Hilary Cass and Those Uncomfortable Questions: The Orthodoxy of Transgender Medicine

Hilary Cass, a Scottish pediatrician has done a courageous thing: She has insisted on critically evaluating the science behind current medical practice.

Dr. Hilary Cass

And not just any medical practice, a practice which in the commercial medical system of the United States has become a mighty industry, and in the socialized national health systems of Scandinavia, the Netherlands, France and the United Kingdom has skyrocketed into a huge cost and some would say, burden, for those publicly funded systems: Transgender Clinics.

Her report was commissioned and prompted owing to the explosion in demand for transgender care seen across Europe. Some have asked, "Where have all these kids been, until now?" Tens of thousands of children from age 10 to 18 have been brought to clinic by their parents with the chief complaint: I do not feel like a girl, although I was born a girl. I'm in the wrong body. I am the wrong sex for what I am.

This is called "gender dysphoria."

This complaint is not new, but what is new is the vast numbers of children presenting for care.

Some have claimed these kids were always out there in the real world, but like homosexuals, they were in the closet, afraid to report the torment they were going through.

Unlike homosexuals, however, these children are not seeking to be simply left alone; these children are patients because they are presenting themselves asking doctors to help them, and this help takes the form of powerful hormones and, ultimately for some, reconstructive surgery and castration.

More than fifty years ago, patients with a variety of abnormalities in production of various hormones, usually testosterone or its downstream products, were described, and some of these people were born with "ambiguous genitalia" which could not be clearly called either scrotum or vulva, penis or clitoris. Some were born with normal appearing female external genitalia, i.e. vulva, clitoris, but who in fact did not have female internal genitalia (i.e. uterus, ovaries). But these patients could be understood biochemically and ultimately, genetically. 

The current wave of patients presenting to transgender clinics have no such biochemical or genetic abnormalities yet identified.

Curiously, Dr. Cass notes, over the past decade most of the flood of patients have been requesting female to male transition, which was not the case twenty years ago.

When she looked at the data to try to ascertain the fates of kids who had been "transitioned" to the opposite gender, it was not clear, but it appeared many if not most of the preadolescents treated at the clinics had, by age 18, reverted to identifying as the gender they had originally been designated at birth, mostly female.

Simply put, these children had "outgrown" their problem or "got over it." (Not Dr. Cass's words)

I was particularly interested in this report because this whole phenomenon has been such an anomaly in medicine: It is the only session at the Endocrine Society meetings where scientific method, open inquiry and challenging the data and conclusions presented were shouted down and treated as heresy, blasphemy really. To question what was being done in the Transgender Clinic was to declare yourself as one of "them," the censorious world of bigots who, blinded by hate and intolerance, refused to acknowledge the suffering of this cohort of patients.

Paul McHugh, MD

In fact, this reaction was not new or confined to the Endocrine Society: Dr. Paul McHugh was vilified at Johns Hopkins after he questioned the Transgender Clinic programs which included surgery to transform female to male and male to female. Medical students refused to even speak with  him. At Johns Hopkins!

McHugh arrived at Hopkins in 1975  to assume the chair of the Department of Psychiatry, and one of the first things he was asked to do was to integrate psychiatry into the Hopkins Transgender Clinic, which included  plastic surgery, gynecology, urology and endocrinology.  And, being a scientist, he sat down to review the data and one thing leapt out at him: The patients at the clinic were committing suicide (or making serious attempts, not just gestures) at a rate exceeding 45%.  He asked: if you had a program in cardiology or surgery which had a 45% death rate, would you not pause that operation to re-evaluate it? 

Galelio

Hopkins had been doing sex reassignment surgery since 1966, but it was hoping to ramp it up in 1975. McHugh withdrew psychiatry from the program. By 1979, the Hopkins sex reassignment surgery program was discontinued. 

In 2017, McHugh wrote an amicus brief in a Supreme Court case outlining his objections: 

--Policy Should Not be Used to Enforce Bad Medicine — Treating Gender Dysphoria Through Social Transition and Mandatory Gender Affirmation Rests on Unreliable Testimonials

-- Social Transition Encourages a Gender Dysphoric Person to Indulge in a Falsehood, Which does not Address the Root Issues Causing Clinical Distress and Makes it Harder for the Mind to Accept Reality

--Hormone Therapy has not been Proven Beneficial, and there are Harmful Consequences to Artificially Manipulating the Body

--Surgical Intervention has not Proven Beneficial, and there are Harmful Consequences to Surgically Altering Healthy Bodies

--There is Insufficient Scientific Evidence to Support Treating Gender Dysphoric Children as if They are the Opposite Sex

-- Gender Dysphoric Children Suffer from a Psychological Disorder that Can Be Resolved through Therapy in Many Cases

--Gender Affirmation and Medical Intervention for Gender Dysphoric Children is Not Helpful, and Can be Harmful

--Protocols Calling for Social Affirmation, Hormone Treatment, and Sex Reassignment Surgery are a Reflection of Ideology and Activism, Not Evidence Based Medicine

 His basic argument was, and is still, that gender dysphoria is analogous to anorexia nervosa, where a 90 pound woman who is 5'7" looks in the mirror and says, "I'm so FAT!" She has a single "wrong idea" and the child with gender dysphoria is similarly afflicted. He was arguing that the doctors in the Clinic were participating in confirming that wrong idea to the patient and to the patient's family. 

Attending the Endocrine Society meetings some years ago, I went to a session on "Androgen Abuse Syndrome" where cases of men who looked like the Incredible Hulk, with huge musculature, visited clinics asking for testosterone injections because they looked in the mirror and saw themselves as 98 pound weaklings. In Dutch clinics,  patients signed contracts to taper themselves off exogenous testosterone, run on the model of their opiate addiction clinics and their anorexia nervosa clinics. 

My next session was the Transgender Medicine session, where the speakers readily admitted the suicide rates in their clinics had always exceeded 40%, and showed no signs of declining--which they attributed not to anything they might be doing to their patients, but to the pressures society puts on transgender people. 

The doctors in these clinics were using doses of testosterone which were 4-5 times higher than I had ever used to treat males.  I was stunned, and I texted the man from University of Michigan who had led the "Androgen Abuse" session, and he replied, "There is nothing wrong with that, because these doses are being used in gender affirming therapy."

So in one patient, we've got him signing contracts to taper himself off testosterone, and in another patient we are giving patients orders of magnitude higher doses to affirm their new gender.

One case presented was a male to female (still with penis and testicles) and the lesbian partner who wanted expensive IVF treatments to get pregnant. Nobody asked, wait, what kind of sex are they having?

Another case of a female to male was being given testosterone in 5 times the usual dose because menstruation had not been ablated and the monthly menstrual flow was undermining the patient's new identity as a male.

We are not talking science here. We are talking faith.

The problem with complaining about Transgender Clinics is you immediately find yourself grouped with Marjorie Taylor Greene and the "there are only two genders" crowd, or with Abigail Shrier, who wrote a screed calling Transgender Medicine part of a "craze," doing irreparable harm to young people. 

What doctors crave is a pathway to the truth, and the way there is, and always has been, the dispassionate, rigorous pathway and in the case of transgender medicine, this has been discarded by the medical profession, until now, until Dr. Cass published her report.

What to Say When

 

Watching Katie Porter (D-CA) during a hearing in the House of Representatives, when a witness (Lindsey Burke, of the Heritage Foundation)  testifying before the Committee inveighed against Congress "spending other people's money," Rep. Porter made the simple, but devastating observation that the job of Congress is, in fact, to spend other people's money, namely taxpayer money, and if Congress refused to do this job we would "zero out all spending for the Defense Department." And turning to the witness, she asked, "Is that what you want?"

https://www.youtube.com/shorts/3c-qT2wZ9CY

This is just one example of someone who has heard a simple, telegraphic prop, a synecdoche really, where a short hand phrase stands in for a whole, longer argument, and who explodes into a longer, more detailed deconstruction of what that, by logical extension, would actually mean.

So, the Heritage Foundation would like us all to believe that taxation is really government imposed theft, taxes being robbed from citizens, and thus are, ipso facto, illegitimate and taxes should not be collected, because doing so is the crime of theft. 

Of course, as Porter explains, without taxes, without a source of revenue, there can be no government, which the Heritage Foundation would possibly like, but then, even the Heritage Foundation realizes there are some things the government does even the most ardent Republican, libertarian likes: armed forces. 

Built into the macho proponents of strong men, violent men of iron will, is the love of guns and armed forces.

So Porter demolishes that empty phrase: "You are spending other people's money," with the riposte: "Of course we are spending other people's money, and other people want us to spend their money to provide for their defense, and likely, for a variety of other things."

Another phrase adored by people like Marjorie Taylor Green and other gun worshipers is, "If you make guns illegal, only the bad guys will have guns." Or, the spin off, "The best way to deal with a bad guy with a gun, is a good guy with a gun!"

To this, Dominic Erdozain ("One Nation Under Guns") replies: The good guy with a gun is always good, until he becomes a bad guy with a gun.

In fact, as he asserts, citing a welter of gun death statistics, the vast majority of gun deaths, in particular mass shootings, are committed by people who, until they unsheathed a gun, were thought to be good guys--no criminal record, no actionable history to deny or question their right to gun ownership.

But what Erdozain is saying is people who own guns are the people who kill other people with guns. He cites statistics which suggest a very common murder scenario is fathers who shoot to death their own sons. 

Who knew? 

Actual good person with gun

My real point is here, if we know or can identify an argument which is really, at heart, stupid, we can torpedo that particular piece of stupidity if we are prepared. Otherwise, the moment passes and we are left sputtering.

Congressmen like Jamie Raskin seem particularly adept and prepared to blow Ms. Greene out of the water, likely because they have heard it all before. When MGT tells Raskin she will not answer his "stupid questions" he rejoins with, "Well, will you answer my intelligent questions? Or my devastating questions?"

What we Democrats really need is a playbook, a hymnal, filled with Republican tropes, so we can develop our own tropes, prepared in advance, to sink those Republican vessels.

Trumpkin Police: Beyond Law and Order

Sometimes, a picture can speak more eloquently than words. 

Looking at those police goons in Michigan, standing behind Trump, tells you all you need to know about some police departments. 

You could see it in Birmingham, Alabama in that iconic photo of the cop and his police dog--although, as is so often true in life, that photo may have been misleading.

You can see it in Texas with Governor Abbott.

You could see it in Alabama when George Wallace stood in the school house door and declaimed, "Segregation today. Segregation tomorrow. Segregation forever," backed up by his police. 

Today I have stood, where once Jefferson Davis stood, and took an oath to my people. It is very appropriate then that from this Cradle of the Confederacy, this very Heart of the Great Anglo-Saxon Southland, that today we sound the drum for freedom as have our generations of forebears before us done, time and time again through history. Let us rise to the call of freedom- loving blood that is in us and send our answer to the tyranny that clanks its chains upon the South. In the name of the greatest people that have ever trod this earth, I draw the line in the dust and toss the gauntlet before the feet of tyranny . . . and I say . . . segregation today . . . segregation tomorrow . . . segregation forever.

--Governor George Wallace

You see it in the New York City Police.

Police often, but not always, are people who like beating people up. They are frequently resentful. They like tough guy leaders who "have our backs."

Less of that in New Hampshire, but true in many places.

George Orwell got it right in "Animal Farm," where Napoleon the pig takes a brood of puppies from their mothers, raises them and then unleashes them to run his rivals off the farm and to intimidate all the other animals, especially those who might challenge his authority.

Police like the ones standing behind Trump in Michigan ought to be in the mind of every voter walking into that voting booth on November 5, 2024.

2nd Amendment Blues

 

"A well regulated militia, being necessary to the Security of a Free State, the right of the people to keep and bear arms shall not be infringed."

--Second Amendment, United States Constitution

Watching a youtube Obama town hall, I saw a man rise to say that Chicago has among the most onerous gun laws in the nation, and yet it has the highest murder rate, and this in a city run by Democrats who want to take away guns from the good guys, the law abiding citizens who want guns only for their own protection. Wherever Democrats are in charge, the man said, murders by guns are way higher than in Republican places where law abiding good guys can defend themselves with guns.

President Obama responded by saying there is a lot packed into that question, but he began by saying that neither he, nor Hillary Clinton have ever suggested taking away guns legally owned by citizens, even though there are now more guns than citizens in the United States. 

He also noted that Congress has refused to allow the government to study gun deaths. And he pointed out that without confiscating automobiles, the nation has managed to reduce auto accident deaths by government regulation and intervention, requiring seat belts, air bags and certain improvements to road design, implying that government intervention isn't always ineffective and onerous. 

But he might have pointed out, if he really wanted to embarrass this proponent of the "good guy with a gun" theory, there are two flagrantly wrong things about this argument:

1/ Most gun murders or accidental deaths are perpetrated by a good guy with a gun who, until he murders someone with it, was a good guy--the man in an argument at a bar, the outraged husband, the father who shoots his son (a surprisingly, statistically frequent scenario.)

2/ The gun death rate per capita is far higher in Mississippi (33.9) than in Chicago(16.4), higher in Louisiana (29.1 ) than in Philadelphia (18.7), higher in Alabama (26.4) than in Washington, DC (18.2)  higher in Wyoming (26.1), Montana (25.1), Alaska (25.2), Tennessee (22.8) than in Chicago (16.4). 

So those red states where gun ownership is so high, where the good guys own the guns, are places where the good guys are killing their fellow citizens at far greater rates than in those supposedly wild and untamed urban centers where President Trump says there is nothing but mayhem and chaos.

Of course, death rates by jurisdiction and guns are all about statistics: Are we going to add in death by guns for suicides? (Do suicides even belong in this discussion?)  Are we including only homicides or do we add in accidental deaths where a child finds a gun and shoots his brother? And then there is the odd fact, often unmentioned, that the likelihood of your dying by a gunshot is highly related to how quickly you can be got to a trauma center where they have surgeons who are really good at treating gunshot wounds. Part of why people who are shot in Mississippi die so often is that when they do get shot, they are a long way from any trauma surgeon.

But the fact is, if you want to talk about where you are most likely to be shot by someone, and fatally, it has never been the big Democratic cities; it has been the deep Red, Confederate South. 

Why this image of the violent inner city has been so widely accepted as truth is complex, but it surely includes the depiction in film and media of city carnage ("The Wire," LAPD etc) but also it fits the preconceived notion of the white guy who posed the question to President Obama, namely that we got Black guys with guns in those cities, and even out here in suburbia and we need White guys with guns to shoot them. This was clearly as subtext, as the White guy posing the question was saying all this murder is happening in those urban centers with strict gun laws (which just happen to be Black) and so we need to arm our Whites.

And then there is the right to individual gun ownership: Until 2008, every court at state level (even in Texas and the Confederate states) and the federal level and the Supreme Court stated the obvious: There are two parts to the 2nd Amendment, and the part about gun ownership being tied to a "well regulated militia" has always meant individual ownership is not a right guaranteed by the Constitution.

You can refer to all the wise men who said this is so, or you can simply believe those who do not want to accept this, like Antonin Scalia, who wrote the opinion in Heller v DC, which said individual gun ownership is in fact guaranteed by the 2nd amendment, and all that jurisprudence, all those scores of decision and opinions between 1789 and 2008 were wrong and it all depends on the history and what the founding fathers meant by words like "the people" and how you define "the people" and "bear arms" and what "keep" means. You see Justice Scalia tying himself into knots to get to the place he was determined to get to in the first place: Gun ownership cannot be interfered with, not in Washington, DC nor in New York City, places where you might think restrictions on gun ownership might be a public health good.

Then there is the whole topic of whether what we think of a man owning a gun as he travels across the continent, in his Conestoga wagon in 1859, across hostile Indian territory, might be different from what we think about a man who lives today in Columbine, Colorado or Newtown, Connecticut, where Sandy Hook school was found--whether the circumstances of new problems in new times might make us want to think anew for new solutions.

All of this is well reviewed in "One Nation Under Guns," by Dominic Erdozain. 

Mad Dog was pleased to see him say what Mad Dog has often said about Heller--it is one of those infamous, ignominious decisions which will take its rightful place alongside decisions like the Dred Scott decision, which hinged on the idea that a slave is not a human being, or Plessey, which sanctified racial segregation. But Heller is distinctive because it disregarded all prior decisions, it crushed the idea of stare decisis, i.e. that any decision by a court ought to be consistent with prior decisions on a subject. Scalia was so determined to get to the result he wanted, he simply abandoned all principle to get there. The only principle which counted for Scalia was guns are good.

And so, our Court, has almost by itself, allowed for the ongoing reality that we will have schoolhouse slaughter for the foreseeable future and shopping centers, concerts, really any public venue where Americans gather, will continue to be bathed in the blood of citizens sacrificed on the alter of the good guy with the gun.

The Sacred Right to Murder Mallards

In a sense, Heller raises a bigger problem than just the 2nd amendment. It goes to that famous remark from Roy Cohn to Donald Trump: "Don't tell me about the law: tell me about the judge."  This is the key insight--America is not a nation of laws, but a nation of people with opinions and the law can always be bent and interpreted to get to the result you want. If that is true, then the Supreme Court of the United States is nothing more than one more political group, guided only by the prejudices of the judges, and ought to be treated that way. If Mad Dog had his way, every new President could appoint 3 new justices per term and the justices would rotate from the federal judiciary in and out of the Court. They would still serve for life pending "good Behaviour" but they would no longer hold the nation hostage for 30 years at a time.

Dragged Out of the Shire

 

Mad Dog, like any Hobbit, is content in his happy home, in his lovely shire, but he is occasionally compelled by obligations to travel outside it. And like the Hobbits shepherding the ring, he finds that travel beyond his shire is an adventure, if not sought, at least possibly edifying.

Sedona, Arizona

The ocean at the end of his street, the town with all its amenities just a short walk away, the woods and ponds and birds are enough for contentment, but there is some value in seeing the larger world.

Hampton, New Hampshire 

Sedona, Arizona provided enough edification to make him think over how Hampton might be improved. 

Town Clerk, City Hall, City Manager Sedona

Take the public buildings, for example: In Hampton, our town building with its clerk's office is a converted bank, and its soviet style block brutalist architecture cannot be improved by the recent attempts at new siding, but in Sedona, every effort is made to make the building reflect and complement the natural colors and lines of the mountains and soil of the surroundings.

Blending In

Even the police station is subdued and not allowed to disrupt the karma. 

Of course, you have to be very determined to find the police station in Sedona, which has no signs visible from the road, and is ensconced in a courtyard. If you were a distressed citizen, hoping to find help from the police, you'd need a Google Maps to find it. Mad Dog, walking down the main drag, Rte 89A, saw a sign "Police" with an arrow, but walking down Roadrunner Drive, as directed, even on foot, Mad Dog could not espy the place, because the station has no door on Roadrunner drive, only a camouflaged back wall, and you have to make your way down a service road and walk into a courtyard to find the police station, and even then, it's not easy. 

Stealth Police Station

There are no electric wires on poles, and anything which is unsightly seems buried.

There are two urgent care/ emergency medical facilities in Sedona, but neither is open on Wednesday and any medical emergency would have to be medivac'd to somewhere else and it's not clear where.

Even national chains are melded into the color scheme: Mad Dog drove past the McDonalds four times before he recognized it.

There is a lot of talk around Sedona about spirituality, and karma and spiritual vortexes and things you might see after inhaling mushrooms, which you do not hear about in Hampton. Mad Dog never quite got an explanation of what a spiritual vortex might be, but whatever it is, they have it in Sedona, apparently. It may be connected to the Indians who once had Sedona to themselves, but to Mad Dog, that sort of spirituality derives from a pre scientific culture which sought to imagine explanations for observed phenomenon rather than investigate anything with experiment and deduction. 

Doughty New Englanders will drive you crazy when you are on line at the post office, trying to send your package off while the lady at the counter banters on with the postal clerk, who wants to hear about all the grandchildren. Same thing at the dry cleaners and the bank, but if you're in a hurry, why are you living in Hampton?

View From Plaice Cove Obadiah Youngblood

This sort of connectivity in Hampton has its charms: Mad Dog picked up his laundry at the dry cleaners, and the owner, who is the son of Korean immigrants, asked him about Mad Dog's grand daughter in California, who just turned one and in the Chinese tradition, had a ceremony which involved the baby being presented with a display of objects and whichever object the baby chooses is supposed to predict the path in life that baby may follow--a sort of Chinese ground hog day ritual, predicting the future by signs. 

Covered Bridge Obadiah Youngblood

The dry cleaner man remembered about Mad Dog's grand daughter because the Koreans have something similar, and he had chatted with Mad Dog's wife about it. But the point is, this dry cleaner store owner remembered and he made the connection and he took some joy in it.

Hampton Barn

Rte 1A Hampton

Most of the people Mad Dog encountered in Sedona seemed to be from somewhere else, having wound up in Sedona much as flies wind up on flypaper. In Hampton, you are apt to meet people who grew up in town, graduated from Winnacunnet High School and either never left, or returned after a time outside the sect.

Rte 27 Hampton

At the end of the tale, the Hobbits have returned safely home to their shire, and they watch the fireworks from their front yards as everyone celebrates the joy of living in the shire--and that is how Mad Dog felt, returning from the 6000 feet above sea level to the Ocean at the end of the street.

Pink House, Drinkwater Road

Explaining Democracy

 

Mad Dog is riding in the far back of a Chrysler Pacifica, with his son and his son's wife, young mother,  up front, and two granddaughters, 5 years old and 3 y.o., in the middle row and the two aged ones behind them. 

They are on holiday in Arizona, where President Biden just managed to squeak out a victory last election. Democracy survived.

Young mother is struggling to answer a question from the 5 year old about what democracy is. 

Young mother  begins by explaining that democracy is a form of government which was designed to replace monarchy, or autocracy, in which one man ruled and made all the decisions and all the people had to simply obey his commands. 

"So, how does he get to be king?"

"Well, that post is usually hereditary, and gets passed down to the child of the king, usually a male child, but sometimes a girl."

"But what if the king has twins?"

  (The 5 year old has friends who are twins.) 

"Well, that might be a problem--perhaps the twin who was born first got to be king."

"But what if they were conjoined twins?" 5 year old persists.

Now we have spun off into George Carlin land and young mother is left speechless. 

"Where did she ever hear about conjoined twins?" Mad Dog demands from the rear seat.

Five year old ignores that query.

"We no longer ask," young mother replies.

"I can see why they replaced monarchy," five year old says.

"But where did you hear about conjoined twins?" 

Mad dog is insistent. Five year old ignores him. Her mind is spinning so far ahead of him, as the red vistas fly by her window. She is coming up with a new question.

Mad Dog understands why monarchy was doomed. 

Conjoined twins. His 5 year old granddaughter got that. But she is not done. 

"But what if a pair of conjoined twins ran for President," 5 year old asks,  "And one was Republican and one was Democrat? And they won!"

Mad Dog now understands why Democracy must fail.

We are all doomed. 

 

Empty Suits: ACLU and Americans United

 

What is the meaning of the phrase, "Empty Suit?"

Generally, it is reserved to describe a person who may look potent, important or consequential, who is really effete, ineffective or simply cowardly.

For me, the classic use of the expression came when Jimmy McNulty ("The Wire") meets with federal officials from the FBI and the (Republican) Department of Justice, trying to enlist their help in bringing to heel the powerful, efficient and lethal drug mob he and his Baltimore Police Department have been struggling to contain. The federals are indifferent to a mob which simply pushes heroin, murders local citizens and controls the corners of a minor American city. What the feds want is to trap some corrupt (Democratic) elected officials and to prosecute them.

McNulty finally jumps to his feet in frustration and exclaims, "And here I thought you were real police! But no, just putting away an organization which has been destroying half of a city with murders, drugs and extortion isn't of interest to you. All you want is a few political pelts. You're not real police at all, just a bunch of empty suits!"

That contains all the meanings and nuances: the phony aspect of sworn officers who don't actually care about crime; the pretense of potency; the showy exterior covering a hollow interior. A suit of armor, with no knight inside it.

$250,000 

And that is what Mad Dog has found when he looked for help from the American Civil Liberties Union (New Hampshire) and Americans United for Separation of Church and State. The CEO of Americans United gets over $250,000 a year to fight for the principle of church/state separation, and the CEO of the New Hampshire ACLU gets about $100,000 to fight for the First Amendment.

$100,000 looking for a rock to hide under

But neither was interested in fighting the good fight in Hampton, when the Our Lady of the Miraculous Medal church pushed through it's annual stipend/slush fund using the corrupt warrant article process in town.

What happens in Hampton is unique in America, as far as Mad Dog can tell. It is not like the case in Everson, where the courts found a town which says it wants to offer a service to all the town's children, namely busing them to school, then that town cannot refuse to bus children simply because they want to be bused to a Catholic school. It is not like Carson, where children who have been guaranteed by the state of Maine a free public education, are denied funds for the only school in their remote part of the state, a school which is a Christian Bible school. It is not like Espinosa, where Montana made voucher funds, underwritten by the taxpayer, available to church schools. In all these cases the state was offering to make funds available to all members of the public; in Hampton special funds are designated to a special group of children--those attending a Catholic church school.

In the case of Hampton, the parish congregation puts its request for $50,000 on a "warrant ballot" and uses its parishioners on the School Board and Budget Committee to vote to endorse this ballot initiative, endorsements which appear on the ballot, and almost assure passage in the voting, and they create a slush fund from which the SAU treasurer (a government employee) writes checks from the town account to cover invoices for computers and who knows what (?crucifixes molded of clay?) for the church school, a slush fund available only to those children who attend the church school, over and above what other town children have available to them.

This is straightforward establishment of a state church (i.e. funding a church with public funds) as clearly as has ever occurred for the Anglican church in England, or the German system of designating 3% of income tax from each member of any congregation.

The CEO of the New Hampshire ACLU reportedly has said, off the record, that those who have objected to this slush fund, to this violation of the First Amendment's guarantee against establishment of state religion are entirely correct, but it is simply not worth fighting this battle "given the current Supreme Court and the environment we have now."

Which is to say, we think we cannot slay this dragon, so we will simply cut and run.

The CEO of Americans United is even worse: she simply refuses to respond but she sends out weekly announcements about all the good work she does and asks for contributions. 

So we have not got warriors fighting the good fight. The days when the ACLU signed on to defend the right of Nazis to march in Skokie are long gone. That took real guts. The ACLU risked alienating its donor base. But it said, "If we are not going to defend the First Amendment for everyone, why do we defend it at all, for anyone?"