57. Are there biological mechanisms that consistently determine the way people identify themselves sexually?

May 26, 2020

I take a conservative view of the question. The MedScape article  below is highly technical and I caution against over-interpretation of the meaning or importance of any single observation.

Much of the speculation regarding possible biological causation for gender dysphoria pertain only to very rare biological conditions, such as congenital adrenal hyperplasia.

In discussing brain differences, in many of the cases the evidence was not clear whether differences might not have been caused by hormonal treatments rather than inherent brain physiology.

The evidence was obtained mostly for transgender individuals and may have only limited application, or none, to the question of homosexual behavior.

Another thing not discussed is the huge effect upon brain architecture that early attachment experiences and parental relationships clearly have.  That is, some of the gender-related differences in the size of the collections of brain cells that embryologists and neuroanatomists call “nuclei”, may have been caused by childhood attachment-development rather than the nuclei having caused the specific gender identity.

Nevertheless, the article is a useful collection of information and provides a basis for interesting speculations.

With reference to the sixth paragraph, it is useful to know that in a certain very small number of babies, the genitalia are ambiguous and at one time were “corrected” surgically soon after birth to resolve the uncertainty.  The surgeons often went in the direction of what the genitals most resembled, which was sometimes not consistent with whether the baby was chromosomally XX (female) or XY (male).  The parents, not knowing the chromosomal gender raised the kid according to what the surgeons had decided. This may have led to a certain number of those children just never feeling right about their gender assignment, some of whom requested a reassignment in later life.

So with those warnings against thinking these matters are settled, here is a recent Medscape survey article on the topic.  I would have just given the URL, but you have to be a member to gain access.


All the rest is a report from MedScape, a medical magazine – sorry I have lost the name of the author(s) and the date of publication.


Objective: To review current literature that supports a biologic basis of gender identity.

Methods:   A traditional literature review.

Results Evidence that there is a biologic basis for gender identity primarily involves (1) data on gender identity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with (2) neuroanatomical differences associated with gender identity.

Conclusions Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis [Ed. not the same as “cause”]  of gender identity.


Gender identity is a fundamental human attribute that has a profound impact on personal well-being. Transgender individuals are those whose lived and identified gender identity differs from their natal sex. Various etiologies for transgender identity have been proposed, but misconceptions that gender identity can be altered persist. However, clinical experience with treatment of transgender persons has clearly demonstrated that the best outcomes for these individuals are achieved with their requested hormone therapy and surgical sexual transition as opposed to psychiatric intervention alone.[1] In this review, we will discuss the data in support of a fixed, biologic basis for gender identity.


This traditional literature review was conducted using a search of PubMed and Google Scholar for the following key terms: gender identity, gender dysphoria, transsexual, transgender, transmen, and transwomen.


Disorders (or Differences) of Sex Development (DSDs)

A seminal study by Meyer-Bahlburg et al involving outcomes of XY individuals raised as females due to severe nonhormonal, anatomic abnormalities of sex development provided the most convincing evidence that gender identity is fixed.[2] These congenital abnormalities include penile agenesis, cloacal exstrophy, and penile ablation. For many years, female gender assignment along with surgical feminization was the dominant approach for these patients. In this study, 78% of all female-assigned 46 XY patients were living as females. While the majority of these patients did not initiate a gender change to male, none of the 15 male-raised 46 XY patients initiated a gender change to female. Thus, the risk of questioning gender identity was higher in those 46 XY subjects raised as females than in those raised as males. The same group examined the degree of satisfaction with surgical intervention reported by patients with 46 XY genotypes and found that those subjects raised as boys were considerably more comfortable with their gender identity.[3]

Another seminal study relevant to this topic was by Reiner and Gearhart.[4] In their review of 16 XY genotype subjects with cloacal exstrophy who underwent female gender reassignment surgery, 4 of the 14 individuals raised as girls announced they were male, and 4 later chose to live as boys when they became aware of their genotype. The 2 individuals who were raised as males identified as males throughout life. The sexual behavior and attitudes of all 16 subjects ultimately reflected strong masculine characteristics regardless of gender assignment. Thus, children who were born genetically and hormonally male identified as males despite being raised as females and undergoing feminizing genitoplasty at birth. Although the cohort sizes in these studies were small, the data provide the strongest evidence for the biologic underpinnings of gender identity.

In congenital adrenal hyperplasia (CAH), the adrenal glands produce excessive amounts of androgens, causing genital virilization with a spectrum of different phenotypes in 46 XX neonates. Dessens et al[5] reported that the prevalence of male gender identity in 46 XX female-raised subjects with CAH was higher than the prevalence of female-to-male (FTM) transgender individuals in the general population of chromosomal females. In this study, the large majority (95%) of 250 female-raised patients later maintained a female gender identity. However, 13 (5.2%) had serious problems with their gender identity. 

Deficiencies of 5 alpha-reductase-2 and 17-beta-hydroxy-steroid dehyrogenase-3 are similar conditions in which the synthesis and conversion of testosterone to dihydrotestosterone is inhibited, preventing the development of external male genitalia and resulting in potential genital ambiguity. As with CAH, affected individuals are often raised as females. In a study of affected subjects, gender role changes were reported in 56 to 63% of cases with 5 alpha-reductase-2 deficiency and 39 to 64% of cases with 17-beta-hydroxysteroid dehydrogenase-3 deficiency who were raised as girls.[6] These data support the concept that gender identity might be attributed to hormone milieu during intrauterine development.

Data from DSDs highlight the potential influence of abnormal hormone exposure on the development of transgender identity in some individuals. However, it is important to note that most transgender individuals develop a gender identity that cannot be explained by atypical sexual differentiation. It is possible for individuals with normal sexual differentiation to develop transgender identity later in life.

Neuroanatomical Differences. Many of the current hypotheses for the biologic origin of transgender identity are based on atypical sexual differentiation of the brain. The perception of one’s own gender is linked to sexual differentiation of the brain, which differs from the body phenotype in transgender individuals.[7] Swaab et al have proposed that this discrepancy could be due to the fact that sexual differentiation of the brain takes place only after sexual differentiation of the gonads in early fetal life.[8] Along these lines, the degree of genital masculinization may not reflect that of the brain.

The notion of transgender-specific cerebral phenotypes is further supported by postmortem brain studies investigating the underlying neuroanatomical correlates of gender identity.[9,10,12] The vast majority of these studies have compared particular regions of interest only in male-to-female (MTF) transgender individuals.[13–15] These studies support the hypothesis that atypical cerebral networks in transgender individuals have a neuroanatomical basis.

Gray Matter Studies. Studies of cerebral gray matter in transgender individuals have provided the strongest neuroanatomical case for transgender gender identity. Postmortem brain studies suggest that some subcortical structures are feminized in MTF individuals. One of the earliest and most influential studies in this area investigated the bed nucleus of the stria terminalis (BSTc), which was reported to be a sexually dimorphic nucleus in humans with a larger volume in males than in females. In 1995, Zhou et al reported that the size and number of neurons in the BSTc of 6 MTF estrogen-treated transgender individuals was typical for the size and neuron numbers generally found in control females.[9] The authors further reported that these findings could not be explained by differences in adult sex hormone levels.

A similar study by Kruijver et al provided further data supporting the role of the BSTc in transgender identity.[10] They examined tissue from the same 6 MTF estrogen-treated transgender persons studied by Zhou et al and found that the number of neurons in the BSTc was more similar to genetic XX female controls. BSTc neuron number was also in the male range in the 1 FTM androgen-treated transgender individual studied.

Most transgender individuals experience feelings of gender dysphoria that begin in childhood. However, in a study of BSTc volume in postmortem brains of 50 control subjects, Chung et al reported that sexual dimorphism in the BSTc did not develop until adulthood.[11] Yet, the same group remarked that changes in fetal hormone levels could have delayed effects on BSTc volume and neurons in adulthood, thereby suggesting a role for BSTc as a marker for gender identity. Still, delayed development of sexual dimorphism in the BSTc would not explain childhood development of gender dysphoria or gender identity discrepancy.

In 2008, Garcia-Falgueras and Swaab were the first to report a sex reversal in the uncinate nucleus. They examined the third interstitial nucleus of the anterior hypothalamus (INAH 3), which is a sexually dimorphic component of the uncinate nucleus, in relation to the brains of transgender individuals.[12] They reported that the mean INAH3 volume and neuron number in 11 MTF transgender subjects were in the female ranges.

The above studies are limited by the fact that they involved postmortem examinations of a small number of brains from MTF individuals, some of whom had either received hormone treatment or surgery. Therefore, the study findings may represent confounding effects from exogenous hormones in a small group of transgender individuals. Despite their small sample size, these studies provide valuable evidence that gender identity is linked to neuroanatomy.

Studies by Luders et al provided further evidence that transgender identity is associated with distinct cerebral patterns.[13,14] In 2009, the group analyzed magnetic resonance imaging (MRI) data of 24 MTF transgender individuals who had not yet begun hormone treatment. These subjects were shown to have a pattern that was more similar to control males. However, they also observed a significantly larger, more “feminized” volume of regional gray matter in the right putamen in these subjects. In 2012, the same group observed thicker cortices in 24 MTF transgender individuals who had not yet received exogenous hormones compared with 24 age-matched control males in a number of regions across the lateral and medial cortical surfaces. The data supported a dichotomy between MTF transgender individuals and gender congruent males with regard to brain structure.

Differences in brain volume and cerebral activation patterns have been proposed as potential explanations for transgender identity. In 2011, Savic et al examined brains of 24 living MTF transgender individuals and found significant volume reductions of the putamen in MTF transgender individuals and significant increases in gray matter volumes compared with male and female controls.[15] Although these findings differ from the findings of smaller, “feminized,” putamens in MTF transgender individuals, they still indicate that certain brain areas in the transgender group have characteristic structural features compared with controls.

The same group investigated 12 living MTF transgender individuals who smelled 2 steroidal compounds: the progesterone derivative 4,16-androstadien3-one (AND) and the estrogen-like compound estra-1,3,5,[10] 16-tetraen-3-ol (EST). These compounds have been reported to activate the hypothalamic networks in a sex-differentiated way. MTF transgender individuals who had not received hormone treatment were found to respond similarly to female controls, with AND activating the anterior hypothalamus.[16] Another study by Gizewski et al showed a similar cerebral activation in MTF transgender individuals relative to female controls while they viewed erotic stimuli.[17] While the above studies only involved MTF transgender individuals, they nonetheless provided evidence of neuroanatomical pathway alteration as an explanation for transgender identity.

The following 2 studies were unique from the aforementioned ones because they included both MTF and FTM transgender individuals who had not received hormone treatment. Zubiaurre et al reported that FTM transgender individuals showed evidence of subcortical gray matter masculinization in the right putamen, while MTF transgender individuals had feminized cortical thickness.[18] In 2013, Simon et al reported differences in gray matter in 17 living transgender subjects compared with controls.[19] Differences were seen in transgender patients in the cerebellum, angular gyrus, and parietal lobe compared with controls, independent of their biologic gender.

White Matter Studies. Although an early study by Emory et al[20] found no difference in the whole corpus callosum or splenium region between MTF and FTM transgender individuals, the following MRI studies of white matter brain characteristics of transgender individuals suggested a strong neuroanatomical explanation for transgender identity. Yokota et al reported that the pattern of corpus callosum shape in both FTM and MTF transgender individuals was closer to subjects with shared gender identities than to subjects who shared the same natal sex.[21] Among FTM transgender individuals who had not received hormone treatment, certain white matter fasciculi involved in higher cognitive functions were closer to the pattern of control males than to control females.[22] Among MTF transgender individuals who had not received treatment, diffusion tensor imaging revealed an intermediate white matter pattern that was between those of male and female controls.[23]

Genetic Factors and Exposures

Although limited in size and scope, the role of genetic factors in transgender identity is supported by small studies of gene abnormalities associated with steroid hormones, twin case studies, neuroproteins, and prenatal exposures.

Steroid Hormone Genetics. Select genes have been associated with transgender identity. Although these studies have been small, they are most convincing findings to date linking atypical genes with transgender identity in both MTF and FTM transgender individuals. The CYP17 gene encodes the 17-alpha hydroxylase enzyme and is associated with elevated serum levels of estradiol, progesterone, and testosterone. In a case-control study of 151 transgender individuals, Bentz et al reported a significant association between the CYP17 gene and FTM transgender individuals but not in MTF transgender individuals.[24] Another study by the same group examined a polymorphism in the gene coding for 5-alpha reductase and found no association in a sample of both MTF and FTM transgender individuals.[25]

Various groups have investigated steroid hormone receptor gene variants to determine if they confer risk of developing transgender identity. Steroid hormones exert profound influences on fetal sexual development and act via specific receptors. It is therefore plausible that abnormal sex hormone receptor function may predispose to transgender identity. However, the existing studies on this topic have been contradictory and require replication. Henningson et al found an association between MTF transgender individuals and a dinucleotide CA polymorphism in the estrogen receptor beta gene (ERb).[26] However, 2 subsequent studies by separate groups reported different results. Hare et al performed a larger study of MTF transgender individuals and found no relationship with the ERb, but they did find a significant association with an androgen receptor repeat.[27] In a similar study of 242 MTF and FTM transgender individuals, Ujike et al examined sex steroid receptor genes and found no association with transgender identity.[28]

There have been several small case reports of atypical sex chromosomes in transgender individuals. The most common association reported was with disomy-Y (47, XXY); however, no statistically significant association between particular genes has been described.[29] Two recent studies of MTF and FTM transgender individuals reported that aneuplodies are slightly more common in transgender individuals than in the general population, but neither was controlled. In the first, karyotype abnormalities were found in 2.5% of the 368 transgender individuals studied.[30] A second study of 302 transgender individuals also showed a low overall incidence (1.5%) of chromosomal abnormalities.[31]

Twin Studies. Twin literature supports the potential contribution of genetic factors to the development of transgender identity. In 2 separate retrospective studies of twin pairs, Bailey et al and Coolidge et al demonstrated a strong heritable component among twins with transgender identity.[32,33] Hylens et al performed a similar study of 23 monozygotic twin pairs and showed that 9 were concordant for transgender identity compared to no concordance among dizygotic twin pairs.[34] Two small studies[35,36] also demonstrated a higher concordance for transgender identity among monozygotic twins versus dizygotic twins. Nevertheless, the overall prevalence of monozygotic twins discordant for transgender identity still outnumbers those who are concordant.

Neuroproteins. Brain-derived neurotrophic factor (BDNF) is a member of the growth factor family involved in synaptic plasticity and neuronal development. Altered BDNF signaling is thought to be a contributor to psychiatric conditions. Fontanari et al[37] reported that serum BDNF levels were 15% lower in an uncontrolled study of 45 MTF transgender individuals. However, all study subjects were treated with hormones, and no female subjects were included.

Neurokinin B (NKB) is a potent regulator of gonadotropin-releasing hormone secretion, which is essential for reproductive function. A postmortem brain study of 4 MTF transgender individuals by Taziaux et al[38] showed a mean infundibular NKB volume similar to control females. The observed feminization may have been explained either by medical estrogen therapy or lack of androgens due to orchiectomy.

Prenatal Exposures. Dessens et al[39] reported that 3 prenatally anticonvulsant-exposed subjects were transgender individuals. For many years, researchers have been assessing the impact of prenatal exposure to the estrogenic antimiscarriage drug DES (diethylstilbestrol) on the development of gender dysphoria in affected offspring. While the vast majority of DES-exposed children have not developed transgender identity, a 5-year online study of DES-exposed sons by Kerlin et al reported at least 150 cases of moderate-to-severe gender dysphoria among 500 sons with confirmed or suspected prenatal DES exposure.[40]

Although no studies to date demonstrate mechanism, multiple studies have reported associations with gender identity that support it being a biologic phenomenon. Table 1 organizes areas studied by study type and lists the associations that have been made.


Current data suggest a biologic etiology for transgender identity. Studies of DSD (Disorders of Sex Development) patients and neuroanatomical studies provide the strongest evidence for the organic basis of transgender identity. Because the sample sizes of most studies on this subject were small, the conclusions must be interpreted with caution. Further research is required to assign specific biologic mechanisms for gender identity.


56. Big Irv

July 21, 2018

Today a friend recommended watching West Side Story and the video about the making of West Side Story.

By coincidence, last evening I spent an hour on the phone with a chum and roommate from my college days, Irwin (Irv) Kostal, who is living in Indio.

We met and were pals when I was on vacation from college and was working that summer at home in New Jersey.  Irv was then going to the local college in my home town and we met at the local ice cream shop.

I soon met his family on Long Island and learned that his father was the music director for several TV  variety shows, (Sid Caesar, Carol Burnett, Gary Moore).   During several visits I got to know his dad, who had the same name as his son and was known as “Big Irv.  My pal was “Little Irv”, which was pretty funny since they were both several inches over six feet tall.   Irv transferred to the University of Chicago and we became roommates in an off-campus apartment.

At some point in those early months of our friendship, Big Irv began working with Leonard Bernstein as the orchestrator for his new broadway musical then in production, West Side Story.  Later, when West Side Story was made into a movie, Big Irv went to Hollywood and began a career as musical director, making movies that included, Mary Poppins, Sound of Music, Charlotte’s Web,  and Chitty Chitty Bang Bang.  His Oscar, as I recall was for Mary Poppins but I could be wrong about that.

In the early days when they were working on the stage version of West Side Story I was hearing Big Irv at the piano working on the music arrangements at their home, which was an ordinary suburban home to which a previous owner who was a dance teacher had attached a 30 by 40-foot dance studio.  That studio became a living-room/work room with a Steinway grand piano and a huge hi-fi system (before “stereo” came along).

Big Irv died in the early 1990’s, and Little Irv lost his second wife a few weeks ago, but my glancing exposure in 1953 to the entertainment world, and music at that level of brilliance seems as if it happened only yesterday.

One other connection.  Though it had always been an open secret in the movie world, most people weren’t aware of the fact that leading ladies often had their singing voices dubbed by vocalists well known in the industry, but who never got a line in the credits.  Such a one was Marni Nixon, who sang for Natalie Wood in West Side Story, and for Audrey Hepburn in My Fair Lady (another one of Big Irv’s films).  I last exchanged e-mails with Ms Nixon a few years ago, when she was still performing in clubs.  

On one weekend visit, I had taken two of my favorite records over to Long Island to share them with Big Irv.  I wanted him to hear two unknown singers I thought were great.  One was Julie Andrews, a young British understudy who had brought “The Boyfriend” to New York when the London star didn’t want to risk it flopping in America.  Big Irv didn’t like the ’20’s “flapper” music.  And the other was singing on a kids record called “The Mother McGoo Suite”, featuring the Mister McGoo cartoon character.  Big Irv scoffed that anyone could sound good using an echo chamber and brought out his example of a great singer, on a record of tone poems by Arnold Schoenberg, with whom he had once studied.  His singer was hitting each note perfectly in sequences of impossibly difficult intervals.

I was impressed, and the voice began to sound familiar to me.  We checked the records.  It was Marni Nixon singing on both of them.

Of course he later worked with both those women in wildly famous films, and, years later, pretended not to remember how he resisted listening to them that day.


55. Gwen, and Robert Moses’ Daughters

October 23, 2019

I didn’t know the man myself, but as a child I often heard his name mentioned by the sturdy but lumpy woman who looked after his daughters, Barbara and Jane, every summer for several years.

Robert Moses was, for half a century, arguably the most powerful man in the city of New York, the planner and so-called “master builder” responsible for its development in the early and mid-20th Century, and for huge projects on Long Island, and in Rockland and Westchester Counties as well.


Before and during World War II, in order to escape the swelter that was New York City, every summer, Moses and his family moved to their place at “The Lake”, where they hired a local woman, Gwen Larlham, to look after their children.   

Gwen was the second-oldest of the five girls and four boys of a woman widowed in 1923, when a drunk driver killed her contractor husband as he stepped off a trolly near a hotel lobby renovation job in neighboring New Jersey. 

After his death, Della had supported her brood by turning their large home, built with his own hands by their husband and father, into a boarding house.  Like the others of her siblings in their turn, Gwennie had gone to work early in order to add her salary to the income from the boarders, and help support her mother and the younger children.

Unlike her eight brothers and sisters who were all extremely bright, Gwen was slower to understand some things than the average person, moved with an awkward, plodding gait, lacked animation, and wore glasses as thick as the bottom of a Coke bottle.  Peering through her glasses her magnified eyes always made her seem like she didn’t quite comprehend what was going on, which wasn’t strictly true.  Her plain face rarely held a smile.  It was as if everyone else had gotten the joke and she didn’t. That was true.  She never got a joke until it was explained.  It was as if she was a few beats behind, trying to catch up with whatever was going on. Still, no one in the family teased her or treated her unkindly.  She in turn, was a friendly and loving person towards others, if seeming a little out of touch and and tentative.

The other eight did very well in high school.  The boys went off to be iron workers and craftsmen in the building trades, one girl became a beautician with her own shop, another an executive secretary. One ran off to Toronto with a handsome Canadian, and another married a tall, shy fellow who could fix anything, was a talented photographer, and made his living as a postman carrying the mail in Hackensack. Gwen, however, remained at home with her mother and worked as a domestic — which is presumably how she happened to be hired the first time to look after the Moses girls.

After which her inclination to treat children as her equal, which in some ways they were, must have helped her form a bond with them that their parents found they could trust and rely upon.

At home, Gwen often talked about Mister-Moses-this and Mister-Moses-that.  With a bit more enthusiasm than one might expect to hear from an employee. But again, it was as if her simplicity had resulted in a trusting loyalty towards Robert Moses and his family.  She often said that he was a very important man.  On the other hand her tone carried no implication of celebrity worship — and in any case, he was not that kind of celebrity.  Most local people had no idea what power he wielded.  Even later, most people didn’t know that it was because he wouldn’t build them a new stadium that the Dodgers left Brooklyn.

Towards the end of the war Gwen met and married George Schafer, a corpulent laborer of normal intelligence,  who had a florid complexion, and who loved her and treated her well.  Rather than Gwen leaving her mother’s home, he moved in with them.  Which turned out to be fortuitous, because a couple of years later George, who was epileptic, had a seizure while digging a ditch on a road project.  He was alone when he fell face down, and drowned in three inches of water in the bottom of the ditch before others found him.

Gwen remained with her mother until Della died in her nineties, then moved in with a niece and lived to a similar age, helping with household chores and with the niece’s children. 

This story is told from the perspective of the ten-year-old that I was when I formed these impressions and I may have mis-imagined some of the facts.  Now, with 75 years of hindsight and a medical degree, I’d guess Gwennie was on the mild end of the autism spectrum and would now be diagnosed with Asperger’s syndrome.  Gwen Larlham was my mother’s older sister and my Aunt Gwen when these events transpired, in Greenwood Lake, New York in the early 1940s.


54. Some Specific Facts About the Federal Court Injunction Sheriff Arpaio Violated — And the Background Context Surrounding the Present Case

January 6, 2018

Deep Background:  The overarching question is whether a nation has a right to decide who may enter through its borders.  Under the principle of national sovereignty established by the Treaty of Westphalia in 1648, one of the powers that characterizes a nation is that only it may decide who enters and who may not.  On the other hand, there are people who assert the argument, on its face utterly absurd, that national borders should be open to any who want to cross them.  

Though they do not often say it out loud, the open borders position is the one taken by many “globalist” liberals and by most immigrant advocates and organizations.  One way they imply this position is by avoiding the term “illegal immigrant” and referring to those who have sneaked across the border as “immigrants” or at most, “undocumented” people, as if permission to enter a sovereign state were not required.

So the first question we need to consider, if only briefly, is, is there still a reason to have nations (with borders) in this present-day world.  A person’s answer to that question will influence how he or she views the rest of the events in this controversy.

Because of its position on the Mexican border, this controversy has played out in Arizona for many years. Under the Obama administration in the most recent decade, the policy of the federal government was that, by executive order from the president, it would not enforce immigration laws.  Under his Attorney General Eric Holder, Obama’s Department of Justice went even further, asserting that it was not the business of the States — in particular, Arizona — to enforce Federal immigration laws.

One further background element:  When Obama ran for president and some questioned whether he was born in the U.S. as is required of a presidential candidate, the AZ Secretary of State — in charge of elections — asked the Sheriff to investigate whether Obama was eligible to be placed on the ballot.  Arpaio’s investigators found that the birth certificate published by the White House was probably altered in Photoshop and contained some errors suggesting it may have been forged.  Many Arizonans, possibly a majority, have felt that later DOJ investigations of the Sheriff were in retaliation for his investigation of Obama’s birth certificate.

An Attempt to Describe and Clarify the Specific Issues in Sheriff Arpaio’s Case

Specific Background: of the criminal contempt of court for which the Sheriff was just pardoned by the President.

After being told that Arizona could not enforce federal immigration laws even though it is one of only four Mexican border states and is heavily impacted by illegal immigration, the state legislature passed two state laws, criminal statutes 13-2008 and 13-2009, making it a Class 4 or Class 3 felony to steal the identity of another person in order to defraud them or to obtain employment — which can mess up the victim’s social security, unemployment or worker’s compensation accounts.  The laws were also amended to make it a felony under the Legal Arizona Workers Act to assume the identity of a fictitious person to obtain employment.

One effect of these laws was to bring anyone who violated them, including illegal immigrants, under the jurisdiction of Arizona law enforcement officials, including Sheriff Arpaio.



A Phoenix-based immigrant rights group (that is careful never to distinguish between legal and illegal immigrants and essentially pretends they are the same thing), filed a class action law suit on June 18, 2014, in the Federal District Court in Arizona, against the Sheriff, the County Attorney and the Director of AZ Public Safety (the state police), challenging the two laws.


Ignoring the identity theft aspect, the suit framed the issue in terms of Arizona intending to criminally punish individuals “who do not have federal authorization to work” (because they have entered the country illegally and have stolen someone else’s identity) simply for the act of securing employment.  The suit says the laws were favored by “Arizona nativists”, meaning legal citizens, “to make life difficult for immigrants coming from Mexico and Latin America”.  (Again, the suit seeks to conflate illegal immigrants with legal immigrants.)

The suit alleged that portions of Arizona Statute 13-2008 and 13-2009 are preempted by federal law and violate the Equal Protection Clause of the U.S. Constitution.

Preemption means that if a government, like a state, makes a law, then no lower jurisdiction, like a county or city, can also make a law covering the same subject matter.

The Equal Protection Clause of the 14th Amendment to the Constitution says: “…nor shall any State deprive any person of life, liberty or property without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”

 In this lawsuit the judge agrees that on the face of it as written, the law applies to citizens as well as immigrants and illegal aliens.  On page 20 of the 48 page decision he says that, however, in a case where federal preemption is in question, the court may look at the intent of the statute in question, and that in this case there is an arguable likelihood that there was an “intent” for it to be applied mostly to illegal aliens, who would almost exclusively be the ones needing to use a false or stolen identity in order to get work.   (Not, as I understand it, that this court will decide the equal protection issue in this hearing, but the judge may have used this reasoning to satisfy one requirement for a “pre-trial” injunction: that the maker of the motion for injunction is likely to win on the Constitutional issue when the trial is finally held.   This is called “a likelihood of success on the merits”. )

The judge also decided that there was a likelihood and not just a mere possibility that the various plaintiffs would suffer irreparable harm if the court did not prevent the enforcement of the law while awaiting the later decision as to whether it was constitutional.

Finally, the court found that pubic interest favored an injunction.  Therefore in January of 2015 it granted the plaintiff’s request and enjoined the Defendants “from enforcing ARS section 13-2009(A)(3) and the portion of ARS section 13-2008(A) that addressed the actions committed ‘with the intent to obtain or continue employment’.”

To see thefull text of the Judgement granting injunction:

In this decision the court was not deciding the equal protection issue, but did consider that issue because it was deciding various motions, e.g. motions to dismiss the charges by the defendants and motions by prospective plaintiffs to be a part of the case.  He found the plaintiffs’ allegations plausible, but was not hearing the case in chief, and not, of course, hearing all the evidence that would later be presented.

[On the matter of the equal protection clause of the 14th Amendment of the Constitution, the Plaintiff’s argument might be said to be analogous to an argument that since 96% of murders committed in the inner city are done by black people, laws making murder illegal violate the Equal Protection clause because they will be enforced largely against black people.  The absurdity of such an argument in that context may be used to support the Constitutionality of the Arizona law against stealing identity or creating a fictional one in order to work illegally, even though that crime would usually be committed by illegal aliens.   The Plaingtiff’s argument may be reframed thusly:  Laws against criminal behavior violate the Equal Protection clause because they fail to protect criminals as much as they do those who are innocent.  This is a bizarre case of circular reasoning that will surely fail when the Constitutional issue is tried and appealed. ]

It was the injunction of the court trying only the motion to enjoin that the Sheriff violated, by continuing to enforce the Arizona laws.

When someone violates a court order or refuses to do what a judge says, he or she is said to be holding that court’s order in contempt and is said to be, “in contempt of court”.  

In many cases the court may find that person in “civil contempt” which is defined as follows:  

Civil contempt generally involves the failure to perform an act that is ordered by a court as a means to enforce the rights of individuals or to secure remedies for parties in a civil action.

However this judge found Arpaio guilty of criminal contempt:

Criminal contempt involves behavior that assaults the dignity of the court or impairs the ability of the court to conduct its work. Criminal contempt can occur within a civil or criminal case. For example, criminal contempt occurs when a witness or spectator shouts or insults the judge during a trial. A civil contempt usually is a violation of the rights of one person, whereas a criminal contempt is an offense against society. Courts use civil contempt as a coercive power, wielding it only to ask that the contemnor comply with the courts’ actions. Criminal contempt is punitive; courts use it to punish parties who have impaired the courts’ functioning or bruised their dignity.

Therefore, he was facing jail time until he received a pardon from the president.  A pardon means that he is declared innocent and the crime is not part of his record.  Every president pardons a dozen or two people, many of them on his last day in office, all of them having been convicted of crimes and many of them while serving their sentences.  These pardons are virtually always “political” in nature.

Though pardoned and declared innocent, Sheriff Arpaio was left with hundreds of thousands of dollars of legal fees, for which to this day he seeks contributions from his many supporters.


53. When they started calling doctors “providers”

August 2, 2019

As a once-upon-a-time journalist, and to some extent a propagandist,  I was very sensitive to and suspicious of this linguistic trick when it was first applied by those in government who favored Kaiser’s HMO model, what, forty years ago ?  Sure enough, within a year, insurers began encouraging and covering visits to “providers” with training one or two orders of magnitude less intense and extensive than that of physicians.

It has been the frog in the pot-of-water-heated-gradually ever since.  Physician-control over “health care” (which used to be called “medicine”, remember ?) was taken over by stealth, and the standards, methods and means of rendering medical care was relinquished by doctors themselves into the hands of the business class.

Keep in mind that Business Ethics is the prototype oxymoron.

When I worked for a large airline as the director of one of its busy regional medical departments, I had a decade to ponder the question of who, in a business hierarchy, it the “boss”.  After about 30 years in private practice, and the last 20 as a solo practitioner, I was able to conclude that the person who tells you how you will spend your working hours and can hire and fire you is the boss, no matter how exalted your title.

Not too many decades ago it was illegal in my state for a corporation to practice medicine.  A good call, because if a patient walked into my office with the personality characteristics displayed by the average corporation, I would, as was suggested by a famous Canadian film documentary, diagnose him or her as sociopathic.

Those who coveted the control of doctors over medical care have followed a clever strategy, because by gradual encroachments they have avoided provoking doctors into a direct confrontation of powers, in which they would have lost.  And they have trained a generation of doctors in the submissiveness that will prevent them from ever reclaiming what was once their profession.  By preferring to concentrate on the technological aspects of medicine and the satisfactions of patient care, physicians have now become incapable even of understanding the concept of a profession, much less of being able to reclaim their own.  Because, as people who have always tried to please their parents and their teachers, they are constitutionally incapable of doing anything that would incur the displeasure of patients or authorities – or virtually anyone.

Someone once said that other than direct force, which I do not advocate, the only power we have over others is to withhold ourselves from them.  It is because of this that the STRIKE has been the driving force of the union movement.  But thus far, physicians have been unwilling, except in very isolated cases, to strike in order to resume control over how they spend their time and to what standards of care they will respond.  As a consequence, 60% of their time is consumed proving to people who are incapable of understanding their explanations, that they have reasons for what they do.

Ironically, because doctors are forced to waste that time, they no longer have time to spend with the patient, listening, thinking, and explaining what is going on and what needs to be done.

We have become the “providers” they wanted us to be, and now we provide CONSUMERS with the products of the limited imaginations of our bone-ignorant bosses.  We provide what THEY, totally untrained in medicine, THOUGHT medicine was providing.  And we have given up what was, unbeknownst to them, the essence of our professional value, the healing relationship we had with our patients, and the unbending adherence to our professional standards of care.


52. A Jump-Rope Song

September 27, 2020

One of the mysteries of life is what our brains are doing when we are asleep.  We now know it is not simply a matter of recharging their energies, and that the brain is, for instance, actively processing and forming memories.  And that problems we pondered before going to sleep are often resolved when we emerge from sleep.  But our knowledge of the brain asleep is still very sketchy.

This morning I stumbled out of bed, peed and washed my hands and face.  As I placed the sliver of soap back in the dish, a bubble dome, about an inch in diameter, formed on top of it, and instantly, in the sing-song voices of little girls, a fragment of the words of an old jump-rope song, not heard in 80 years, came into my head:  “the next day he died with a bubble in his throat”.

A few minutes later I found on line, and immediately recognized, the rest of the song.

Lulu had a baby, 

his name was Tiny Tim; 

she put him in the bathtub 

to teach him how to swim.

He drank all the water, 

he ate all the soap, 

the next day he died with a bubble in his throat.

Now I am wondering about jump-rope and the songs from children’s games.  I remember learning that “Ring around the rosie;  Pocket full of posies;  Ashes, ashes; all fall down”, is from the time of the bubonic plague, when flowers were used to ward off contagion, and perhaps the smell of death, and the bodies and belongings of the dead were burned to ashes to stop the spread.

So how did I know then, and why was it so, that girls were expected to jump rope and boys could not, except on the occasional dare from the girls?  I think I took the dare once, maybe twice, but knew it couldn’t be a regular thing.

Ah, well, I spent a pleasant hour just now browsing through the metaphorical and allegorical meanings of jump-rope songs and nursery rhymes.

How does this connect to recent conversations here?  Well, in many cases the true political meanings were concealed in nursery rhymes because adults were not free to speak of them.   To speak against the king resulted in severe punishment, just as today, speaking against the established mob, (the one that designates itself as the arbiter of political rectitude), results in threats to, and assaults upon those who dare it. 

Whereas centuries ago in Europe it would have resulted in actual decapitation, now that is still true only in existing islamic theocracies or among those who aspire to establish them.