Anatomy of a Medical Scandal

From OxyContin to puberty blockers: Big Pharma’s playbook for creating iatrogenic medical scandals.

Gerald Posner’s groundbreaking investigative book, “Pharma, Greed, Lies and the Poisoning of America” (2020) exposes Purdue Pharmaceutical’s playbook in manufacturing the opioid scandal that resulted in the death of 800,000 people in the U.S.

In the book, Posner lays bare the universal components required for iatrogenic medical scandals from opioids to paediatric gender medicine:

1. Create or expand a new or underserved cohort of patients

2. Develop and promote a body of pseudoscience and junk research

3. Invest in “front” organisations and frame treatments as a “human right”

4. Offer financial incentives to obtain compliance and collusion.

5. Promote medical treatments as “breakthrough” solutions.

Grow the Patient Pool

Opioids were originally prescribed for short-term use by terminal cancer patients in hospitals, but Richard Sackler wanted to grow Purdue’s market share to increase profits. In court filings, Sackler was shown to direct marketing efforts to target “opioid-naïve” groups: returning veterans, the elderly, postpartum women and workers in labour-intensive industries.

OxyContin was Purdue’s patented controlled-release oxycodone, designed to provide steady pain relief over a 12-hour period that could now be marketed to those with arthritis, back pain, migraines, work injuries, fibromyalgia and general musculoskeletal pain.

In 1996, OxyContin prescriptions totalled just 317,000 for palliative and cancer patients. But by the early 2000s, the number of prescriptions surged to 14 million, with 86% of the market shifting to non-cancer chronic pain patients.

Gender Medicine

Just as the opioid crisis was driven by marketing OxyContin to a new, untapped patient cohort, the explosion in gender clinic referrals for puberty blockers, cross-sex hormones and surgeries required an entirely new patient pool with markedly different clinical presentations from the original cohort.

The group of transsexual patients was diagnosed with ‘early onset gender dysphoria’ by sexologists - a persistent sense of discomfort about being male and a strong desire to be the opposite sex.

Looking back, it’s difficult to fathom how a tiny, adult-male-focused field became the most politicised and consequential area of modern paediatric medicine. The change in patient population, age and clinical presentation is a stark reversal – from adult men with sexual fetishism to prepubescent children and (mostly) girls struggling with a range of comorbidities.

How Did this Happen?

The first step in this shift came in the late 1990s when Dutch clinicians in Amsterdam began offering puberty blockers to adolescents followed by cross-sex hormones and surgeries. The “Dutch Protocol” as it became known, was based on the first clinical trial with 70 adolescents put on this medical pathway between 2000 and 2008.

The Dutch Protocol marked a pivotal shift in the treatment of gender dysphoria from the traditional “watchful waiting” model, that emphasised psychological support and allowed natural resolution of dysphoria in over 80% of cases, toward an “affirmation-only” model. (The Dutch received funding from AbbVie, that make the puberty blocker Lupron).

Activist clinicians and LGBTQi+ lobby groups cited the Dutch Protocol as the gold-standard, evidence-based model for paediatric gender care. And from the mid-2000s insisted on the “affirmation-only” model that included social transition.

Soon school age children began to change their names and pronouns and present as the opposite sex at school. Girls began binding their breasts (with known physical harms) and boys began ‘tucking’ in order to present as if they were girls.

By the mid 2020s, gender clinics saw a dramatic reversal from the males to an explosion of adolescent girls, often clustering by friendship groups, peer circles, or classrooms, where multiple individuals began identifying as ‘trans’ simultaneously.

In her 2018 study, Lisa Littman termed this phenomenon “rapid-onset gender dysphoria” (ROGD) while many of this new patient cohort experienced multiple comorbidities including depression, anxiety, autism, sexual abuse, family breakdown and bullying.

Demographic at the U.K.’s Tavistock gender clinic. (Cass Review)

Pseudoscience and Junk Research

To gain widespread acceptance of a novel or untested medical treatment it helps to present it as a “medical breakthrough.”

First generation opioids delivered a single dose with 3-6 hours of relief per dose which led to peaks of euphoria followed by troughs of pain and withdrawal. Purdue promoted its 12-hour time-release capsule as promising a steady, slow release of oxycodone into the bloodstream. But this was a lie.

OxyContin marketing relied on the 1980 Porter-Jick letter written by Jane Porter and Herschel Jick. The Jick letter was only five sentences long and reported results for hospital patients given opioids short-term under hospital supervision. And yet the letter was cited 608 times in Purdue marketing to position OxyContin having addiction rates at less than one per cent.

Likewise, the carefully selected adolescents in the early Dutch trial were very different from the adolescent girls flooding gender clinics from the 2010s onwards.

From “Watchful Waiting” to “Affirmation-Only”

The Dutch trial was based on a small sample of 70 patients, of whom 15 failed to complete the study. The final report overstated the evidence, lacked robust controls and contained methodological flaws. Most critically, the report excluded the death of a boy who died from necrotising fasciitis (“flesh-eating disease”) in the final report reclassifying him as a “non-participant.”

A death of 1 out of 70 participants is a significant adverse event by any reasonable medical standard, while the loss of 15 patients to follow-up further undermines the overly positive outcomes initially reported.

The trial claimed puberty blockers allow time to “pause” and are “fully reversible.” But independent reviews from the U.K, Sweden, Finland, Norway and the U.S. found that those prescribed puberty blockers proceed to cross-sex hormones in 98 percent of cases - effectively locking them in.

Build “Front” Organisations run by Activists

“Front” organisations stacked with activist clinicians allow a pharmaceutical company to create the illusion of clinical independence while advancing its agenda.

In the opioid scandal the American Pain Society (APS) and the American Academy of Pain Medicine (AAPM) helped legitimise Purdue’s medical fraud. The APS and the AAPM were given millions in funding and included ‘experts’ who endorsed Purdue’s misleading claims.

Like the APS and the AAPM the World Professional Association for Transgender Health (WPATH) positions itself as the global authority on gender medicine - issuing Standards of Care adopted in countries including Australia, New Zealand, and Canada.

WPATH’s current SOC8 (2024) is cited as the authoritative international reference but includes major deficiencies e.g. low-quality evidence, circular referencing and selectively reporting medical outcomes.

Unsealed court documents from a 2024 Alabama case challenging a state ban on gender medicine included emails from Biden’s Assistant Secretary for Health, Rachel Levine requesting WPATH eliminate any age minimum for children seen at gender clinics.

Rachel Levine (left) and Karine Jean-Pierre

Reduxx, an independent online news website revealed that WPATH’s SOC8 contained a metadata link to an online portal - the Eunuch Archive that hosts thousands of user-submitted erotic stories involving extreme sadomasochism, castration fantasies and themes of child sexual exploitation depicting the rape, torture, or forced castration of children.

In the whistleblower WPATH files by Environmental Progress, WPATH members are caught on camera admitting that children do not understand, nor can they consent to the harms of puberty blockade. In a secret recording, WPATH’s then-president, Dr. Marci Bowers says:

“To date, I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner 2.” (ages 9–11)

While in another panel discussion an endocrinologist says: “We are creating people we’ve never seen before.”

Reward Compliance, Silence or Collusion.

A medical scandal requires deep pockets to fund lobbying, medical conferences and aligned organisations but these costs are dwarfed by potential profits. Launched in 1996, OxyContin generated $48 million in sales from 317,000 prescriptions but by 2010 sales peaked at $3.1 billion which was a 6,358% increase in 14 years.

Pharma’s Golden Goose

While the patient pool for gender medicine is far smaller than the 50-80 million Americans prescribed opioids at the peak of the crisis it represents Big Pharma’s golden goose: patients for life.

The lifetime cost of medicalising one individual from puberty through age 50 ranges from a conservative estimate of US $100,000 to over $500,000.

Using the midpoint of $300,000 per patient:

50,000 patients generates a lifetime revenue of $15 billion.

300,000 patients generates $90 billion.

The global gender medicine market is worth hundreds of billions of dollars given the significant lifetime value per patient.

The Global Rights Narrative

The abuse of “human rights” rhetoric fuelled both the opioid and the gender medical scandals by framing restrictions on treatments as violations of fundamental rights.

Opioid-friendly organisations lobbied aggressively against regulatory restrictions and popularised the term “opiophobia”to discredit anyone calling for caution.

The WHO held the inaugural Global Day Against Pain in 2004 with funding from Purdue Pharma and repeated the concept of “opiophobia” in its guidelines.

The WHO, UN, EU, WPATH, Endocrine Society, LGBTQi+ lobby groups as well as many national medical organisations continue to frame restrictions to puberty blockers as human rights abuses and demand unrestricted provision while labelling critics “transphobic.”

This “affirmation-only” rhetoric is designed to silence debate and provide moral legitimacy to the biggest medical scandal in history.

How Medical Scandals End

“In my view, the paediatric gender industry represents the most serious medical scandal since the lobotomy era: an entire class of vulnerable patients subjected to irreversible interventions driven by ideology, debunked evidence, and institutional groupthink.”

Gerard Posner

The first successful malpractice case in the U.S was won by detransitioner, Fox Varian in early 2025 who was awarded $2 million dollars compensation after being given a double mastectomy at age 16. In a recent Substack article Posner writes:

“This verdict is not the end of the story. It is the beginning. As with opioids, asbestos, tobacco, and defective medical devices, once a viable legal theory survives a jury trial, the plaintiffs’ bar takes notice. Many trial lawyers are politically liberal. That is irrelevant. What matters is that there is now blood in the water, a proven pathway to liability, and deep institutional pockets behind these practices.”

Many more lawsuits are currently advancing through the courts in the US, UK and Canada.

Once the lawsuits begin, pharmaceutical companies will move on to the final phase of a medical scandal and offer medical treatments to correct the harm it helped create.

Following the opioid scandal, the market for Opioid Use Disorder (OUD) treatments has grown to $5.9 million. Corrective surgeries, psychological support and new medical treatments will be needed for a growing number of detransitioners.

Early signs are that Big Pharma and the LGBTQi+ lobby is already pivoting from a push for child transition to an ‘adult-only’ sex modification industry framed not as a cure for “gender dysphoria” but as a right to achieve our “embodiment goals”.