You Must Be Some Kind of Therapist

222. Diana Lutfi
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[00:00:00] Diana: You're seeing essentially the war over the push for more drugs and more procedures, as opposed to just listening to our bodies, making lifestyle changes, making dietary changes, understanding that perhaps the [00:00:15] problem that you're having can be solved with one thing, and that one thing you'd have to essentially find throughout this morass of the system because nobody is essentially going to tell you.

[00:00:27] Announcer: You must be some kind of therapist[00:00:30]

[00:00:32] Stephanie: Today, I'm welcoming back to the podcast Diana Lutfy. She's an independent legal expert, healthcare regulatory and bioethics consultant, and coalition movement builder. You may have [00:00:45] originally heard her on this podcast on episode 138, where we discussed the United States versus Skrmetti Supreme Court case, in which, uh, Diana played a role helping put together a Detransitioners amicus brief.

[00:00:58] Stephanie: Today, we're going to talk about [00:01:00] how broken the American healthcare system is. Diana has some insight on that, and I might get an opportunity to rant about a personal saga. And besides that, we have important news to discuss with regard to Colorado House [00:01:15] Bill 26-1322, called Civil Actions for Conversion Therapy Survivors, which appears to have been a reaction to the Chiles versus Salazar Supreme Court victory.

[00:01:27] Stephanie: So Diana, I'm so glad to have you here to talk [00:01:30] about what the heck is going on in Colorado, which I have deemed, uh, unofficially, a- according to me, um, the worst state to be a parent in the United States. Um, we're, yeah, [00:01:45] worse than the whole West Coast. Um, so the parents in our audience and everyone following the gender wars and the therapy wars, definitely going to want to, um, stay tuned for your expertise on that.

[00:01:57] Diana: Before we get into Colorado and my

[00:01:59] Stephanie: [00:02:00] conversation with today's guest, Diana Lutfy, I want to give you a personal on-ramp into the subject of just how broken the American healthcare system is, because I just personally lived through it. In our conversation, I explained all of this to [00:02:15] Diana, but that story took too long, so I'm giving you a condensed version instead.

[00:02:19] Stephanie: So for context, I do not trust the American healthcare system, and I don't trust health insurance I think it's a scam, so I'm on a health share plan instead, [00:02:30] and I am accustomed to paying for things out of pocket, many of which I'll never be reimbursed for, and some of which I will. I recently ran headfirst into the system's brokenness with a gastrointestinal problem.

[00:02:41] Stephanie: It started with acid reflux and abdominal [00:02:45] pain. I went to a gastroenterologist, answered several intake questions, and the answers apparently meant that I needed a $3,000 procedure called an endoscopy under sedation, which would send a camera down through my esophagus to the [00:03:00] upper small intestine to rule out ulcers, tumors, and visible damage to my esophagus and stomach.

[00:03:05] Stephanie: It took me a while to get the procedure scheduled because I had a cold and work, and it was about six weeks until I could finally have the [00:03:15] procedure. The whole time, I was suffering, and I was taking over-the-counter antacids, which ended up making the problem much worse. When I finally did the procedure, there was nothing visibly wrong with any of the tissues that the camera was able to examine.

[00:03:29] Stephanie: The [00:03:30] biopsies for celiac and H. pylori will take a few more weeks to come back still, but I expect those to be negative as well. But here's the thing. At the very first appointment where I sought care for acid reflux, I told the doctor at the time that I was burping a lot, which was not common for me, [00:03:45] something I'd never really experienced before, frequent belching.

[00:03:47] Stephanie: That is a classic sign of SIBO, small intestine bacterial overgrowth. Not one of the three doctors I talked to at that clinic ever raised the possibility that SIBO might be part of the problem. In [00:04:00] fact, some of them even had this attitude of, "Well, some doctors don't even believe in SIBO," as if it's a belief system, not a diagnosable and treatable condition.

[00:04:09] Stephanie: So it took me doing my own research and connecting the dots myself. SIBO produces gas that pushes stomach [00:04:15] acid upwards. That's what was causing my reflux. And the acid-suppressing drugs that they kept steering me toward and that I was relying on while waiting for the endoscopy and results can actually cause or worsen SIBO.

[00:04:28] Stephanie: Meanwhile, I had multiple doctors [00:04:30] reassuring me that being on a proton pump inhibitor for life would be no big deal. The problem was that taking antacids to manage my condition in the interim did worsen my underlying condition and shifted the location of the pain so that I was experiencing profound [00:04:45] cramping sensations in my mid-abdomen.

[00:04:47] Stephanie: What this means is that the SIBO was likely causing the acid reflux in the first place, and as one would predict, suppressing acid worsened the problem. So by the time I begged to get tested for [00:05:00] SIBO, I was in a lot of pain every day and taking a lot of over-the-counter things and supplements just to get through each day.

[00:05:10] Stephanie: I was also on an extremely restrictive diet. I went low FODMAP and I lost eight pounds. [00:05:15] I had to beg to get tested for SIBO nonetheless. I had to come up with that hypothesis myself, book a new appointment to present it to a new provider. I had to take a lot of action on my part to expedite the process of getting tested, and then I had to chase down the results, which [00:05:30] came to my patient portal looking blank, and pull out of a nurse the phrase, "Hydrogen positive, methane negative."

[00:05:37] Stephanie: That nurse didn't know what it meant. Thankfully, I did. I-- and I already knew the drug that I needed, which is called rifaximin. [00:05:45] Uh, the brand name is called Xifaxan. Then it got worse. I learned that that drug costs $2,000 plus. I'd assumed that it was available as a generic. Turns out the generic is available in Canada, but not the US for some [00:06:00] reason.

[00:06:00] Stephanie: And unfortunately, my lack of knowledge about the cost of this drug was communicated to the wrong nurse at the wrong moment, and that resulted in a miscommunication where the doctor thought I wanted a cheaper alternative before I knew what the [00:06:15] cheaper alternative was. The doctor wasn't responding to any of my messages, wasn't calling me, wasn't responding in the portal.

[00:06:22] Stephanie: Everything was getting routed through staff. While the doctor remained silent on me, though, I finally heard that they sent in a prescription for a cheaper [00:06:30] alternative called Cipro. Cipro is a cheap antibiotic in a class called fluoroquinolones that carry a black box warning for permanent neurological damage.

[00:06:41] Stephanie: The only reason that I knew to refuse this drug [00:06:45] was that I had happened to have recently come across social media content warning against what this drug can do to people. Surely enough, when I heard that name Cipro, I opened the X app and searched for it, and the first thing I saw was actually a former guest of this podcast, [00:07:00] Dr.

[00:07:00] Stephanie: Josef Witt-Doerring, who has been on here to talk about the harms of psychiatry. I saw a clip of Dr. Witt-Doerring saying he would never let anyone in his family take Cipro or any kind of fluoroquinolone. So once again, I'm doing my own [00:07:15] research. The doctor is not communicating with me to ask my preferences.

[00:07:18] Stephanie: The doctor simply assumes because he hears from a nurse that I'm just learning about the cost of Zyfax, and he just assumes that I'm going to want the cheap alternative, and he doesn't take into account my medical history. Here's why this matters for me. I'm a POTS patient. [00:07:30] I have dysautonomia. My nervous system is already not working optimally, and I'm on three medications when I'd rather be on zero just to manage day to day.

[00:07:39] Stephanie: So no, I'm not going to risk taking a drug that could permanently damage my nervous system. I would rather [00:07:45] spend the $2,000. But because the doctor isn't responding to any of my messages in the patient portal, isn't calling me back, everything seems to be miscommunicating, getting routed through different people answering the phone, I end up physically going to the clinic, making [00:08:00] eye contact with a human being to explain the miscommunication.

[00:08:04] Stephanie: Oh, and by the way, I had told the doctor now several times that I had this upcoming family vacation that was very important to me, that my symptoms were currently at such a level that I wouldn't be able to enjoy the vacation [00:08:15] at all, I was worried about ruining it, and that I would really like to complete the two-week course of antibiotic before the vacation.

[00:08:20] Stephanie: If he had responded in a timely way, that would have been possible. It is possible because I made it happen, but that's because I chased down people. So the next thing that happened is that I went to the [00:08:30] clinic, made eye contact with a human being Explained the miscommunication and asked to please receive a prescription as soon as possible for the $2,000 plus drug.

[00:08:41] Stephanie: I was also in touch with my pharmacy to find out if they had it in [00:08:45] stock. I knew what it cost. That's what it took. So by this point, I'd repeatedly explained to the doctor through messages of various types that I was trying to get on the drug of choice, Xifaxan, for this condition, and that I needed to complete the two-week course of [00:09:00] antibiotic before the trip, which was about two and a half weeks out.

[00:09:02] Stephanie: My situation, however, was treated with no urgency. That's why I had to go make eye contact with the nurse, explain it to her, ask for her help advocating for me, have her call the doctor after hours. He still didn't respond to any of my messages in [00:09:15] the, the portal, but finally, the prescription for Xifaxan showed up at my local pharmacy.

[00:09:21] Stephanie: So this is a prescription that I'd... I'd begged for the diagnosis, then I'd begged for the right treatment. I'd had to decline the wrong treatment, which could have done permanent n- neurological [00:09:30] damage. I finally pick up the prescription, and when I receive it, I learn that he's prescribed it twice a day instead of three times a day, 14 days either way.

[00:09:39] Stephanie: But three times a day for 14 days is the standard of care that I'd read about online, and apparently, it is pretty [00:09:45] universal I don't know why he prescribed it twice a day. Maybe he was trying to save me money, but he never asked me if I wanted to, to him to cut corners. He never asked me if I was trying to save money.

[00:09:53] Stephanie: He simply assumed, I guess. So while this saved me a few hundred dollars, he never [00:10:00] asked me if my preference was to cut corners or to have the most effective form of treatment. So once again, I had to help myself, do my own research, and figure out that with the gap that that left between breakfast and dinner, I should continue taking the herbal supplement oregano oil as an [00:10:15] antimicrobial with my midday meal to ensure a steady stream of antimicrobials.

[00:10:18] Stephanie: I will also mention somewhere in the middle of all of this, I had a telehealth urgent care visit in which I was told that I needed to go to in-person urgent care, and there they basically spent no time on differential diagnosis and [00:10:30] floated the idea that it might be a gallstone, and because of that, erring on the side of caution, I might need to go to the ER.

[00:10:36] Stephanie: There was no real workup. My later research told me it would've taken a couple minutes more of asking questions for her to do the differential diagnosis. I just had to ask my intuition, "Do I have a [00:10:45] gallstone?" No, I did not have a gallstone, and she could have done that through a differential diagnosis, but she treated it in a very surface way, so I wasn't given any real, real guidance as to whether or not I needed to go to the ER.

[00:10:57] Stephanie: But no, I don't have a gallstone. Anyway, now [00:11:00] I'm on Xifaxan. My symptoms are already changing. I even had to figure out my own diet because I had told this doctor that I'd adopted a low FODMAP diet to manage before getting the Xifaxan, and he never told me that although the low [00:11:15] FODMAP diet does manage symptoms, it also sends the bacteria into hiding, sort of hibernation mode, because it deprives the bacteria of their preferred food.

[00:11:25] Stephanie: And as a result, the low FODMAP diet makes it harder for the [00:11:30] Xifaxan to do its job. In other words, when you're on Xifaxan, you should not be following a low FODMAP diet. In fact, there's a supplement you can take, which I'd already started taking because of my own research, called PHGG, partially hydrogenated or hydrolyzed guar gum, [00:11:45] and taking PHGG, which is a certain type of fiber, with Xifaxan actually increases the chance that it will do its job properly.

[00:11:53] Stephanie: So I had to do my own research once again and find out what type of diet I should, should or should not be on while on [00:12:00] Xifaxin treatment. The doctor never told me any of that. So when I finally went back to meet online with my naturopathic primary care physician, who's not a specialist, I realized and told her that I wished I'd worked with her from the start.

[00:12:12] Stephanie: She actually has plenty of experience treating [00:12:15] SIBO and was well familiar with the protocol I'd designed for myself in the absence of real care. My doctor was disturbed that the gastroenterologist prescribed me Xifaxin twice a day rather than three times a day, which is, as she said, the standard for everyone.

[00:12:28] Stephanie: It's not because I'm smaller [00:12:30] or anything like that. Um, she did confirm that the standard for any patient like me with these symptoms, uh, would be to take it three times a day. So she didn't know why he prescribed any less. Um, she is currently chasing [00:12:45] down my medical records to try to find out what my hydrogen gas levels were and why he prescribed it at that frequency.

[00:12:50] Stephanie: But considering how severe my symptoms were, I'm guessing that my levels were actually pretty high. My doctor validated the supplement plan that I'd come up with myself, [00:13:00] um, the diet plan that I'd come up with myself, and just added a few adjustments, a few new pieces of information that were helpful And my doctor, my naturopathic primary care physician, also helped me work out a plan for obtaining [00:13:15] generic rifaximin from a Canadian pharmacy for much less should I need it again.

[00:13:19] Stephanie: So if you happen to be experiencing any of this yourself and you need to know, in the US it's 2,000 plus dollars for brand name Xifaxan. That's all you can [00:13:30] get. Apparently Canadian pharmacies it's like $100, but you have to go through some extra hoops and, um, it takes longer to arrive. So it's about four to six weeks to get the Canadian, um, generic, and I'll probably just go through that in case my [00:13:45] symptoms come back.

[00:13:45] Stephanie: So the moral of the story and what really stuck with me is that to get through this, I had to be my own advocate, do my own research, I had to have excellent communication skills, I ha- had to have a willingness to fight for myself, um, the willingness to treat someone who sees himself as an [00:14:00] authority as an equal, and the willingness to trust my own intuition.

[00:14:04] Stephanie: And the whole time I was met with this attitude that frankly felt quite dismissive, and it felt like they were like, "Oh, another middle-aged white lady with digestive pain. It must be anxiety." So I actually broke down crying to my husband [00:14:15] and explained my feeling like what about the people who don't have the same skills as me?

[00:14:19] Stephanie: What about people who don't have the IQ, the verbal skills, the system, healthcare system navigation skills, the, the fighting spirit, whatever it might be? What about the people [00:14:30] who didn't happen across a piece of content on social media about the black box warning on Cipro and other fluoroquinolones?

[00:14:37] Stephanie: What about people who are wary of using AI and would never research their symptoms to find out that [00:14:45] the small intestine bacterial overgrowth actually makes sense as the explanation for why I was having acid reflux in the first place? What about all of those people who aren't me, who could have the same symptoms and could be stuck with them for life, who would be stuck on a proton [00:15:00] pump inhibitor for life, which weakens their stomach acid, which creates further digestive pain downstream?

[00:15:05] Stephanie: The people who don't know how to ask for SIBO testing or don't know how to fight back against a false negative, 'cause I also learned that while I did test positive, there are a lot of false negatives when it comes to SIBO [00:15:15] testing. What about people who don't have the money to pay out of pocket for a $2,000 antibiotic or for oregano oil and allicin and PHGG and all of these other drugs, or who don't have the knowledge [00:15:30] or income or self-discipline to put themselves on a low FODMAP diet?

[00:15:32] Stephanie: I mean, there's so many ways that this could have broken down, and it's only because of all the strengths that I have at this point in my life, which I haven't necessarily had at other points in my life, and which I might not have if I, you know, get older and lose some of my [00:15:45] abilities. It's just very sad that I had to work this hard to be my own advocate, and what that says about how other patients are treated.

[00:15:51] Stephanie: So that's the story that I shared with Diana in a much less organized way than I shared with you just now. I hope I was able to condense it a little bit. And that's where I'm gonna [00:16:00] hand it off to Diana and bring her into the conversation, because the problems in the healthcare system are her world and her field of expertise.

[00:16:08] Stephanie: Here's Diana's response to my story.

[00:16:10] Diana: That's been part of the merge in, on a national scale to [00:16:15] understand chronic diseases, but also to figure out how to reform the system. Um, and the first sort of element is actually getting more physicians talking about, like, underlying causes as well as whether or not [00:16:30] what they're doing within their protocols are working, um, helping or harming the patients that they're claiming to essentially help.

[00:16:39] Diana: And that's part, like, I mean, that's, it's huge. Uh, it, [00:16:45] this has been an ongoing effort. There are definitely advocacy groups and organizations out there that are talking a little bit more about, like, giving patients and giving people a lot more information. The problem is At [00:17:00] the highest level, um, whether or not you're taking that generic drug versus the $2,000 drug, you wouldn't have had that information if you didn't have, um, Joseph Witt-Doerring on.

[00:17:14] Diana: [00:17:15] If he didn't even disclose, um, some of those black box warnings as, as well as, um, all sorts of issues in terms of how that complicates the body further, that wouldn't have gotten to you. You wouldn't have [00:17:30] had any information. You would've taken the drug that, uh, was prescribed, and countless, um, thousands, hundreds of thousands, millions of Americans do.

[00:17:42] Diana: Um, so at the highest level within [00:17:45] government, that has to get reform. Um, and that's i- in part what HHS and Kennedy and the FDA is trying to do right now. It's just extraordinarily difficult because any [00:18:00] individual or any organization that does try to h- make those changes happen, that tries to essentially take an active step towards reforming, um, even if you have very accurate [00:18:15] and robust scientific data, uh, you would have to essentially convince individuals that are used to not just making their profit, but who've trained their brains to essentially see healthcare and see their [00:18:30] patients in a particular way.

[00:18:32] Diana: It's a paradigm shift. That's what we're entering into, and your experience essentially demonstrates a lot

[00:18:38] Stephanie: of that. I remember the first gastroenterologist I spoke with, it felt [00:18:45] like half his job, he was kind enough, but it felt like half his job was just mentally preparing me for a life of being on PPIs, of, on proton pump inhibitors.

[00:18:58] Stephanie: And, you know, [00:19:00] having had a sharp decrease in my health in my 30s, um, which I'm now several years into that, I'm in my 40s, I'm, I'm stabilized compared to what I was, but, like, I am already on three medications, and I'd rather be on none. I already have to [00:19:15] walk within very tight guardrails in terms of my diet, my lifestyle, everything, if I wanna be able to function.

[00:19:21] Stephanie: And so I wasn't just gonna accept that, but it felt like that is the standard of care and, and encountering this over and over and over, [00:19:30] these drug pushers who don't even wanna bother to do a differential diagnosis-- Oh, I forgot to talk about the urgent care visit. I had an urgent care visit somewhere in there, because I had a virt- I had, like, a telehealth virtu- I had a telehealth urgent care visit, and they [00:19:45] were like, "Yeah, you need to go to urgent care."

[00:19:46] Stephanie: So I went to urgent care, and this lady spent, like, no time on differential diagnosis, but because she identified it was possible that this was actually a gallstone, she was like, "Well, it could be a gallstone, in which [00:20:00] case you need to go to the ER." And I was like, "Well, do you really think I have a gallstone?"

[00:20:03] Stephanie: And she's like, "I can't really tell you. Just erring on the side of caution, it could be a gallstone." So once again, I had to do my own research, tap into my own intuition, ask my body, "Do I have a gallstone?" And my body was like, "No, you don't have a [00:20:15] gallstone. That's not what this is." And I thought about, like, it would've taken her five more minutes to ask 20 questions that would've helped with a differential diagnosis.

[00:20:25] Stephanie: And, and it's like as a patient, you have to be your own best advocate. You have to [00:20:30] be not too afraid of conflict. You have to have good verbal communication skills, good research skills. You have to be willing to honor your intuition. You have to be willing to treat someone who, who views themself as an authority figure as an equal.

[00:20:41] Stephanie: And if you don't have all that, I mean, I, I honestly broke [00:20:45] down crying to my husband, and this is gonna sound like I'm really full of myself, but I was like, "What about people who aren't as smart as me?" Okay, these are my skills. I'm a professional communicator. Like, what about people who don't have those communication skills?

[00:20:56] Diana: Again, this is what makes it really, really scary. Um, within the [00:21:00] context of the profession, if you advocate too strongly, uh, to the wrong person, they can essentially, um, consider you more than just an incompetent patient. They can essentially hold you, [00:21:15] and that's what's essentially happened within the psychiatric community.

[00:21:19] Diana: This is essentially why we're at war, and it, it's more than just a war over medical freedom. Um, in the average daily person's context it is. [00:21:30] Um, but it is a war over whether or not the, hopefully the hospital system and the physician that you're essentially visiting, um, would allow you to, uh, basically advocate for yourself versus if, [00:21:45]

[00:21:45] Stephanie: if they're not.

[00:21:46] Stephanie: There is a lot of gaslighting in the psychiatric system, and I feel like that's opening a whole can of worms 'cause that's my field and I've worked there, and I, I, I see it both ways. But this is one of those things that they try to cancel me over, too, is when I say things [00:22:00] like, "Hey, look, we, we actually have psychiatric survivors who swear by a ketogenic diet, and it fixed them."

[00:22:06] Stephanie: It fixed them. They were psychotic. They were hallucinating. They were homeless. They were delusional. And switching to a ketogenic diet [00:22:15] completely fixed their psychosis. Like, we ought to listen to that, and people try to cancel me over saying this, too.

[00:22:22] Diana: Literally. And so that's, you're seeing

[00:22:25] Stephanie: that

[00:22:25] Diana: war. You're seeing essentially the war over the push for more [00:22:30] drugs and more procedures as opposed to just listening to our bodies, making lifestyle changes, making dietary changes, understanding that perhaps the problem that you're having can [00:22:45] be solve with one thing.

[00:22:49] Diana: And that one thing, um, you'd have to essentially find throughout this morass of the system 'cause nobody is essentially going to tell you.

[00:22:57] Stephanie: Yeah

[00:22:58] Diana: That's what makes it so [00:23:00] much more challenging and so much more difficult. There are emerging healthcare technologies, um, that are exciting, uh, novel, but the sort of limitations is convincing them [00:23:15] that dietary supplements changes, um, individuals like Dr.

[00:23:21] Diana: Joseph actually know how to essentially sift through this morass of, uh, [00:23:30] medical research, 'cause other doctors don't. They, they don't believe in that, right? All that every single academic does, um, is they go through research, and they [00:23:45] essentially determine whether or not they're going to trust certain sorts of things.

[00:23:49] Diana: All an organization ends up doing, like the AMA and WPATH and, and others that you've essentially witnessed, they go through whatever sort of [00:24:00] highest regarded medical journal, medical authority, and they say, "See, we have this study," without anyone actually looking at whether or not the data is producing,

[00:24:12] Stephanie: um, the results that it's claiming.[00:24:15]

[00:24:15] Stephanie: You know, we have these, like, TV shows that are popular, and I don't, I don't watch them, so I don't even know what they are. I feel like maybe House is one of them. But there's the fantasy of the doctor that, like, plays Sherlock Holmes, right? The fantasy of the doctor who really [00:24:30] cares about the differential diagnosis, who's passionate about finding a solution for this patient and uncovering, you know, the thing that makes it all better.

[00:24:38] Stephanie: And, and I feel like there's a reason that we have those TV shows, because they appeal to the fantasy in us [00:24:45] of someone taking our pain seriously, taking their job seriously as a detective who's gonna get to the bottom of things. And, and I feel like that's not how the system actually works. The system is designed to keep people [00:25:00] sufficing.

[00:25:00] Diana: That's part of the challenge is there's an emerging movement of independent physicians and independent practitioners that really do love their jobs, and I have seen them essentially play, uh, with Sherlock, right? [00:25:15] Um, they're doing their best, um, to basically treat every single person and every single patient, uh, with the best of their knowledge and abilities.

[00:25:24] Diana: But the problem is they're not necessarily even able to talk about standard of care reform, [00:25:30] because that's, that's a massive, like- real industry shift. Um, and that industry shift is, is tense mostly because a lot of the drugs that are out in the public, [00:25:45] um, now we have to start essentially questioning whether or not they're treating the conditions that they're claiming, and whether or not people should have been diagnosed with those conditions to begin with, and that's, that's part of the problem, [00:26:00] right?

[00:26:00] Diana: Um, that's why, like, I need a chart. Um, and- We are entering- Wait, hold ... into science words.

[00:26:09] Stephanie: Okay. Yeah. So before we bring out the chart, [00:26:15] I wanna frame this because- Sure When you say standard of care, you know, we've talked about the BS of the WPATH standards of care on this podcast, and how WPATH is a fraudulent [00:26:30] group of activists with an agenda who identify as a professional organization.

[00:26:37] Stephanie: And WPATH has made up their standards and identified them as the standards of care, right? Which [00:26:45] is a term that has different, a different meaning in the medical world. And so we've looked on this podcast a lot how fraudulent the WPATH standards of care are compared to the word standards or the phrase standards of care sup- just being something that's supposed to [00:27:00] have a meaning.

[00:27:00] Stephanie: But now what we're getting into is we're branching into other fields of medicine, and we're gonna talk about how the phrase standards of care... I mean, the, the standard of care I just discovered for a patient with acid reflux is you put them on a PPI for life, and you let them develop [00:27:15] small intestine bacterial overgrowth, and you let them live with chronic fatigue because they're not getting nutrition out of their food.

[00:27:20] Stephanie: Uh, that's the standard of care I'm discovering if someone has acid reflux rather than, "Well, why do they have acid reflux? What's causing the acid reflux? Can we fix that?" You know? [00:27:30] So now you're gonna show us our chart, and, uh, and remember that a lot of our listeners are just listening, they're not watching.

[00:27:37] Stephanie: So if you're on YouTube, you'll be able to see Diana's visual. And if you're just listening, we're gonna walk you through what's on her chart. Go ahead and hold [00:27:45] that up as still as you can for the screen.

[00:27:47] Diana: For sure. So I think the best way for me to talk about this is to talk about the timeline, right? From the last podcast that we had, um, in terms of, [00:28:00] uh, Strometti, the United States versus Strometti case.

[00:28:04] Diana: Uh, if anyone has followed it, uh, or any sort of knowledge of it, what it did in the academic [00:28:15] legal community, um, and in the broader academic community, is it revealed the undergirding war. There were 25 states, 26 states, right, that had supported the detransitioners, that [00:28:30] had said, "We're gonna ban this." Um, but the assault on banning it was an assault on the entire academic system, right?

[00:28:41] Diana: The entire medical system's standard of care. [00:28:45] That was essentially the war. That's what they went after. That's why AMA essentially partnered alongside several other organizations and said, "No, we-" We're not gonna stand for this. We're gonna fight. [00:29:00] We're gonna keep people essentially, um, on these standards because we truly believe that we're helping them, and here's the narrative that we're essentially gonna push.

[00:29:11] Diana: And that's the plaintiff's narrative, right? And what that [00:29:15] revealed throughout the country, um, is there is a civil war over all of these states and over how do we care for each other, and what is a essential role of science in society? [00:29:30] The problem is most people aren't really talking about it. Bioethics as an industry, um, and as an emerging industry never really touched upon something called standards of care.

[00:29:44] Diana: It was [00:29:45] only years later that it had gained its prominence because people were doing unethical research, right? So we had witnessed Tuskegee, we'd witnessed, um, a couple of different [00:30:00] sort of unethical scientific experiments, but those experiments are not considered standard. The standard is essentially what's already mainstream accepted by everyone in the [00:30:15] profession to be what's right.

[00:30:17] Diana: That doesn't necessarily make it right. Gender affirming care is one of them. There are many, many other sorts of topics, um, and your personal medical experience [00:30:30] ends up essentially kinda outlining the standard of care in gastroenterology. Like is, is to essentially go after the h- the most rigorous procedure and then charge you and say, "Hey," like, "This is essentially what you're gonna have to just deal [00:30:45] with the rest of your life."

[00:30:46] Diana: And the poor individuals that believe in all of that are the several thousands, if not the countless of Americans that ex- depend on it, that, [00:31:00] uh, almost believe that that's essentially what they have to do. That's just life. That's that. And that's what we're seeing. Um, there's almost an unraveling of the individuals that are essentially [00:31:15] within the system, kind of recognizing that perhaps the system and perhaps what we're telling people is not true, does not necessarily even line up with the latest research.

[00:31:26] Diana: And in the final straw, like why are we giving people [00:31:30] blocks, black box warning for, for their conditions? Um, we don't have to do any of that, and that shift is essentially emerging. Um, but in order for that shift to take place and in [00:31:45] order for more people to have, um, justice on like the detransitioner front We need to start talking and defining what science is, as well as all of the standards and all of the research that kind of go [00:32:00] into someone saying that this is science, that these standards are essentially based on science.

[00:32:07] Diana: That's the science wars. Um, last year, uh, from like the moment that the [00:32:15] detransitioner movement kind of came about and got consolidated because of that brief, uh, I discovered that a lot of this was essentially also centralizing around, um, RFK. And so whether or not you like him or hate him or [00:32:30] are indifferent to him, um, he rose into prominence and this was essentially my background.

[00:32:37] Diana: I was his law clerk. So I, I'd actually seen a lot of the horrifying data, um, [00:32:45] that had kind of emerged with the context of public health and the pandemic And, uh, we had, like, communities, if not individual members, uh, and [00:33:00] people essentially emerging and trying to speak up, trying to just say, you know, "We should have the right to say no.

[00:33:09] Diana: Um, we should have the right to essentially say we don't trust something. We don't trust the [00:33:15] system. We don't trust the government, and we don't necessarily trust healthcare to essentially say, 'Hey,' like, 'this is essentially what you need to do.'" Right? But, um, in order to tip him over, what we had [00:33:30] witnessed, all right, after the detransitioners ended up asking me, saying, "We wanna support RFK," had to consolidate all of them and, um, you know, push that through.

[00:33:42] Diana: But now there's an emerging [00:33:45] 6,000 physicians throughout the country that also support RFK, and that's not heard of. That's not necessarily out in the news because the mainstream news does not necessarily want people to know, [00:34:00] "Oh my gosh, there are other individuals that are recognizing that shift has to happen."

[00:34:07] Diana: So 6,000 physicians, scientists, healthcare practitioners, doctors, Eitan Heim, um, [00:34:15] Joseph was not necessarily part of that, but he's also part of, like, independent medical, uh, associations, uh, lists of physicians, individuals that are essentially emerging and talking about, like, the problems within the system.[00:34:30]

[00:34:30] Diana: Um, and the craziest part of all of this is here's where Lawfare comes in. So Lawfare, the first front of Lawfare, and this is the Colorado bill that we'll get into, it's to essentially curb [00:34:45] professional speech. If more healthcare professionals start recognizing that they have the power and the ability to start talking about what is wrong within the system and whether or not the [00:35:00] patients that are- being almost held captive by these systems are, um, essentially being hurt.

[00:35:09] Diana: When they have that a- ability, when they have that authority, um, [00:35:15] that's where a lot of the changes can start to emerge, right? So Joseph had protected his license by, um, going independent. There's a movement of a whole bunch of physicians trying to, to be independent and trying to, to figure out the [00:35:30] states, uh, where their license are not necessarily going to get yanked.

[00:35:34] Diana: Um, and unfortunately, in the context of Colorado, um, it's not, it's not necessarily the worst family-friendly states. They're-- The, the state on its [00:35:45] core is trying to, to protect the patient, but they're doing so by curbing professional speech, right? And they're essentially, um, viewpoint discriminating against, uh, any licensed professional that does not adhere to [00:36:00] how they view standards of care.

[00:36:02] Stephanie: Your trans-identified kid won't listen to reason because reason isn't what they need right now. They need a parent who knows how to communicate in an empathic yet strategic manner. [00:36:15] ROGD Repair gives you over 120 lessons in the psychology and communication tools that actually work when normal parenting doesn't.

[00:36:23] Stephanie: Plus RepairBot, your 24/7 AI coach trained on my entire body of work, ready to help you [00:36:30] navigate tough moments in real time. Visit ROGDRepair.com and use code SOMETHERAPIST2026 to take half off your first month I wanna acknowledge that when we have [00:36:45] conversations like this about not trusting the system, and healthcare freedom, and all that kind of stuff, we sound paranoid.

[00:36:53] Stephanie: And, you know, those of us with more paranoid traits might find ourself in this space more, those of us with issues [00:37:00] trusting authority, you know, myself included, right? And, and it's easy to dismiss our perspectives based on that, but I think it's also important to acknowledge when certain powers have lost people's [00:37:15] trust, when they've done things to undermine that trust, right?

[00:37:18] Stephanie: And that's part of the reason I started with my story, as long-winded as it was, because it's like I did go to the professional gastroenterologists hoping for a higher [00:37:30] quality of care within the system, and unfortunately what I discovered is very similar to what I've discovered in other fields. You know, like for example, in gynecology the standard of care is throw women [00:37:45] on birth control, and throw them on Lupron, and bone density be damned, and mental health be damned.

[00:37:51] Stephanie: And who cares about those studies saying that birth control increases the risk of suicide? Come on. Come on, right? Like, that [00:38:00] it changes who you're sexually attracted to. I mean, do we wanna look at the connections between birth co- control and the divorce rate? Women marrying men they were attracted to when they were on synthetic hormones, and then they go off of hormones, they get [00:38:15] pregnant, they have a kid, and suddenly he's disgusting and he doesn't smell right.

[00:38:18] Stephanie: Okay, so I already had my experiences with all of that before gastroenterology. But even someone paranoid like me, even a smarty pants know-it-all who doesn't trust [00:38:30] authority, who has... I, I have very little respect for social hierarchy, like that's my personality. But even someone like me, I can be vulnerable and try to trust them sometimes, and I'm let down every time.

[00:38:40] Stephanie: So I just wanna acknowledge, because I know there are certain listeners who, you know, they might [00:38:45] be a little bit, um, more normie, a little less paranoid and obsessive like me, you know? And it might sound, uh, you know, a- and I understand how it sounds [00:39:00] paranoid when you haven't had your trust broken over and over again, but we have to look at how these healthcare authorities have handled one thing after another.

[00:39:10] Stephanie: And for many listeners of this podcast, the gender issue is, like, the one and [00:39:15] only issue that drove them into realizing there was a problem. Or they've tried trusting therapists and been shocked and let down, like so many of my clients have, to discover that even a therapist they thought they vetted well ended up trying to pressure them into using their [00:39:30] kid's new name and pronouns, showing total ignorance.

[00:39:33] Stephanie: I mean, even therapists who, who supposedly recognize the harms of these kids going on life-altering hormones, um, you know, when they encourage that little bit of so-called [00:39:45] compromise, it really shows ignorance as to how these things work because the goalpost will keep shifting, right? So, um, I just wanna acknowledge that, uh, yes, personality and temperament play a role.

[00:39:58] Stephanie: Yes, someone like me tends to be [00:40:00] more obsessive and paranoid, and it can make us sound crazy. I recognize that. But also, trust has been lost for reasons, and that's the kinda stuff that you're talking about. And so I don't, I don't feel like we [00:40:15] completely went over your chart, though. Do you wanna just pull it back up and, and maybe put it a little closer to the screen and show us?

[00:40:22] Stephanie: 'Cause y- I think you were trying to point out something about this identity wars section.

[00:40:29] Diana: Yeah. [00:40:30] So a lot of, a lot of what's going on right now started with the identity wars. And it starts with individuals kinda coming and, and questioning, like, what, what it means to be [00:40:45] human. Um, but more so, like, how to essentially relate to the world, um, and to society, and to, and to the people that are essentially around them.

[00:40:57] Diana: We hadn't had any of [00:41:00] those topics or discussions in, in the context of academia and education. Instead, what we had was gender studies, right? Which, um, was kind of the emergence of, uh, essentially [00:41:15] pushing for, uh, a very distinct, uh, like, pro, like, gender fluidity agenda. Um, and that's also [00:41:30] where a lot of the conservatives and a lot of the individuals that had, um, garnered their support for detransitioners are also recognizing.

[00:41:39] Diana: That's also why we have 26 states, essentially, in the country that [00:41:45] are talking a lot about, like, "Okay, we need to start protecting people against medical abuse." So the government needs to essentially start stepping up because the medical community won't[00:42:00]

[00:42:03] Diana: That's where we get into the science wars because on a legal level, um, part of the problem is We have created within the legal [00:42:15] system, um, any regulated profession is self-regulated within that profession. So your, um, your license is essentially dictated and controlled by other therapists, um, in [00:42:30] the context of law.

[00:42:31] Diana: That's where the deference of judicial authority will go towards, um, on a state by state by state level. Uh, similarly any sort of doctor, any sort of nurse, um, [00:42:45] anyone that essentially has a license, including lawyers, um, their license is essentially dictated by the legal authority that governs their sort of pr- profession.

[00:42:56] Diana: Um, it's not necessarily controlled nor dictated by the [00:43:00] government, right? What the government can end up doing is the government can end up creating laws like the one that you're talking about in terms of Colorado to, to start, uh, shifting what a regulated [00:43:15] professional can or cannot do.

[00:43:16] Stephanie: And then it starts looking really wacky from inside the profession.

[00:43:20] Stephanie: So we're gonna get into that. I'm sure some listeners have suffered through my gastroenterology saga just to get to this more, uh, [00:43:30] on-topic subject of what's going on in Colorado as, uh, what do I wanna say? Colorado like a hotbed for the culture war over this issue right now?

[00:43:40] Diana: Colorado is a hotbed over the censorship of [00:43:45] professional speech.

[00:43:46] Diana: Um, so that tends to be Colorado's niche. Um, they've censored even attorney speech, right? So there, there was a previous case of a, uh, attorney that [00:44:00] had, um, passionately advocated for his client, uh, before a judge that he considered unfair, and because he ended up calling the judge fat, gay guy. The term gay used in [00:44:15] any sort of derogatory way, um, uh, triggered a licensing disciplinary action in the state of Colorado, and it triggered a disciplinary action against his attorney [00:44:30] license, um, which is crazy.

[00:44:32] Diana: But that's, that's the state of Colorado. That's the, the regulated speech censorship in Colorado. And so that's essentially also playing out with regards to like other regulated professions, right? [00:44:45] So in therapy, um, and in speech therapy, Colorado used to have a law that, um, essentially outline that they were not going to allow any therapist, um, anyone essentially practicing, uh, in, in the [00:45:00] public context to, to talk openly about, um- A non-affirmation only model.

[00:45:09] Diana: So, um, if you, uh, had a client and you said, "You know, let's [00:45:15] actually explore your, your identity, um, your, your natal sex identity," that would be essentially prohibited under Colorado's original ban.

[00:45:28] Stephanie: So this is where I [00:45:30] want to be very careful and very specific because, uh, things that I've said on this podcast have ended up being heard by people in a way that it becomes a game of telephone [00:45:45] that gets further and further away from the truth.

[00:45:47] Stephanie: Let me give an example. I'm going to read a text from a f- a beloved friend of mine. Uh, absolutely no shade to this friend, but this is a text that a s- a friend sent me that I think [00:46:00] does a good job of summarizing what people sound like when they get it wrong on this issue. And, and it's not their fault, it's because they're following this issue and they're, they're not therapy professionals, they're not legal professionals.

[00:46:13] Stephanie: They're just keeping up with [00:46:15] the culture war. They're trying to understand. They end up getting it wrong, and here's what it sounds like. Okay, so my friend texts me the other day, "I have a dumb question about gender-affirming care, but wanting to make sure I'm clear on how it works. I get that if you have a client who says, [00:46:30] quote, 'I'm trans,' you're required to affirm, and the next step is referral for medicalization.

[00:46:36] Stephanie: Talk therapy or questioning is off the table at this point." Is the same true if a client says, quote, "I think I might be trans," [00:46:45] or something to that effect that expresses ambiguity or uncertainty? What are the guidelines? Should you ask them, quote, "What makes you doubt that you're trans?" Or something like that.

[00:46:55] Stephanie: What's the correct response according to GAC? In other words, gender-affirming care. [00:47:00] So this is what my friend texts me. God bless his heart for trying to understand the issue. This is not accurate, okay? So I, of course, I text back, "Not exactly accurate. Too detailed to text." And we ended up having a [00:47:15] conversation later this day.

[00:47:16] Stephanie: But it's, it's a good description of what people come to me with all the time saying, "Okay, I understand you're required to affirm, but blah, blah, blah, blah, blah." Hold on. You're not required to affirm. People need to understand this point. Here is my [00:47:30] understanding, Diana, and you can tell me if there's somewhere that you know I'm factually incorrect.

[00:47:34] Diana: Okay.

[00:47:35] Stephanie: Number one, it's regulated state by state.

[00:47:39] Diana: Yes.

[00:47:39] Stephanie: Laws vary by state.

[00:47:41] Diana: Yes.

[00:47:41] Stephanie: But the definition of conversion therapy [00:47:45] is nationwide. It was redefined during the Obama administration to, from sexual orientation change efforts to sexual orientation and gender identity and expression change [00:48:00] efforts during the Obama administration.

[00:48:01] Stephanie: Do we agree on those facts before we proceed?

[00:48:04] Diana: Yes and no. So-

[00:48:06] Stephanie: Okay. Where do you

[00:48:07] Diana: disagree?

[00:48:07] Stephanie: Yes,

[00:48:08] Diana: as in it was defined nationally. No, as in it can still be [00:48:15] redefined- On a state-by-state level

[00:48:18] Stephanie: So some states, some states might actually choose not to include SOGIECE. They might choose to exclude gender identity and expression, [00:48:30] and have laws that specifically govern SOCE, sexual orientation change efforts.

[00:48:34] Stephanie: Correct?

[00:48:35] Diana: Yes.

[00:48:36] Stephanie: Okay. So just- Yes ... making sure we're keeping pace with each other- Yeah ... so far, right? So I am licensed in Oregon. My friend who texted me is in [00:48:45] California. He might be thinking of a family in Colorado. Individual state laws vary. Yeah. But now I wanna talk about the phrase required to affirm. So again, gonna give you an opportunity, gonna give Diana an opportunity to correct [00:49:00] anything where you know that I'm wrong, but here is my understanding.

[00:49:05] Stephanie: I don't know of any state with any law that s- specifically uses that language, therapists are required to affirm. That is m- in my opinion, not a correct [00:49:15] interpretation of the existing laws. What I would say is that the laws that do exist which govern so-called sexual orientation and gender identity and expression change efforts create a chilling and [00:49:30] hostile atmosphere in which therapists are-- therapists with a conscience that's more aligned with mine are extremely reluctant in that chilling and hostile atmosphere to explore [00:49:45] matters of gender and sexual identity and gender expression because of the hostility towards the perception that there is an effort at changing this thing.

[00:49:57] Diana: So that's a very general [00:50:00] statement, um, that applies to certain very s- distinct states, um, California being one of 'em, 'cause California actually gives, uh, licensed professionals a lot of leeway within their [00:50:15] regulated profession to practice based on their, um, understanding of an issue. They might, you know, feel uncomfortable with their colleagues and with whatever national associations, but that is part of the reason why the Childs versus Salazar case became [00:50:30] a national Supreme Court case, and why we had liberal justices essentially siding with Childs in that case.

[00:50:36] Diana: Um, Colorado regulates speech. Colorado legally does not make a distinction between your [00:50:45] personal speech and your professional speech. So if you end up having a client, and you are licensed in the state of Colorado, and you say, "Let's explore," or, "Let's do something," any, any [00:51:00] different than their gender-affirming care affirmation-only model Your license is not only on the line, but you can lose it.

[00:51:08] Diana: You can lose it as an attorney just as much. And so in the state of Colorado, if you are licensed [00:51:15] in that particular state, and there are some other states that basically also govern licensing too, um, it is much more than just let's, you know [00:51:30] Let's bravely speak out. It is, you can, and y- you might, uh, end up having to essentially fight for your position and fight for your license.

[00:51:43] Diana: And part of the reason why Colorado [00:51:45] ended up essentially doubling down after the Childs v. Salazar decision, um, with SCOTUS is because they know that their legislature can essentially create another scope within the context of law that would give [00:52:00] recourse if licensed professionals end up speaking and, you know, going and anything can be qualified as, as, uh A non-affirmation only model.

[00:52:14] Diana: So [00:52:15] they, uh The case was mostly about conversion therapy, but it undergirds a lot of the laws that make up the licensed professional speech. No one really talks about that in the context of Colorado, because [00:52:30] Colorado has a really good job of not only disguising that, but you have to find the actual regulatory codes, um, that undergirds those statements.

[00:52:41] Diana: Hang

[00:52:41] Stephanie: on.

[00:52:42] Diana: Wait. So in the context-

[00:52:42] Stephanie: Sorry. I'm sorry. I feel like we're [00:52:45] rushing through this, and I feel- It's a lot. I feel it's very important to me, because I have actually been- Yeah ... criticized. Uh, there, there is a gender critical therapist out there, I don't even know her name, but she has criticized me for, she thinks, [00:53:00] fear-mongering about this issue-

[00:53:02] Diana: Yeah

[00:53:02] Stephanie: because I haven't always been specific enough. So here's the thing. I don't feel comfortable using the language "required to affirm" unless we can point to where in the law it says required to affirm. So- And if that's not what it [00:53:15] says, I wanna know what it does say, because I think people are hungry for accurate information, and I know that I can stand on what I said when I said that the SOGIECE laws create a chilling and hostile environment.

[00:53:29] Stephanie: Yeah. [00:53:30] But if you mean something else, Diana, let's find the words. Let's make sure that we can represent accurately what the law actually says.

[00:53:38] Diana: We are looking at regulatory licensing wars. [00:53:45] So what does that mean? If you go into, um, what you're able to essentially say and not say, you have to go through, um, your essential board.

[00:53:55] Diana: In the state of Colorado, um, those professional licensing [00:54:00] boards have something called the catch-all unprofessional conduct. Within the context of unprofessional conduct, uh, they have, uh, specific sort of policies. Some of those policies are outlined in the state, and others you have to essentially do [00:54:15] deep database research in order to discover that.

[00:54:19] Diana: In the state of Colorado, I did research on four licensed professionals, including, um, essentially social workers and therapists. In so [00:54:30] far as there is that sort of model, anything that is cons- any speech that any licensed professional says that goes against an affirmation-only model that is [00:54:45] reported to the Colorado Board will be qualified as unprofessional conduct.

[00:54:50] Diana: They will not actively say that, because in law, the broader context of a legislation or a policy [00:55:00] or a regulation is, does not necessarily have to be actively defined. So administrative authority, like statewide authority, um, is governed by the profession that it is [00:55:15] The broader you make a legal language, so in the state of Colorado, for, for example, unprofessional conduct, that's governed by the board.

[00:55:24] Diana: That determination on whether or not a conduct or a speech is [00:55:30] professional or not professional, whether or not what you did was right or wrong in the context of your patient, in the context of the people that comes to you, is governed by that board. So whenever a complaint occurs, [00:55:45] um, it triggers a board investigation, and what the board ends up looking at is whether or not they have the legal authority to essentially yank that person's license or to, to hold that person in lower regard, [00:56:00] um, to issue a disciplinary, uh, notice, to issue a warning, to, to basically say, "Curb your speech In the context of Colorado, that language is not, quote unquote, "required to."

[00:56:14] Diana: No [00:56:15] law has language that is in the context of healthcare professionals, um, that says r- required to. What happens, um, administratively is you have a broadening subset of [00:56:30] authority, so unprofessional conduct, right? Or whatever the, the undergirding regulation is, and it trickles down. Um, and it doesn't just create a chilling effect when you know that in the [00:56:45] context of those medical boards and in the context of the licensing boards, that's essentially what they're going to do.

[00:56:52] Diana: That's how Childs v. Salazar ended up becoming a Supreme Court case, because the state of Colorado actively admitted that they [00:57:00] were not just going to discipline and punish anyone that does conversion therapy, but it goes beyond just conversion therapy. It goes into professional speech. Um, the Supreme Court decision in the Childs v.

[00:57:13] Diana: Salazar case [00:57:15] says professional speech, in essence, uh, should still be protected, um, alongside, like, personal speech, right? So your, your [00:57:30] ability to speak on behalf of your patient m- and to speak on behalf of what you're seeing should still be protected, just like our First Amendment, you know, constitutional right to free speech.[00:57:45]

[00:57:45] Diana: That's what the Colorado Supreme Court is essentially, uh, against, right? And that's essentially part of the, the whole trickle-down process with the Childs v. Salazar case. And n- n- the [00:58:00] latest iteration is now the state of Colorado is, is essentially saying, "Look, if we have people who are hurt by, uh, their therapists and their speech," right?

[00:58:14] Diana: "They [00:58:15] should be able to essentially sue their therapists." That's how the legislative process ends up essentially playing out. That's not just how politics ends up playing out, but that's, that's where every single person, um, coming [00:58:30] into a different contact space on the stage ends up either getting regulated by whoever is on that board and what their views are, but more importantly, what the overarching sort of reflection of [00:58:45] the laws that are in place would be for those states.

[00:58:49] Diana: Okay, so- That's also why I can make a qualification in Colorado. There is more of a requirement, and that requirement is not necessarily [00:59:00] as spoken, but if you're a researcher and you specialize in this area and it-- you're in regulatory, and that's also really where I come in with tons of, of data and case examples, and not [00:59:15] just case examples, but actual, um Like beyond charts, we had interviewed, uh, individuals as well as, um, understanding the, the people that make up those boards.

[00:59:29] Diana: The only [00:59:30] way to essentially challenge that is to challenge defining what unprofessional conduct is.

[00:59:36] Stephanie: Okay, so I really wanna make sure that we're kind of laying things out clearly step by step, right? So you've used this phrase that is in the law, unprofessional [00:59:45] conduct, and that the Colorado Licensing Board gets to decide in Colorado what counts as unprofessional conduct.

[00:59:53] Stephanie: Do you recall or can we look up what specifically is considered or [01:00:00] was before Childs v. Salazar? 'Cause this is all leading up to ba- basically where we're going, listeners, this is a long story arc, right? Because we're leading to Colorado HB 26-1322, which is a reaction to Childs v. Salazar, right? And so first you have to understand [01:00:15] Childs v.

[01:00:15] Stephanie: Salazar, which went to the Supreme Court to fight for free speech for therapists in Colorado to practice in accordance with their conscience. But in order to understand that, we need to understand this piece of what was [01:00:30] Kayla or Kaylee, sorry, I forget, Kaylee Childs, um, what was, what was her complaint, right?

[01:00:36] Stephanie: And so it was that the Colorado law said that unprofessional conduct included, [01:00:45] like, what specifically? What was the language in there?

[01:00:48] Diana: Colorado's unprofessional conduct laws are actually much, much broader. The case, uh, went up against, um, Colorado's, uh, ban on, um, [01:01:00] conversion therapy. So on the legislative front, there was a ban on anyone that, uh, could be considered doing conversion therapy.

[01:01:10] Diana: How that ended up connecting to, um, a [01:01:15] licensed professional's, uh, speech and their license is Colorado, uh, and a host of, uh, a number of other states, um, around 20, uh, have a very broad [01:01:30] language within the regulatory codes. So if you look up your licensed, uh, regulated profession, so if you're in therapy, your, your state licensing board, they have a list of policies.

[01:01:43] Diana: If those policies [01:01:45] essentially include something called unprofessional conduct, that Is an arbitrary language that basically gives the board the ability to decide whether or not something that happens in the context [01:02:00] of the profession is professional. You can lose your license essentially if they consider it not professional.

[01:02:07] Diana: In the context of Colorado, what Colorado has culturally done is it's, uh, regulated their [01:02:15] professionals' speech. So, a couple of different examples. In the Colorado attorney, um, regulated profession, uh, there was a case, like I said, [01:02:30] of, uh... And you can Google this. It's not, it's not like it's essentially hidden.

[01:02:36] Diana: There was a lawyer that said, "Fat gay judge By saying gay in a closed-door context, [01:02:45] um, and just being absolutely upset, uh, by a judge who made, uh, an unfair decision, he ends up going through a couple of different courses, um, and gets a black mark [01:03:00] on his license. That is the state of Colorado. In the context of a licensed therapist, that's also, uh, what ends up happening, right?

[01:03:11] Diana: So if you have a client that, uh, [01:03:15] either comes to you really seeking help or unfortunately might not necessarily be a great client coming to you and trying to deceive, they make a reporting and says, uh, "My therapist is, [01:03:30] uh, basically making me uncomfortable because I, I think they're practicing, uh, conversion therapy."

[01:03:39] Diana: The state of Colorado, um, because of both its laws and the individuals that [01:03:45] make up that state, uh, within the licensing regulatory board can consider that unprofessional conduct.

[01:03:51] Stephanie: Okay. So actually we're not saying things that are too terribly different because

[01:03:55] Diana: when- We're not saying things that are terribly different.

[01:03:58] Diana: We're, we're pushing [01:04:00] alongside the lines of some states having a lot more, um, of a legal requirement than other states. So- So ... I just, okay.

[01:04:09] Stephanie: May- maybe we're, we're, we're workshopping- Yeah ... like how my brain works versus how your brain works. Sure. [01:04:15] Here's my understanding, right? When you say conversion therapy, that is defined in Colorado as- Yep

[01:04:22] Stephanie: S-O-G-I-E-C-E, sexual orientation and gender identity and expression change efforts, correct?

[01:04:29] Diana: Yes and [01:04:30] no. So the state doesn't really define that. Um, lawyers have to essentially pull to, to define those things. That's part of the problem. We have to essentially pull from, like, federal regulations to start defining what, [01:04:45] um, something is because within the context of the actual statute, the statute basically just says, you know, "You can't practice conversion therapy.

[01:04:55] Diana: We're not necessarily going to define it, or we're going to defer that back [01:05:00] to whatever the federal definition is." So the

[01:05:02] Stephanie: statute- In the case of- ... that Chiles versus Salazar was contesting didn't include that acronym? It just said conversion therapy, and it wasn't defined?

[01:05:12] Diana: I can pull it up. Yeah, [01:05:15] it didn't define it.

[01:05:16] Stephanie: Okay. Wow. This is new for me, right? Because this is my issue, right? Everyone knows this is, like, my claim to fame, like, Helen Joyce episode 11, where I got accused of conversion therapy. Like, this is how I ended up in the spotlight, [01:05:30] right? And, and so my deep dive, not as a legal analyst, but as a therapist, was, like, understanding that, like, conversion therapy is defined as SOGIECE, and so I just assumed [01:05:45] that, uh, in, in Colorado it's the same.

[01:05:48] Stephanie: And so that with Chiles v. Salazar, conversion therapy is defined as SOGIECE, and our problem is the, uh, GIE, [01:06:00] you know, and, and then the vagueness of the concept of change efforts. But I'm hearing it's even worse than that. It's even more vague. It's even more up to interpretation. So, like, what someone calls conversion therapy here is very subjective in the law, [01:06:15] and, and so that's part of the problem that Chiles v.

[01:06:18] Stephanie: Salazar was addressing, if I understand you correctly. And now part of the backlash against Chiles v. Salazar, which is HB [01:06:30] 26-1322, um, are, are you saying that likewise in this, in this act, uh, the... It's called Civil Actions for Conversion Therapy Survivors. It's also not defined.

[01:06:39] Diana: Nope.

[01:06:40] Stephanie: Okay. So tell us about the vagueness.

[01:06:44] Stephanie: [01:06:45] When you create a law

[01:06:47] Diana: Um, when you write anything into essentially policy, um, whoever is essentially writing that, um, gets to essentially define whether or not they're going to broaden the definition [01:07:00] or leave that up to legal interpretation. And when you leave certain sorts of things up to legal interpretation, then you're obviously always going to have groups that end up getting into law fair and legal battles over the definition and the meaning [01:07:15] of words, right?

[01:07:16] Diana: So we have seen that, and perhaps all of law, um, is about, um, finding the true meaning of a, a, of a particular legislative intent, of a particular word. Um, but it's even more [01:07:30] the case, uh, when it comes to professional licensing and speech. There is no sort of inherent definition. If, um, if you're in the practice of medicine, there's a lot more, uh, [01:07:45] words essentially to describe a condition, and that may not necessarily be true, uh, mostly because people have, like, a lot more description.

[01:07:52] Diana: But in the context of law, when you're writing certain sorts of things in the context of the legislature, all of those words can [01:08:00] mean all sorts of different things. So in the case of Childs, she was doing something called talk therapy. Um, she was helping her clients, and she was essentially accused of [01:08:15] conversion therapy.

[01:08:15] Diana: The same thing could happen in the legal context in the state of Colorado and perhaps even beyond, uh, the state of Co- Colorado. Whatever you end up doing not only ends up creating a, a public persona and [01:08:30] perception, but as soon as essentially a license is challenged, um, and you have, uh, the actual legal words to, um, trigger, uh, an investigation.

[01:08:41] Diana: Um, and even if you don't have the legal words, if you [01:08:45] just happen to have a really bad client that says, "You know, I don't like my therapist, and, um, I'm gonna trigger a reporting," that triggers a whole legal process. We live in a healthcare legal [01:09:00] system, which means, um, you with a good attorney can sue anyone for practically anything.

[01:09:06] Diana: It's kinda scary, but that's law fair This law in Colorado just makes it a lot [01:09:15] easier because all you now need to essentially claim is, "I've been hurt by someone doing conversion therapy."

[01:09:24] Stephanie: And it's completely up to the patient or the aggrieved party to [01:09:30] decide how they're interpreting the, the word conversion therapy.

[01:09:34] Stephanie: So what I, I wanna contrast this with what it's not, right? Because you're highlighting just how vague it is, and it's even more vague than I thought it was. And let's contrast that [01:09:45] with something like aversive conditioning or electroconvulsive therapy, right? These are defined Forms of conversion therapy from the past that aren't done anymore that are known to be abusive and [01:10:00] not work, right?

[01:10:01] Stephanie: So something like aversive conditioning, uh, you know, like, uh, it's, like here's a creepy horror story I heard once. Uh, like a gay man whose therapist advised him to, like, smell [01:10:15] dog poo while looking at pictures of naked men. That's aversive conditioning. Or electroconvulsive therapy. Okay, literally shocking someone as punishment for having the wrong thoughts.

[01:10:27] Stephanie: These are, these are definable things. Like, you [01:10:30] can define if it happened or not, right? And of course there's a case for, um, you know, seeking some kind of recourse if a professional were to engage in this kind of conduct. But it would [01:10:45] also be equally unprofessional if a therapist were to employ the same techniques in response to something having nothing to do with gender or sexuality.

[01:10:52] Stephanie: You know, if they were to try to treat obsessive compulsive disorder, you know, well, okay, telling someone, "Smell dog poo next [01:11:00] time you want to, um, do the compulsion," right? Like, that is just as bad and nobody would go to see that therapist anyway, right? So, like, I, I just wanna contrast because that level of [01:11:15] specificity is missing in this vague definition.

[01:11:18] Stephanie: Um, up to the patient to say, "This person was trying to change this thing about me," right?

[01:11:23] Diana: Yep, and it is. Like, so Colorado has, um, a lot more [01:11:30] patient-centric protections, I would say. Um, which means all that you need to do essentially as a patient is say, "Hey, I feel extraordinarily uncomfortable with this professional, and, um, I'm gonna trigger a reporting," or, "I'm gonna, [01:11:45] you know, seek after a lawyer."

[01:11:46] Diana: And, uh, that lawyer can very easily, because of, uh, their political ideology and, um, you know, belief that they're doing right, um, take you [01:12:00] seriously and just go after the, the therapist for supposedly practicing conversion therapy.

[01:12:06] Stephanie: Are you a therapist in need of continuing education that's not over-the-top woke?

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[01:12:40] Stephanie: Again, use code SOMETHERAPIST at [01:12:45] lisamustard.com/podcourses. I'll include that link and coupon in the show notes for your convenience. All right, now back to the show. And I think it's notable in this law that m- patients' families can sue for damages up to five years after [01:13:00] their death, which to me really seems like it's something that can open the floodgates because we, we know that as much as suicide statistics have been exaggerated and manipulated for political gain, and that's not something that I [01:13:15] condone on this podcast, so I will always wanna be very careful when we talk about the subject of suicide.

[01:13:19] Stephanie: That being said We're looking at a population with higher than average rates of suicide and parasuicidal behavior, which can [01:13:30] also be attributed to the overlap with Cluster B personality disorders. Part of where I specialize is in educating parents in how to deal with- Yeah ... the intersection of gender identity issues and Cluster B personality traits, and that's what my course is for, ROGD Repair.

[01:13:44] Stephanie: Yeah. [01:13:45] Right. So we know that there is a high degree of overlap between patients who have gender identity issues and those who have Cluster B personality traits. Um, we, we know that the suicide level is pretty much on par with what [01:14:00] you'd see with that level of comorbidity- Yeah ... with the other psychiatric diagnoses involved, so I don't wanna just make it about the gender issue.

[01:14:07] Stephanie: Yeah. That being said, we're looking at a population that is at increased risk of self-harm, self-injury, and suicide, [01:14:15] and essentially saying their aggrieved loved ones now can potentially take out their frustration on a professional who tried to help by alleging- Yep ... that they tried to help in the wrong way, and this- Yes

[01:14:29] Stephanie: feels like it ve- [01:14:30] offers very little protection for the professional.

[01:14:33] Diana: That's exactly what the, the language of the bill is set out to do.

[01:14:38] Stephanie: And this is already every p- every therapist's worst fear, by the way. In case, in case listeners haven't thought of that, every therapist's [01:14:45] worst fear is a patient completing suicide, and it's, it's an occupational hazard that you learn how to live with.

[01:14:51] Stephanie: You learn how to mitigate risk, how to compartmentalize your feelings, how to assess the likelihood of risk, but also to live with that uncertainty. And many therapists, [01:15:00] unfortunately, do go through that as part of their initiation at some point in their career. Um, it, it can be humbling. It can create vicarious trauma for the pa- uh, for the therapist.

[01:15:12] Stephanie: Um, and of course, therapists tend to [01:15:15] blame themselves, right? They tend to think, like, "What could I have done differently? What should I have done differently?" Like, therapists already carry the weight of that guilt on their conscience, and then to add to the equation that, that, that the patient's family could blame them.

[01:15:29] Diana: [01:15:30] That's this. That's the Science Force. Science course. That's, that's really where, again, if you're practicing in the state of Colorado, um... And it's not just Colorado. Like, we-- I think most people kind of [01:15:45] pin that sort of blame on the state of Colorado, but, like, it's, it's probably even worse, like, in certain other states.

[01:15:52] Diana: Um, Colorado has gotten a lot more national attention 'cause it's, it, it's the speech censorship state. Um, [01:16:00] so right now the battle is over whether or not, um, all of these licensed professionals are going to have speech censored, um, in terms of their practice. But if you go into perhaps the most liberal of the [01:16:15] states, uh, when it comes to, like, speech censorship, which is Massachusetts, um, then you essentially run into the experience of then you can absolutely, like, pursue really crazy harmful treatment and have [01:16:30] zero accountability for it.

[01:16:31] Diana: So, um, that's, that's what's really scary. So the things like electroshock therapy, smelling dog poop, the things that we think and would hope are not actually in practice right [01:16:45] now, they are in practice under the guise of states that heavily, heavily protect the licensed professional and their license.

[01:16:52] Diana: And that's Massachusetts, huh? And that's Massachusetts. I did not know this. Mm-hmm. Most people don't. Most [01:17:00] people don't do a 50-state survey on, like, the various different regulatory powers, right? And the only way to fully actually go after and challenge it is to see the implication of how that works on a practical scale.[01:17:15]

[01:17:16] Diana: That's why what I do is just, I mean, I ex- I have to explain to people, like, 24/7. Um, and then, you know, create charts like this and go in [01:17:30] whatever other direction. Um, but the, here's the good news. The good news is right now we're seeing a lot of that revealed within the mainstream media. Um, we're seeing a lot of people who are talking about the chilling, [01:17:45] damaging effects of w- healthcare gone wrong, and terribly, terribly wrong.

[01:17:52] Diana: And the good news is we are also witnessing lawfare essentially reveal, uh, the [01:18:00] undergirding issues within the context of, of the greater system, and how not only does that need to be reformed, but how the next frontier is, is going to be on professional licensing. That's, that's really where I [01:18:15] come in and specialize, and it's kind of crazy how fast everything had moved, um, since the time of the amicus.

[01:18:23] Stephanie: I want listeners to understand the practical implications of things like this, um, because, [01:18:30] uh, that's why I point to the chilling effect because I feel like it's kind of the best way for people to begin to understand, like, you're n- you're not gonna find the therapist that you're looking for in this [01:18:45] environment, right?

[01:18:45] Stephanie: It's not that there aren't therapists who share your views and concerns and who would love to help that patient in a holistic way. It's what would you do if you had gone into $100,000 of debt to get a master's degree [01:19:00] and worked on 3,000 post, uh, postgraduate hours, internship hours towards your license, and studied hard to pass an exam, and you finally get your LMFT or LPC or LCSW [01:19:15] or PsyD or whatever your, uh, professional license is, and you're finally in a position to do this work that you've been called to do potentially your whole life, helping people, talking about their feelings and their problems?

[01:19:26] Stephanie: You get to that position And then you're faced [01:19:30] with this threat that if you honor your conscience with regard to a young person who's confused about their gender, then you are not only at risk of threats to your license, you are at risk of [01:19:45] civil pene- penalties- Yeah ... of a lawsuit, of being blamed for someone's tragic, untimely death.

[01:19:51] Stephanie: You are at risk of all that. What would you do as a professional? You'd probably not work with that population at all. You would probably find [01:20:00] ways to turn down those patients, whether it's setting age requirements on your practice, whether it's how you market yourself. You're just not going to be open.

[01:20:09] Stephanie: You're just gonna try to avoid it. Why? Because you want to practice therapy, and you wanna put food on the [01:20:15] table, and you wanna save for retirement. And, you know, between those things, like, that's why you ther- the, the parents in the audience listening who are frustrated as to why you can't find the type of therapist you want [01:20:30] for your child or family, that's why.

[01:20:32] Stephanie: It's because of that effect, and it's not gonna be as bad in every single state as it is in Colorado, but Colorado is a great example.

[01:20:40] Diana: Yeah. So Colorado has been the epicenter for, [01:20:45] um, speech censorship, uh, on multiple fronts, uh, including physicians and their speech. But it, it definitely highlights a lot of this, uh, tension.

[01:20:58] Diana: So the, the [01:21:00] tension that the Supreme Court says, "Look, you should be allowed to say what you consciously believe in." Um, and it doesn't make sense that just because you're a therapist, just because you're a doctor, just because you're a licensed [01:21:15] professional, that that's gonna curb your speech. Um, the liberal justices on that court also agree, right?

[01:21:21] Diana: The, the chilling effect does not make sense. But in this context of the state of Colorado, their retaliatory efforts is then we'll make this a [01:21:30] tort issue. And what a tort issue is, is it basically allows, okay, if you end up practicing in that state, and let's say somebody ends up dying or committing suicide or [01:21:45] whatever, right?

[01:21:46] Diana: You can, you can then blame, um, someone, uh, who is deemed by that state to be practicing conversion therapy That's the chilling effect. And that's not [01:22:00] just the chilling effect, that's rightly what you're discovering as, as being haunting, and that's also what most other individuals, um, massive think tank political members don't realize.

[01:22:14] Diana: 'Cause [01:22:15] no one's actually ever going to get into healthcare licensing and healthcare regulatory unless you specialize in that topic. Um, and the people that end up specializing in that topic from the other side are essentially guardrailing and safeguarding the entirety of that [01:22:30] system. And so what's being done to fight back?

[01:22:34] Diana: This, this, this war. So Healing Science is gonna fight back. Um, that's a lot of what I'm doing right now, um, basically rallying, uh, [01:22:45] the licensed professionals and the physicians and the scientists and the people who are essentially seeing that it is a war within the context of their regulated profession.

[01:22:55] Diana: It is literally a war over whether or not you as a licensed professional [01:23:00] can do what's right.

[01:23:01] Stephanie: Well, thank you, Diana, for w- for the work that you're doing on that front.

[01:23:05] Diana: We're, we're unraveling that, and I think the first sort of element there is, is to start going after something called unprofessional [01:23:15] conduct and start defining that.

[01:23:16] Diana: So thank you for making me reveal that as not just the next step, but as the broadest thing of what I'm doing right now, um, which is [01:23:30] fundraising for that.

[01:23:31] Stephanie: Yeah, I mean, it's... So what I'm really hearing is that the ph- the phrase unprofessional conduct is not defined in Colorado. It's subjective. It's open to interpretation.

[01:23:42] Stephanie: And in 20

[01:23:43] Diana: other states, yep.

[01:23:43] Stephanie: Mm-hmm. [01:23:45] And I mean, you know, I think the good-natured part of me, the more trusting part of me, um, would like to believe that we all have some kind of common sense shared definition of something like unprofessional conduct, like showing up to [01:24:00] work naked or drunk or, you know, things like that that are just obviously unprofessional.

[01:24:06] Stephanie: But what's- Yep ... deemed professional and unprofessional has changed- Oh, it- ... so much that

[01:24:13] Diana: It's not just changed. So the [01:24:15] most chilling thing is I had, during law school, did a 50-page study on not just that word, um, but all the times that a licensed professional has been disciplined. And what you find is that [01:24:30] about 50% of the cases that I had focused on, um, that didn't, you know, that wasn't about, uh, drug misuse, um, was actually far more political.

[01:24:41] Diana: It was over whether or not, um, someone had triggered a [01:24:45] reporting. There was a case where, uh- Like, and, and this was completely stupid 'cause it still occurred. Like, someone gave Jell-O to their patient. So a [01:25:00] midwife essentially gave Jell-O to, um, a, a patient under the direction of a nurse. And instead of the nurse getting in trouble, she got in trouble for giving that patient Jell-O [01:25:15] because, um, there was an OBGYN that did not necessarily like the m- the midwife being in the room because she was actually advocating for that patient.

[01:25:29] Diana: That's [01:25:30] essentially lawfare. That's the types of cases that are, that are out there. And despite having the patient who, um, you know, provided evidence that, you know, this person was literally just caught in the crossfires [01:25:45] of, of political power, um- They still gave a mark against that professional's license, and that's part of the reason why we don't have, like, enough, if not more, [01:26:00] individuals that are championing, um, and actively speaking out, 'cause they're terrified of, like, having another sort of mark, um, legally on their license.

[01:26:09] Diana: The good news is, again, we can change a lot of that by [01:26:15] literally just looking at the governmental regulatory language and defining what something is, whether or not something is unprofessional conduct or not. But in order to do that, that is essentially waging another form [01:26:30] of war. That's how Do No Harm got to be so successful, because they went into the legislation and started actually actively defining what they're, you know, what they're gonna essentially pursue as not just an organization, [01:26:45] but in terms of, like, gender-affirming care and what that really entail.

[01:26:51] Diana: That's, that's the battle, and that's, like, I know it might sound dep- depressing, but the, the good [01:27:00] news is this: when people are aware that an issue exists, it gives them a lot more hope and courage to essentially start rising up and start talking about it. Um, because [01:27:15] we haven't had-- we haven't seen that.

[01:27:18] Diana: We, we've been on the front of a lot of the detransitioner issues, and that is amazing, and they're essentially waiting for, for a healthcare [01:27:30] reform A lot of those cases.

[01:27:33] Stephanie: Well, thank you for your advocacy, Diana, and, um, having studied cases in which professionals were sanctioned, um, I'm sure you, you saw [01:27:45] that it's not black or white in the sense that not everyone who is the subject of some kind of professional complaint loses their license over- Yeah

[01:27:54] Stephanie: that issue. So I do just wanna remind listeners of that, because I think- Yep ... when I hear from [01:28:00] laypeople on this issue, they tend to think of it that way. It's like, no, a complaint or even a lawsuit, which are two different things, by the way- Yeah ... don't necessarily mean loss of license, but it's, you know, what, what most people need to just bear in mind is the process is the punishment, and most people don't [01:28:15] wanna go through the process, even if their actions are defensible.

[01:28:18] Stephanie: Yeah. Um, and so I'm sure you've seen plenty of that- Yep ... in your review of cases.

[01:28:23] Diana: Yeah. And it's, it, I mean, it goes beyond the process. It really does go into whether or not, like, [01:28:30] on the legal professional level, if a case can prevail. Um, and unfortunately, within, like, the context of law, um, anything that happens on the front of any sort of regulated profession is going to be dependent upon the standards [01:28:45] of care that are essentially governing that profession.

[01:28:47] Diana: So everything in terms of unprofessional conduct, that language, um, across 20 different states actually, um, is defined by, as set by professional [01:29:00] associations. That's essentially what's in the regulation. Um, that's within the policy. So in Colorado, as set by professional associations, who are they going to end up looking to as professional associations?

[01:29:12] Diana: Whatever, um, [01:29:15] whatever organizations, uh, national organization and otherwise, um, end up dictating what- That licensed professional should be practicing.

[01:29:25] Stephanie: For counseling, a lot of states look toward [01:29:30] the ACA Code of Ethics from 2013, and I would encourage anyone who really wants to geek out on this issue to go ahead and take a look at the ACA Code of Ethics from 2013 'cause a lot of it is pretty basic and most people would sign o- you know, sign on board with.

[01:29:44] Stephanie: And [01:29:45] then some of it is on the woke side. And, you know, when counselors are required to put in their professional disclosure statement something like, "I abide by the ACA Code of Ethics," you know, they're essentially signing off on some pretty [01:30:00] woke policies. So that's, that's one place that I would look if anyone wants to look- Yeah

[01:30:03] Stephanie: a little further into this issue. Um, but Diana, thank you so much for your advocacy. Uh, where can people find you?

[01:30:10] Diana: Right now, healscience.org is the best website. Uh, that's the [01:30:15] collection of a ton of healthcare professionals, uh, physicians and scientists and others, uh, that had, uh, supported Kennedy's, um, shift and are part of this healthcare revolution.

[01:30:27] Stephanie: Very cool. Thank you so much. Yeah. Really appreciate [01:30:30] your bright spirit. Thank you for listening to You Must Be Some Kind of Therapist. If you enjoyed this episode, kindly take a moment to rate, review, share, or comment on it using your platform of [01:30:45] choice. And of course, please remember, podcasts are not therapy and I'm not your therapist.

[01:30:52] Stephanie: Special thanks to Joey Pecoraro for this awesome theme song, Half Awake, and to Pods by Nick for production. [01:31:00] For help navigating the impact of the gender craze on your family, be sure to check out my program for parents, ROGD Repair. Any resource you heard mentioned on this show, plus how to get in touch with me, can all be [01:31:15] found in the notes and links below.

[01:31:18] Stephanie: Rain or shine, I hope you will step outside to breathe the air today. In the words of Max Ehrmann, "With all its sham, drudgery, and broken dreams, it is still a [01:31:30] beautiful [01:31:45] [01:32:00] world."