Perspective

Trump’s ban on transgender troops could threaten patients

President Donald J. Trump
Donald J. Trump

President Donald J. Trump’s decision to ban transgender troops from serving in the military drew a sharp rebuke from physicians as stigmatizing and potentially dangerous to patients.

“As HIV medical providers, we stand firmly opposed to any laws and policies that discriminate against lesbian, gay, bisexual and transgender (LGBT) individuals,” HIV Medicine Association Chair Wendy Armstrong, MD, FIDSA, FACP, said in a statement.

Jack Ende, MD, MACP, president of the American College of Physicians, said the group also opposes the ban.

“ACP supports inclusive policies that benefit the overall health and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals and opposes those that reinforce social stigma, marginalization, or discrimination,” Ende said in a statement.

Trump announced his decision in a series of early-morning tweets on Wednesday, but it was unclear if or when any official policy would be enacted.

“Please be advised that the United States Government will not accept or allow Transgender individuals to serve in any capacity in the U.S. Military,” he wrote.

The president said he came to his decision “after consultation with my Generals and military experts.”

“Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail,” he wrote.

Popular estimates of the number of transgender troops currently serving in the military range from over 1,000 to more than 15,000. Trump’s assertion about the financial expense of allowing transgender troops to serve has been widely contrasted with a federally funded report published in 2016 by the Rand Corporation that estimated the health care cost of gender transition-related treatment to be between $2.4 million and $8.4 million annually. By comparison, the Defense Department spends more than $84 million per year on prescriptions for erectile dysfunction medicines, according to a Military Times report.

Ende said the ACP believes transgender health services should be covered by both public and private health plans, including health services provided by the military.

“The cost of providing these services is relatively small and should not be used as a reason to deny coverage and access,” he said. “We urge President Trump to reverse his decision to bar transgender persons from military service. Should he not immediately do so, Congress and the courts must step in to overturn his order so that transgender persons may serve in the military without discrimination, and are able to obtain necessary and appropriate health services.”

Wendy S. Armstrong, MD, FIDSA, FACP
Wendy Armstrong

Armstrong and Ende characterized policies that exclude transgender individuals as not only discriminatory, but stigmatizing and potentially dangerous if it leads to a lack of access to care.

“As clinicians, we see firsthand the far-reaching negative consequences of any type of stigma and discrimination on individual health and on public health,” Armstrong said. “Stigma and discrimination too frequently drive transgender persons away from engaging in health care and too often contribute to late diagnoses, poor outcomes and often higher health care costs for a number of health conditions, including HIV infection.” – by Gerard Gallagher

References:

Kime P. Military Times. DoD spends $84M a year on Viagra, similar meds. July 13, 2015. http://www.militarytimes.com/pay-benefits/military-benefits/health-care/2015/02/13/dod-spends-84m-a-year-on-viagra-similar-meds/. Accessed July 27, 2017.

Schaefer AG, et al. Assessing the implications of allowing transgender personnel to serve openly. 2016. http://www.rand.org/pubs/research_reports/RR1530.html. Accessed July 27, 2017.

Disclosures: Armstrong is chair of the HIVMA. Ende is president of the ACP.

President Donald J. Trump
Donald J. Trump

President Donald J. Trump’s decision to ban transgender troops from serving in the military drew a sharp rebuke from physicians as stigmatizing and potentially dangerous to patients.

“As HIV medical providers, we stand firmly opposed to any laws and policies that discriminate against lesbian, gay, bisexual and transgender (LGBT) individuals,” HIV Medicine Association Chair Wendy Armstrong, MD, FIDSA, FACP, said in a statement.

Jack Ende, MD, MACP, president of the American College of Physicians, said the group also opposes the ban.

“ACP supports inclusive policies that benefit the overall health and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals and opposes those that reinforce social stigma, marginalization, or discrimination,” Ende said in a statement.

Trump announced his decision in a series of early-morning tweets on Wednesday, but it was unclear if or when any official policy would be enacted.

“Please be advised that the United States Government will not accept or allow Transgender individuals to serve in any capacity in the U.S. Military,” he wrote.

The president said he came to his decision “after consultation with my Generals and military experts.”

“Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail,” he wrote.

Popular estimates of the number of transgender troops currently serving in the military range from over 1,000 to more than 15,000. Trump’s assertion about the financial expense of allowing transgender troops to serve has been widely contrasted with a federally funded report published in 2016 by the Rand Corporation that estimated the health care cost of gender transition-related treatment to be between $2.4 million and $8.4 million annually. By comparison, the Defense Department spends more than $84 million per year on prescriptions for erectile dysfunction medicines, according to a Military Times report.

Ende said the ACP believes transgender health services should be covered by both public and private health plans, including health services provided by the military.

“The cost of providing these services is relatively small and should not be used as a reason to deny coverage and access,” he said. “We urge President Trump to reverse his decision to bar transgender persons from military service. Should he not immediately do so, Congress and the courts must step in to overturn his order so that transgender persons may serve in the military without discrimination, and are able to obtain necessary and appropriate health services.”

Wendy S. Armstrong, MD, FIDSA, FACP
Wendy Armstrong

Armstrong and Ende characterized policies that exclude transgender individuals as not only discriminatory, but stigmatizing and potentially dangerous if it leads to a lack of access to care.

“As clinicians, we see firsthand the far-reaching negative consequences of any type of stigma and discrimination on individual health and on public health,” Armstrong said. “Stigma and discrimination too frequently drive transgender persons away from engaging in health care and too often contribute to late diagnoses, poor outcomes and often higher health care costs for a number of health conditions, including HIV infection.” – by Gerard Gallagher

References:

Kime P. Military Times. DoD spends $84M a year on Viagra, similar meds. July 13, 2015. http://www.militarytimes.com/pay-benefits/military-benefits/health-care/2015/02/13/dod-spends-84m-a-year-on-viagra-similar-meds/. Accessed July 27, 2017.

Schaefer AG, et al. Assessing the implications of allowing transgender personnel to serve openly. 2016. http://www.rand.org/pubs/research_reports/RR1530.html. Accessed July 27, 2017.

Disclosures: Armstrong is chair of the HIVMA. Ende is president of the ACP.

    Perspective

    Jeanne Marrazzo

    One of the fundamental tenets of the physician-patient relationship is respect. We need to respect and honor the challenges and attributes that our patients bring to the clinical encounter — it is a prerequisite to the honest exchange of information we need to best serve the patient’s interest. The president’s announcement, and the motives behind it, embody the exact opposite of that ethic in that it is underlain by a complete lack of respect for individual autonomy, decision-making and self-determination — not to mention respect for the service that anyone in uniform provides with such selflessness. Short-sighted, uninformed, mean-spirited, destructive and antithetical to medical ethics and humanism — just a few terms that this brings to my mind.

    • Jeanne Marrazzo, MD, MPH
    • Director, division of infectious diseases
      University of Alabama at Birmingham School of Medicine

    Disclosures: Marrazzo reports no relevant financial disclosures.

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