on a number of issues but said Goldfarb “understands medicine as good as anybody.”

Making headway

Goldfarb and Rep. Greg Murphy, the North Carolina urologist who co-chairs the GOP Doctors Caucus, made the case for Murphy’s bill to ban DEI initiatives in medical schools in another Wall Street Journal opinion piece in March, arguing the initiatives put political activism before the teaching of medicine.

“Until Congress takes action, this ideology will continue to corrupt the institutions that train physicians,” they wrote.

The bill has 56 Republican co-sponsors and a companion measure in the Senate by Louisiana Republican John Kennedy.

It’s a measure that, even if Republicans sweep the November elections, they’ll have trouble advancing — since controversial bills require 60 votes in the Senate.

In the absence of major federal wins, Goldfarb has focused much of his efforts in the states.

There, he’s enjoying considerable success.

Diversity, equity and inclusion policies are under fire. Florida, Texas and Utah have banned DEI offices at state universities and bills are under consideration in numerous others.

Universities including the Massachusetts Institute of Technology and Harvard have recently announced they will no longer require applicants for faculty posts to submit statements pledging commitment to diversity initiatives.

Meanwhile, half of states have banned or restricted gender-affirming care for minors.

Goldfarb and Do No Harm have supplied model legislation and research to support it. Advocates for trans youth say they see the same Do No Harm witnesses pop up time and again at state legislative hearings.

“It seems very obvious that it’s coming from a singular source,” said Christiana Hammond, who works with the Arizona Trans Youth and Parent Organization, which strongly opposed the ban then-GOP Gov. Doug Ducey signed two years ago.

Hammond and her allies say Goldfarb’s prominence has skewed lawmakers’ perceptions about how the medical community at large sees gender-affirming care and that he’s overemphasized the stories of people who transition and then detransition, which gender care experts say is rare.

“It doesn’t matter what age, what population, what treatment protocol, the vast majority of patients that go through the gender-affirming process — it improves their lives,” Bowers said.

Republicans aren’t the only political forces getting involved in the debate. HHS Assistant Secretary for Health Rachel Levine, through her staff, reached out to WPATH asking for specific age guidance for surgeries to be removed from the organization’s standard of care, still being developed at the time. Levine cited concerns that setting an age limit would bolster the movement to restrict access to care, according to recently unsealed court documents.

Requests from administration officials to change the standard of care frustrated some members of WPATH, who felt political strategies were eclipsing focus on the patient, according to email excerpts in the filings. (The final WPATH guidance removed the age recommendations, though its leaders denied political influences in their decision.)

Even so, Goldfarb and critics of the most aggressive — and rare — forms of gender-affirming care for minors, surgery, are finding at least some common ground with Democrats. The White House, in response to the reporting that the administration pushed to remove WPATH’s age restrictions, said last month that it “does not support” gender-affirming surgery for minors.

Goldfarb points to recent decisions in several European nations, including Norway, Sweden and the U.K, to restrict access to gender-affirming care on the grounds that it could be overprescribed.

An April review of the treatments by the respected British pediatrician Hilary Cass questioned the evidence and urged caution.

The Cass report makes the case that the care should only proceed after children are evaluated by a team of providers of varied expertise to determine whether the dysphoria may stem from another condition, like a mental illness or autism, or from peer influence.

But Do No Harm wants to go further — to ban some treatments for youth entirely.

Several doctors who work in pediatrics or gender-affirming care, granted anonymity to discuss internal conversations with their colleagues, said they have worried about discussing risk factors involved with treatment because they believe it could be taken out of context by those, like Goldfarb, who seek to ban the care for minors entirely.

But not everyone sees it that way.

Bowers, while rejecting Cass’ case, said that she is pushing for more transparency and continued space for disagreement at the World Professional Association for Transgender Health.

The American Academy of Pediatrics, which supports gender-affirming care and doctors’ prerogative to prescribe it, is currently reviewing the evidence.

The AAP “will continue to follow the science and put patients and families first,” Dr. Benjamin Hoffman, president of the group, wrote earlier this year.

For Goldfarb, the changing conversation within provider groups could be counted as a win.

“Are we going to replace these organizations? No,” he said. “But I’d like to influence them.”