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In this episode of The Right Idea, TPPF's Brian Phillips and Derek Cohen break down how political activism has seeped into Texas healthcare — influencing diagnoses, treatments, and public policy.
They’re joined by Dr. Lisa Ehrlich, internal medicine physician and former TMA trustee, and Joseph Figliolia, Manhattan Institute policy analyst and author of a major report on the TMA’s drift into ideological advocacy.
Together, they examine:
* How the TMA embraced gender-affirming care despite weak evidence
* Why many physicians feel silenced
* How institutional capture happens inside medical organizations
* The impact on children, parents, lawmakers, and the practice of medicine
* What reforms are needed to bring medicine back to evidence-based practice
00:30 – Thanksgiving politics & family discussions
03:40 – Today’s topic: Gender ideology in healthcare
05:18 – Guest introductions: Dr. Ehrlich & Joseph Figliolia
05:42 – Why Joseph investigated the TMA
07:23 – Is the TMA doubling down despite national pushback?
09:07 – Evidence problems & reversals in Europe
10:25 – Dr. Ehrlich: What clinicians saw on the ground
11:38 – Social contagion & the rise of gender questioning
13:12 – Vulnerable populations & patterns emerging
14:58 – Why endocrinology led the shift
16:02 – “Science by consensus” and activist medicine
17:36 – The problem with WPATH & activist guidelines
18:33 – How TMA was captured: institutional mechanics
19:23 – Why doctors stay silent
20:57 – Fear of being labeled discriminatory
22:08 – Dr. Ehrlich: Intimidation inside the TMA
23:56 – Identity sections and cultural politicization
25:05 – Personal attacks vs scientific debate
26:31 – Medicine requiring ideological pre-commitments?
27:55 – Historical parallels (e.g., lobotomies)
28:58 – Pandemic mandates & ethical shifts
31:09 – Three separate issues: dysphoria, treatment, ideology
32:57 – Suicide risk, treatment failures, evidence gaps
34:18 – Is someone funding this movement?
36:01 – TMA’s definitions avoid “gender dysphoria” entirely
37:44 – The financial incentives behind affirming care
38:39 – Do associations influence medical boards?
41:15 – How TMA influences Texas policy
42:07 – Is Texas protecting kids effectively?
43:30 – Evidence-based standards being ignored
44:56 – CME problems: outdated, debunked studies
45:14 – Can the TMA be fixed?
47:34 – Structural governance problems
49:24 – What shoe drops next?
51:07 – The comprehensive HHS gender dysphoria review
51:35 – Dr. Ehrlich’s advice for physicians afraid to speak up
They’re joined by Dr. Lisa Ehrlich, internal medicine physician and former TMA trustee, and Joseph Figliolia, Manhattan Institute policy analyst and author of a major report on the TMA’s drift into ideological advocacy.
Together, they examine:
* How the TMA embraced gender-affirming care despite weak evidence
* Why many physicians feel silenced
* How institutional capture happens inside medical organizations
* The impact on children, parents, lawmakers, and the practice of medicine
* What reforms are needed to bring medicine back to evidence-based practice
00:30 – Thanksgiving politics & family discussions
03:40 – Today’s topic: Gender ideology in healthcare
05:18 – Guest introductions: Dr. Ehrlich & Joseph Figliolia
05:42 – Why Joseph investigated the TMA
07:23 – Is the TMA doubling down despite national pushback?
09:07 – Evidence problems & reversals in Europe
10:25 – Dr. Ehrlich: What clinicians saw on the ground
11:38 – Social contagion & the rise of gender questioning
13:12 – Vulnerable populations & patterns emerging
14:58 – Why endocrinology led the shift
16:02 – “Science by consensus” and activist medicine
17:36 – The problem with WPATH & activist guidelines
18:33 – How TMA was captured: institutional mechanics
19:23 – Why doctors stay silent
20:57 – Fear of being labeled discriminatory
22:08 – Dr. Ehrlich: Intimidation inside the TMA
23:56 – Identity sections and cultural politicization
25:05 – Personal attacks vs scientific debate
26:31 – Medicine requiring ideological pre-commitments?
27:55 – Historical parallels (e.g., lobotomies)
28:58 – Pandemic mandates & ethical shifts
31:09 – Three separate issues: dysphoria, treatment, ideology
32:57 – Suicide risk, treatment failures, evidence gaps
34:18 – Is someone funding this movement?
36:01 – TMA’s definitions avoid “gender dysphoria” entirely
37:44 – The financial incentives behind affirming care
38:39 – Do associations influence medical boards?
41:15 – How TMA influences Texas policy
42:07 – Is Texas protecting kids effectively?
43:30 – Evidence-based standards being ignored
44:56 – CME problems: outdated, debunked studies
45:14 – Can the TMA be fixed?
47:34 – Structural governance problems
49:24 – What shoe drops next?
51:07 – The comprehensive HHS gender dysphoria review
51:35 – Dr. Ehrlich’s advice for physicians afraid to speak up
Creators and Guests
Host
Brian Phillips
Brian Phillips is the Chief Communications Officer at the Texas Public Policy Foundation. For over a decade, Brian has helped policymakers and political candidates develop effective messages and communication strategies. Phillips is a veteran of presidential, congressional, and gubernatorial campaigns, and has extensive experience working in the United States Congress and public policy think tanks.
Host
Derek M. Cohen
Derek M. Cohen, Ph.D, is the Texas Public Policy Foundation's Chief Policy & Research Officer and Right on Crime Senior Fellow. Previously the Vice President of Policy and director of Right on Crime, the Foundation’s criminal justice reform initiative, Cohen was instrumental in the passage of the First Step Act, federal legislation that borrowed from successful changes to prisons and sentencing that he had helped pass in conservative states. In addition to leading the Foundation’s work on criminal justice, he is also the lead researcher of firearms policy.
What is The Right Idea?
The Right Idea: The Texas Public Policy Foundation's weekly look at the people, policy, and politics that drive Texas.