ETA (18 Oct 2009): This may, in fact, be complete rumour, everyone! Apologies for not checking; I didn’t realise the PBS was online. If you look here, you can see that there are multiple indications under which it can be prescribed, and whilst one of the first is for ‘deviancy’, the secondary indication can be “Moderate to severe androgenisation in non-pregnant women (acne alone is not a sufficient indication of androgenisation).”. I have, however, heard of at least two trans or intersex people who were advised that they would be placed on a sex offender registry if they were prescribed the drug under the PBS, which raises the question of what role physicians play in a potentially scaremongering style of gatekeeping.
OII (the International Intersex Organisation) recently posted this on their website:
That’s right; if you take the specific anti-androgen drug androcur, you are compulsorially added to the Australian Sex Offender Registry, specifically because of how it is listed on the PBS. This means that a whole range of people, intersex and trans, men and women, wind up listed as sex offenders because they need access to a particular hormone. Not only does this compromise the list of sex offenders, but as Zoe Brain discusses, alongside OII’s post above, this places a whole range of people, with various needs and backgrounds, in fairly precarious positions in relation to law enforcement, reinforcing a history of criminalising those who fall outside a very narrow conception of sexual difference.
Categories: health, law & order, medicine, Politics
This is the PBS website – click on the red text “AUTHORITY REQUIRED – streamlined” to see this first-hand. Of course, doctors can write private scripts for “off-label” use and thus penalise their patient financially – quite considerably, in the case of Androcur – when these life-saving drugs are exactly what Medicare needs to provide. You can contact the PBS at firstname.lastname@example.org, the TGA via details here, including phone relay service or Nicola Roxon (who is the Minister responsible for both) via her website.
Jesus. That’s disgusting, horrifying.
(note to commenters: please re-read the post, as there has been an update.)
That second indication still wouldn’t do any good for transwomen who haven’t had surgery, and are not legally considered women, would it?
lilacsigil: I’m not aware of any PBS audit process to check whether someone’s gender documentation is up to date when authority prescriptions are written, and there’s no restriction on “woman” to mean “XX” (or similar) in the indication wording. The indication wording as writ is pretty much all there is when it comes to Authority scripts, there’s generally not any other fine print anywhere clarifying the wording. In my experience, every single authority prescription call is approved so long as the doctor parrots the ‘indication’ line correctly to the clerk. (This doesn’t mean that I’m asserting that doctors know how it is going to work, or that the PBS clerks are always up to date on gender issues.) Does anyone here have any other concrete experience with this particular part of the process?
I think WP’s point about doctors being involved in this aspect of scaremongering could be an important one. It’s also possible, though I’d like to think (hrm) it would be hard to believe with doctors who are specialising in trans and intersex issues, that some doctors haven’t clicked past the cancer/deviancy indication set to find the one for androgenisation.
There is no such thing as an Australian Sex Offender Registry. There is ANCOR and various State registries but you wouldn’t be put on them if you weren’t charged with or convicted of a crime.
I can’t speak for doctors’ behaviour in “reporting” but I don’t buy the idea of the existence of such a list.
lilacsgirl, there’s little doubt that the wording of the PBS indications is, or has the potential to be deployed, in a cissexist way, depending on the cissexism of the doctor. Which is clearly problematic. However, it does allow for other indications than sexual deviancy, which was my (not very clear, sorry about that!) point. In the comment thread over at Zoe Brain’s, it seems that the PBS change their records of people’s sex in order to enter the script. Other scripts might require that it be altered back. According to Zoe (and I have no evidence of this, so I’m not sure if it’s true) this means that people shift back and forth between two different indications (one relating to women, and the other to ‘males’). This seems a fairly odd system of record-keeping, but then, the inflexibility of the sex binary in public records is going to produce precisely these problems.
The issue is more that, as Liam says, it’s not clear that the Sex Offender Registry exists. The only evidence for it seems to come from those whose doctors have prescribed them the drug, and warned them that this is part of the deal. The stories about this have circulated far and wide: there’s a number of people in the thread at Zoe’s who have been told they have been added to this list, and there’s a slightly different version of this story written up as part of HREOC’s Sex and Gender Diversity Report (http://www.hreoc.gov.au/genderdiversity/consultation_report2008.html#6). Some say they’ve been denied permission to Work With Children; others say they’ve had no such issues. If the list exists, I wouldn’t be completely shocked if they used something as odd as scripts entered into the PBS to add people to it. If it doesn’t, and it’s hard to find evidence outside of ‘my doctor warned me’, then I have serious questions about what these doctors think they’re doing telling these discouraging stories without proof, and the effect they have on their trans or intersex patients.
Quite, wildlyparenthetical. I find it much easier to conceive of rumour-created fear of a list designed to make intersex people’s interactions with doctors more difficult, than to accept that any Government agency would place any stock in a register whose data included anything of so little value as PBS scripts. Cops, doctors and policymakers might be bigoted and ignorant, but the people who design criminal databases know more about how to collect useful data.
For the record it’s really quite difficult and onerous to be on these kinds of Registries in Australia; you generally have to be sentenced by a court for certain kinds of offences, and the requirements often involve having to regularly report to the Police. The NSW Child Protection Register, for example, only lists people who have committed offences against children, and the NSW Working With Children check applies only to “prohibited persons” who have been sentenced by a court. You don’t just wind up on some kind of pervert’s blacklist without your knowledge.