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Women in Menopause Are Getting Short Shrift

The Atlantic

www.theatlantic.com › health › archive › 2024 › 04 › menopause-transgender-care-estrogen-testosterone › 678095

After a decade working as an obstetrician-gynecologist, Marci Bowers thought she understood menopause. Whenever she saw a patient in her 40s or 50s, she knew to ask about things such as hot flashes, vaginal dryness, mood swings, and memory problems. And no matter what a patient’s concern was, Bowers almost always ended up prescribing the same thing. “Our answer was always estrogen,” she told me.

Then, in the mid-2000s, Bowers took over a gender-affirmation surgical practice in Colorado. In her new role, she began consultations by asking each patient what they wanted from their body—a question she’d never been trained to ask menopausal women. Over time, she grew comfortable bringing up tricky topics such as pleasure, desire, and sexuality, and prescribing testosterone as well as estrogen. That’s when she realized: Women in menopause were getting short shrift.

Menopause is a body-wide hormonal transition that affects virtually every organ, from skin to bones to brain. The same can be said of gender transition, which, like menopause, is often referred to by doctors and transgender patients as “a second puberty”: a roller coaster of physical and emotional changes, incited by a dramatic shift in hormones. But medicine has only recently begun connecting the dots. In the past few years, some doctors who typically treat transgender patients—urologists, gender-affirmation surgeons, sexual-medicine specialists—have begun moving into menopause care and bringing with them a new set of tools.

“In many ways, trans care is light years ahead of women’s care,” Kelly Casperson, a urologist and certified menopause provider in Washington State, told me. Providers who do both are well versed in the effects of hormones, attuned to concerns about sexual function, and empathetic toward people who have had their symptoms dismissed by providers. If the goal of menopause care isn’t just to help women survive but also to allow them to live their fullest life, providers would do well to borrow some insights from a field that has been doing just that for decades.

[From the October 2019 issue: The secret power of menopause]

American women’s relationship with estrogen has been a rocky one. In the 1960s, books such as Feminine Forever, written by the gynecologist Robert A. Wilson, framed estrogen as a magical substance that could make women once again attractive and sexually available, rendering the menopausal “much more pleasant to live with.” (The New York Times later reported that Wilson was paid by the manufacturer of Premarin, the most popular estrogen treatment at the time.) Later, the pitch switched to lifelong health. By 1992, Premarin was the most prescribed drug in the United States. By the end of the decade, 15 million women were on estrogen therapy, with or without progesterone, to treat their menopause symptoms.

Then, in 2002, a large clinical trial concluded that oral estrogen plus progesterone treatment was linked to an increased risk of stroke, heart disease, and breast cancer. The study was an imperfect measure of safety—it focused on older women rather than on the newly menopausal, and it tested only one type of estrogen—but oral-estrogen prescriptions still plummeted, from nearly a quarter of women over 40 to roughly 5 percent. Despite this blow to the hormone’s reputation, evidence has continued to pile up confirming that oral estrogen can help prevent bone loss and treat hot flashes and night sweats, though it can increase the risk of strokes for women over 60. Topical estrogen helps address genital symptoms, including vaginal dryness, irritation, and thinning of the tissues, as well as urinary issues such as chronic UTIs and incontinence.

But estrogen alone can’t address every menopause symptom, in part because estrogen is not the only hormone that’s in short supply during menopause; testosterone is too. Although researchers lack high-quality research on the role of testosterone in women over age 65, they know that in premenopausal women, it plays a role in bone density, heart health, metabolism, cognition, and the function of the ovaries and bladder. A 2022 review concluded, “Testosterone is a vital hormone in women in maintaining sexual health and function” after menopause.

Yet for decades, standard menopause care mostly ignored testosterone. Part of the reason is regulatory: Although estrogen has enjoyed FDA approval for menopausal symptoms since 1941, the agency has never green-lit a testosterone treatment for women, largely because of scant research. That means doctors have to be familiar enough with the hormone to prescribe it off-label. And unlike estrogen, testosterone is a Schedule III controlled substance, which means more red tape. Some of Casperson’s female patients have had their testosterone prescription withheld by pharmacists; one was asked if she was undergoing gender transition.

[Helen Lewis: Capitalism has plans for menopause]

The other hurdle is cultural. These days, providers such as Casperson, as well as  menopause-trained gynecologists, might prescribe testosterone to menopausal women experiencing difficulty with libido, arousal, and orgasm. Many women see improvements in these areas after a few months. But first, they have to get used to the idea of taking a hormone they’ve been told all their lives is for men, at just the time when their femininity can feel most tenuous (see: Feminine Forever). Here, too, experience in trans care can help: Casperson has talked many transmasculine patients through similar hesitations about using genital estrogen cream to balance out the side effects of their high testosterone doses. Taking estrogen, she tells those patients, “doesn’t mean you’re not who you want to be,” just as taking testosterone wouldn’t change a menopause patient’s gender identity.

Many trans-health providers have also honed their skills in speaking frankly about sexuality. That’s especially true for those who do surgeries that will affect a patient’s future sex life, Blair Peters, a plastic surgeon at Oregon Health & Science University who performs phalloplasties and vaginoplasties, told me. Experts I spoke with, including urologists and gynecologists with training in sexual health, said that gynecologists can often fall short in this regard. Despite treating vaginas for a living, they can often be uncomfortable bringing up sexual concerns with patients or inexperienced at treating issues beyond vaginal dryness. They can also assume, inaccurately, that concerns about vaginal discomfort always center on penetrative sex with a male partner, Tania Glyde, an LGBTQ+ therapist in London and the founder of the website Queer Menopause, told me. A 2022 survey of OB-GYN residency programs found that less than a third had a dedicated menopause curriculum.

Bowers, who is herself transgender, told me she got comfortable talking about sexuality in a clinical setting only after moving into trans care. If she were to return to gynecology today, she said, she would add some frank questions to her conversations with midlife patients who share that they’re having sexual issues: “Tell me about your sexuality. Tell me, are you happy with that? How long does it take you to orgasm? Do you masturbate? What do you use?”

Menopause care has already benefited from decades of effort by queer people, who have pushed doctors to pay more attention to a diversity of experiences. Research dating as far back as the 2000s that included lesbians going through menopause helped show that common menopause stereotypes, such as anxiety over remaining attractive to men and disconnect between members of a couple, were far from universal. Trans people, too, have benefited from advances in menopause care. Because both gender transition and menopause involve a sharp drop in estrogen, many transmasculine men who take testosterone also lose their period, and experience a similar (though more extreme) version of the genital dryness and irritation. That means they can benefit from treatments developed for menopausal women, as Tate Smith, a 25-year-old trans activist in the U.K., realized when he experienced genital pain and spotting after starting testosterone at 20. After he found relief with topical estrogen cream, he made an Instagram post coining the term trans male menopause to make sure more trans men were aware of the connection.

[Read: What menopause does to women’s brains]

The more menopause and gender care are considered together in medical settings, the better the outcomes will be for everyone involved. Yet menopause studies rarely consider trans men and nonbinary people, along with younger women and girls who experience menopause due to cancer treatment, surgery, or health conditions that affect ovarian function. Although these patient populations represent a small proportion of the patients going through menopause, their experiences can help researchers understand the effects of low estrogen across a range of bodies. Siloing off menopause from other relevant fields of medicine means menopausal women and trans people alike can miss out on knowledge and treatments that already exist.

Unlike gender transition, menopause is generally not chosen. But it too can be an opportunity for a person to make choices about what they want out of their changing body. Not all women in menopause are worried about their libido or interested in taking testosterone. Like trans patients, they deserve providers who listen to what they care about and then offer them a full range of options, not just a limited selection based on outdated notions of what menopause is supposed to be.

The Self-Help Queen of TikTok Goes Mainstream

The Atlantic

www.theatlantic.com › technology › archive › 2024 › 04 › shadow-work-journal-keila-shaheen › 678094

In 2006, Oprah Winfrey couldn’t stop talking about The Secret. She devoted multiple episodes of her talk show to the franchise, which started as a kind of DVD seminar and later became a best-selling book. Its author, Rhonda Byrne, claimed to have stumbled upon an ancient principle, one that can teach anyone to manifest anything they want: money, health, better relationships. Winfrey retroactively credited its core philosophy for bringing her success, and her endorsement helped bring the book international fame: It has now sold more than 35 million copies. But in the era of endless scrolling, an author doesn’t necessarily need Winfrey’s stamp of approval. They just need TikTok.

Keila Shaheen figured this out last year, when her self-published book The Shadow Work Journal began to dominate the app’s feeds. A slim volume, the book purports to help people unpack their “shadow” self—the repressed unconscious—through various activities. In video after video, TikTok users show themselves filling out its exercises and talk about the journal as if it has magical powers. They learn about Carl Jung’s model of the psyche. They circle terms related to their trauma. They heal their inner child! If you use a new coupon on TikTok Shop, the app’s new built-in store, you too can heal, for just a couple of bucks! they say. (Many of those posting earn a commission from each sale, but pay that no mind.)

The journal has sold more than 600,000 copies on TikTok alone, and more than 1 million copies in total, a feat usually accomplished by the Prince Harrys and Colleen Hoovers of the world. Shaheen, a 25-year-old writer with a marketing background, is the new breakout star of the self-help genre. She even outsold Winfrey’s latest book.

[Read: The 24-year-old who outsold Oprah this week]

Her story began in an untraditional way: Here is a young author, plucked from obscurity by a powerful app’s algorithm during a conveniently timed e-commerce push and turned into a best-selling phenom. Yet her next chapter is following an expected arc. She has signed a multi-book deal with Simon & Schuster to bring an updated version of The Shadow Work Journal to new audiences. Specifically, she is working with the brand-new imprint Primero Sueño Press, which will launch her book as its “flagship,” Shaheen told me, in addition to releasing a new Spanish translation later this year. The self-help queen of TikTok is officially going mainstream.

Shaheen’s arc, however unusual it seems, actually makes a lot of sense. We live in the age of therapy-speak; talking about one’s mental health isn’t as stigmatized as it once was. And yet a lot of people are still struggling. Teenagers—many of whom say they use the app “almost constantly”—are experiencing hopelessness and sadness at record highs. TikTok is known for authenticity, at least when compared with the picture-perfect posts on Instagram—it is supposed to be messier, more real. The kind of place where you’d talk about your struggles while in your sweatpants.  

The Shadow Work Journal isn’t the only such success on the platform. One of Shaheen’s other books, The Lucky Girl Journal—which teaches readers how to manifest their own good fortune, rather than leaving things up to chance—has sold more than 25,000 copies on the app’s store. Don’t Believe Everything You Think, a self-published volume by Joseph Nguyen, a mental-health content creator with little notoriety outside social media, has sold about 60,000 copies on TikTok, and is currently in the top 10 most sold books on Amazon.

It’s boom times for self-help on social media. Kathleen Schmidt, who helped publicize The Secret and now runs a public-relations company (and writes the Substack newsletter Publishing Confidential), first heard about Nguyen’s book when her 16-year-old daughter asked for a copy. “I can see why it has caught on,” she told me. “It’s very simplistic, and it gives you big promises, like You’ll stop suffering, you’ll understand how to let go of anxiety, and all that.” A lot of self-help books, she explained, are too complicated or ask the reader to do too much; the more successful books tend to be accessible. If The Secret were published today, she argued, “it probably would have gone viral on TikTok and would have had somewhat of the same effect—but without Oprah.”

[Read: TikTok is doing something very un-TikTok]

With all of this in mind, I asked Shaheen why she’d made the decision to go a more traditional route. It was over Zoom, during a meet and greet set up by her publisher (and attended, as far as I could tell, by just me, one other writer, and some folks from her team). “I think I was just at a time and place where I couldn’t control what was going on,” she said, of all the attention last year, “and it was very overwhelming for me.” She realized that if she “wanted to continue helping people and grow the impact of this journal,” then she “would need help from a traditional publishing company.” She said she’d entertained offers from various publishers before settling on Primero Sueño Press, which will take over the production of her books. And anyway, her books will still be available for purchase on TikTok Shop.

One publishing house she hadn’t heard from is 8th Note Press—which is owned by TikTok’s parent company, ByteDance. It appears to have acquired three titles so far, and published its first book last month; a representative for TikTok told me that it has seen significant growth on TikTok Shop and success for a variety of books and book sellers, but did not comment on Shaheen’s decision to sign with a traditional publisher.

Perhaps ByteDance has a little too much on its plate to prioritize courting authors. TikTok still faces the threat of a national ban in the United States. When defending itself in ads or before Congress, the app likes to tout how many small-business owners it supports—people like Shaheen. For some businesses, that’s definitely true. But with all the uncertainty about the platform’s future, a big, traditional publishing house can offer two things that never feel especially present on social media: stability and security. After all, Simon & Schuster has a pretty good track record. It publishes a little book called The Secret.

Eli Lilly's Zepbound could help treat sleep apnea — paving a way to Medicare coverage

Quartz

qz.com › zepbound-sleep-apnea-trial-medicare-1851415775

Eli Lilly announced today that the drug behind Zepbound was found to help alleviate sleep apnea in patients with obesity in late-stage clinical trials. The medication, tirzepatide, is sold by the company in the United States as Mounjaro for diabetes and Zepbound for weight loss.

Read more...

The Rape Denialists

The Atlantic

www.theatlantic.com › ideas › archive › 2024 › 04 › october-7-hamas-sexual-assault › 678091

This story seems to be about:

On October 7, Hamas terrorists crossed the border into Israel and massacred more than 1,100 Israelis. The depths of Hamas’s sadism are almost too sickening to comprehend. Babies and children butchered. Parents murdered in front of their children. Families bound together and then burned alive. Others were tortured, and their bodies mutilated while both alive and dead.

Even the harshest opponents of Israel’s subsequent military campaign in Gaza acknowledge, albeit often half-heartedly, that Hamas acted with brutality on October 7 in killing innocents. But many of those same critics refuse to acknowledge the widespread sexual assaults against Israeli women that day.

Since allegations of sexual violence first appeared in the fall, a contingent of anti-Israel activists have sought to disprove them. “Believe women” and “Silence is violence” have been rallying cries of progressive feminist organizations for decades. But the same empathy and support have not been shown for Israeli victims.

Many prominent feminist and human-rights groups—including Amnesty International and the National Organization for Women—said little about the sexual-violence allegations. International organizations tasked with protecting women in wartime kept their powder dry. UN Women waited until December 1, nearly two months after the Hamas attack, to issue a perfunctory statement of condemnation.

Israel’s critics have insisted that a lack of firsthand accounts from rape survivors or forensic evidence undercut Israel’s accusations—and have dismissed claims that systematic sexual violence occurred as “unsubstantiated.” Others have accused the Israeli government of “weaponizing” accusations of rape to justify Israel’s “genocide” in Gaza, as an open letter from dozens of feminist activists put it in February. The letter has since been signed by more than 1,000 others.

News outlets that reported on the violence were fiercely attacked. For example, in late December, The New York Times published an investigation that thoroughly detailed the evidence of mass, systematic sexual violence. The story drew an immediate response from Hamas, in language echoing that used by Western activists. “We categorically deny such allegations,” Basem Naim, a Hamas leader, said in a statement, “and consider it as part of the Israeli attempt to demonize and dehumanize the Palestinian people and resistance, and to justify the Israeli army war crimes and crimes of genocide against the Palestinian people.”

Stridently anti-Israel independent journalists and activists immediately tried to pick apart the Times story, which culminated in late February with the publication of a more-than-6,000-word exposé by the left-wing outlet The Intercept that accused the Times of flawed reporting. The left-wing magazine The Nation accused the Times of “the biggest failure of journalism” since the paper’s reporting in the run-up to the Iraq War; the leftist YES! magazine claimed, “There is no evidence mass rape occurred.”  

Considering the vitriolic attacks against Israel since October 7, none of this should come as a surprise. The bloodied and dismembered bodies of dead Israelis had barely been collected before accusations of genocide were being levied by anti-Israel activists. Six months later, such denouncements are routine.

Across the United States and Western Europe, criticism of Israel’s actions quickly and predictably veered into rank anti-Semitism, with Jewish organizations, cultural institutions, artists, and individual Jews targeted by pro-Palestine activists because of Israel’s actions.

[From the April 2024 issue: The Golden Age of American Jews is ending]

But rape denialism falls into its own separate and bewildering category. Why have so many of Israel’s critics—and pro-Palestine activists—chosen to fight on this hill?

Many insist, like the feminists who signed the open letter, that they are questioning claims used to justify a war they oppose. But there is also a disquieting sense that pro-Palestine activists believe they must defend Hamas. Accusations of systematic rape and sadistic sexual violence not only tarnish the terrorist group, but also undermine the notion that October 7 was legitimate “armed resistance” against Israeli occupation.

Instead of believing women, these activists have chosen to take the word of a terrorist organization that is responsible for the deaths of thousands of Israelis and Palestinians and that has constantly denied that any sexual assaults occurred on October 7.

Six months into the war in Gaza, many pro-Palestine activists in the United States are so fully invested in the cause of Palestinian liberation, for which Hamas claims to be fighting—and so steeped in their hatred of Israel—that they are casting aside the progressive ideals that they regularly invoke when castigating Israel. In doing so, they are exposing themselves as hypocrites whose ideology is not forged in a set of universal values but rather is situational and dependent on ethnicity or skin color.

Rape denialism also feeds the widely held belief among Israelis that non-Jews refuse to acknowledge the horrors of October 7—and that the world is hopelessly biased against them. At the same time, it excuses Hamas’s actions and perpetuates the notion that Palestinians have little agency or responsibility for the continuation of a 75-year-old conflict with no end in sight. It pushes both sides to retreat to their respective corners, unwilling to see the humanity in the other, and makes the long-term goal of peaceful coexistence between Israelis and Palestinians that much more difficult to achieve.

Orit Sulitzeanu is the director of the Association of Rape Crisis Centers in Israel, an NGO that serves as a coordinating body for the country’s nine rape-crisis centers. As she tells every reporter who calls her, ARCCI does not work for or receive money from the Israeli government.  

In the days and weeks after October 7, ARCCI began getting “trickles of information” from doctors and therapists who were encountering survivors of sexual violence. “Everyone talks to us, and the community of therapists in Israel is small,” Sulitzeanu told me. The calls were intended not to alert ARCCI but rather to ask, “What do we do?”

As Sulitzeanu told me, Israel has virtually no experience with rape during wartime: “No one could imagine what happened, actually happened.” Ruth Halperin-Kaddari, the former vice chair of the United Nations’ Committee on the Elimination of All Forms of Discrimination Against Women and a law professor at Bar-Ilan University, told me that Israel was so unprepared for the onslaught of sexual-abuse cases on October 7 that during the intake process in Israeli hospitals, women who survived the Hamas massacre were not even asked if they had been sexually assaulted.  

Quickly, ARCCI began holding webinars to help therapists understand the special characteristics of sexual violence in wartime. And as time went on, Sulitzeanu and her staff noticed that the stories they were hearing were remarkably consistent.  

The group put together a report combining the information it was receiving (mainly from eyewitnesses and first responders) with media reporting in Israel and around the world. “Hamas’s attack on October 7th included brutal sexual assaults carried out systematically and deliberately against Israeli civilians,” it concluded. “Hamas terrorists employed sadistic practices aimed at intensifying the degree of humiliation and terror inherent in sexual violence.”

The report’s section titles tell the story in even more vivid and disturbing detail:

“Systematic Use of Brutal Violence to Commit Rape”

“Multiple Abusers/Gang Rape”

“Rape in the Presence of Family/Community Members”

“Sexual Offenses of Males”

“Execution During or After the Rape”

“Binding and Tying”

“Mutilation and Destruction of Genital Organs”

“Insertion of Weapons in Intimate Areas”

“Destruction and Mutilation of the Body”

The next month, the Office of the Special Representative of the Secretary-General on Sexual Violence in Conflict reached similar conclusions, although without using the word systematic. After a two-and-a-half-week mission to Israel, the UN body concluded that “there are reasonable grounds to believe that conflict-related sexual violence occurred during the 7 October attacks.”

The UN report does not ascribe responsibility to Hamas and relies on careful, qualified, legalistic language. But Halperin-Kaddari believes the UN report should be applauded. It is, she says, the “most accurate and comprehensive” accounting of the sexual violence that took place that day—and she praised it, in particular, for verifying accounts when possible but also debunking allegations that were not true.  

Halperin-Kaddari noted that investigators “found the same pattern of violence and sexual assault combined with an extreme degree of cruelty and humiliation, and it occurred in several locations in a relatively short period of time.”

This systematic nature of the abuse is obvious from both reports. For example, ARCCI recounts the eyewitness testimony of one survivor who said that the Nova music festival was an “apocalypse of bodies, girls without clothes.” In addition, it notes that “several survivors of the massacre provided eyewitness testimony of gang rape” as well as accounts from first responders of bodies unclothed and bleeding heavily from the pelvic area, and genital mutilation.

[Graeme Wood: A record of pure, predatory sadism]

The UN report draws a similar conclusion, finding “reasonable grounds to believe” that rape, gang rape, and the sexual abuse of female corpses occurred at the Nova festival.

At Kibbutz Kfar Aza and Kibbutz Be’eri, the UN found evidence that female victims had been undressed, bound, and killed (though the mission team “was unable to establish whether sexual violence occurred in kibbutz Be’eri”). In its investigation at Kibbutz Re’em, the UN said there were “reasonable grounds to believe that sexual violence occurred … including rape.” On Road 232, a key escape route from the music festival, the UN found “reasonable grounds to believe that sexual violence occurred,” including “the rape of two women.” In addition, “along this road, several bodies were found with genital injuries, along with injuries to other body parts.”

At an Israel Defense Forces base overrun by Hamas terrorists, there were, according to media stories cited in the ARCCI report, dead soldiers shot in the genitals and as many as 10 female soldiers with clear evidence of sexual assault. The UN report is more circumspect on this issue, saying that reports of genital mutilation are “inconclusive.” But Halperin-Kaddari told me that she saw documentation showing that victims had had weapons fired into their sexual organs.

Both reports also agree that hostages released from Hamas’s captivity had been, in the words of the UN special representative, subjected to “sexual violence, including rape, sexualized torture, and cruel, inhuman and degrading treatment.” The UN report also concluded that violence may be “ongoing” against the approximately 100 hostages, including young women, still held in Gaza. In its response to the Times story, Hamas pointed to the treatment of Israeli hostages, whom they insisted were being well cared for: “If the Hamas resistance fighters held such ideas of sex violence, they would mistreat those who were in their captivity,” a Hamas representative wrote in a lengthy Telegram post at the time. Recently, however, The New York Times published a firsthand account of sexual assault and torture from an Israeli hostage released from Hamas captivity in November.

For Shelly Tal Meron, a member of the Israeli Knesset for the opposition Yesh Atid party, the indifference of once-former feminist allies to the sexual violence on October 7 has been acutely painful. “I sent letters to UN Women, as well as #MeToo and human-rights organizations,” she told me. The response was “complete silence. I was astonished.”

“Before the war,” she said, “I was a member of the Knesset’s women’s-rights movement. I would fight for gender equality and I would work with international organizations. Whenever [attacks on women] happened in other countries like Ukraine or Syria, I felt solidarity.” In the aftermath of October 7, she said, “I felt completely betrayed.”

What is most galling about the pushback on allegations of mass rape is that it is precisely the lack of firsthand accounts and forensic evidence—as well as the initial fog of war—that has opened the door to rape denialists. As Dahlia Lithwick, the senior legal correspondent at Slate, told me, denialists are “capitalizing on the stigma and shame of sexual assault—and often frustrating lack of evidence in these situations.”

That, according to the feminist author Jill Filipovic, is hardly an unusual circumstance. “Sexual violence in conflict is virtually never documented the way sexual violence might be documented on the cop shows you’ve seen,” Filipovic wrote on her Substack last December. “The Israeli recovery and medical teams treated the places where people were attacked on Oct. 7 as war zones and the aftermath of terror attacks, not as standard crime scenes in which a primary goal is to identify a perpetrator.”

Complicating matters further is the particular emphasis in Jewish law on expeditious burial. Sulitzeanu told me that those at the army base who were preparing bodies for burial had “no capacity to keep the evidence from those killed.” The “first priority,” she said, “was to save living people. Second, to collect bodies. Third, identify them and prepare for burial.” Everything else, including proving that widespread rapes had taken place, was secondary.

There is also the distressing reality that so few of Hamas’s rape victims survived. Some were dispatched with a bullet to the head after they’d been assaulted.  

The handful of survivors of rape during the attacks on October 7 have, so far, been unwilling to speak publicly. ARCCI has been so adamant in safeguarding them that Sulitzeanu refused to confirm that her association had spoken with them or that their stories were included in the group’s report. The survivors refused multiple requests to meet with the UN mission team, which the UN report chalked up in part to “the national and international media scrutiny of those who made their accounts public.”

The latter fear is almost certainly a direct by-product of the response to the New York Times story—headlined “‘Screams Without Words’: How Hamas Weaponized Sexual Violence on Oct. 7.” Buttressed by interviews with more than 150 “witnesses, medical personnel, soldiers, and rape counselors,” as well as “video footage, photographs,” and “GPS data from mobile phones,” the story features allegations of sexual violence, including eyewitness accounts. It was the most authoritative investigation by a major American news outlet and should have dealt a major blow to the efforts at denialism and deflection.

But as soon as the Times article appeared, so, too, did the pushback. Much of it came from journalists with a long track record of animosity toward Israel, but it reached a crescendo in late February when The Intercept published its story.

What is most striking about the exhaustive Intercept article is the apparent dearth of original reporting. There is little indication that the authors made any serious effort to contact Israeli government officials, the leaders of Israeli NGOs, or—with three exceptions—even the specific individuals who are named in their story and whose credibility they malign. Instead, The Intercept focuses its inquiry on a freelance Israeli journalist who helped report the story, Anat Schwartz, scrutinizing her social-media activity and parsing a Hebrew-language podcast interview to attack her credibility and, by extension, the credibility of the story as a whole.

The Intercept also sought to chip away at the Times article by focusing on alleged inconsistencies—a process that is easier than it seems when it comes to reporting on sexual violence. After a terrorist attack that killed more than 1,100 Israelis over multiple locations, misinformation ran rampant. False stories, one infamously alleging that multiple babies had been beheaded and another claiming that babies had been strung up on a clothesline, proliferated. In cases of sexual violence, Halperin-Kadderi told me, “it’s not unusual for misinformation to spread,” and beyond trauma-related inaccuracies and memory failures, there could be a tendency “to exaggerate and amplify,” which she links to the high levels of trauma associated with sexual violence—both for survivors and for eyewitnesses. She also noted that exaggerated accounts of sexual violence can be “instrumentalized by leaders to portray their enemy in the darkest way possible.” Even Jeremy Scahill, one of the co-authors of the Intercept article, noted in an interview that inconsistencies in eyewitness accounts do “not necessarily mean that they didn’t witness something.”

[Read: Hamas’s genocidal intentions were never a secret]

But The Intercept, in its effort to undermine the credibility of witnesses to sexual violence on October 7, painted with a broad brush, creating an inaccurate picture. The flaws in its approach are perhaps best illustrated by the complicated case of Shari Mendes, an IDF reservist who served in the army unit responsible for preparing female bodies for burial and whose testimony Schwartz said helped convince her that there had been widespread sexual violence on October 7.

In the weeks after the attack, Mendes worked 12-hour shifts cleaning and preparing bodies for burial. In an emotional and graphic speech delivered at the United Nations on December 4, Mendes related what she and her team saw: women shot so many times in the head, sometimes after death, that their faces were practically obliterated; multiple women with gunshots in their vagina and breasts; faces permanently cast in distress and anguish.

In an interview in October, though, Mendes told the Daily Mail that “a baby was cut out of a pregnant woman and beheaded, and then the mother was beheaded.” That was not true. However, Mendes was neither the first person nor the only person to make this allegation. A video falsely claiming to show such an atrocity had made the rounds on social media in the days before the interview was published, and similar claims were promoted by a first responder.

Ryan Grim, another co-author of the Intercept article, told me that such “demonstrable fabrications” had “thoroughly discredited” Mendes, and the article notes that “she has no medical or forensic credentials to legally determine rape” (a point that Mendes has publicly acknowledged). The Intercept story questions why the Times would “rely on Mendes’s testimony,” and in an interview last month, Scahill suggested that Mendes is among the Times’ “premiere witnesses.” But in fact, Mendes is quoted a single time in “Screams Without Words,” relaying her account of having seen four women “with signs of sexual violence, including some with ‘a lot of blood in their pelvic areas.’” Mendes’s claims are backed up by a second witness, an army captain working at the same facility, who added the horrifying detail that “she had seen several bodies with cuts in their vaginas and underwear soaked in blood.”

The Intercept story fails to mention any of this, and it provides no indication that its reporters attempted to speak with Mendes. (I reached out to Mendes, who declined to comment.) Instead, it criticizes the Times for quoting “witnesses with track records of making unreliable claims and lacking forensic credentials.”

The Intercept has applied useful scrutiny to some specific claims within the Times story. One of the accounts of apparent sexual assault relayed by the Times came from a paramedic in an Israeli commando unit who said he had discovered the bodies of two teenagers at Kibbutz Be’eri. A March 4 article in The Intercept concluded that two victims “specifically singled out by the New York Times … were not in fact victims of sexual assault,” and the Times has since updated its story to note that a video of the scene appears to contradict the paramedic’s account.

But that skepticism is not limited to individual witnesses or accounts. The Intercept concedes that “individual acts of sexual assault may have occurred” but is quick to add that “rape is not uncommon in war.” It raises doubts about the extent to which Hamas members were responsible for attacks, noting that “there were also several hundred civilians who poured into Israel from Gaza that day.” (It is not usually the left that tries to blur the distinction between Palestinian terrorists and Palestinian civilians.) The central question, The Intercept contends, is whether the Times “presented solid evidence” to back the claim that, as the newspaper put it, “the attacks against women were not isolated events but part of a broader pattern of gender-based violence on Oct. 7.” And it devotes more than 6,000 words to calling into doubt that it did.

Yet The Intercept made no mention of independent efforts to answer this question. There is no reference to the ARCCI report—published a week before The Intercept’s story—which relied on 26 separate media reports from the Israeli press, The Guardian, the BBC, The Times of London, and other outlets, as well as confidential sources, eyewitnesses, and interviews with first responders. Neither does it mention a November 2023 report by Physicians for Human Rights, which concluded that “widespread sexual and gender-based crimes” had taken place on October 7. (Asked for comment, Grim dismissed these reports as “derivative of Western news reports and based on the same sources.”)

The Times published a follow-up story on January 29, addressing many of the questions raised by critics of its article. Even in light of criticisms of the piece, the Times said in a recent statement that it continues to stand by its coverage “and the revelations of sexual violence and abuse following the attack by Hamas.”

The UN mission team similarly concluded that the existence of a few false allegations did not undermine the other evidence of sexual violence in “at least three locations” on October 7. Nor did it limit its inquiry to searching for inconsistencies, paying attention only to those claims it had some reason to doubt. Instead, the investigators took pains to carefully review the scenes, to talk to eyewitnesses and first responders, and to assess the evidence in its totality before presenting the conclusion that “there are reasonable grounds to believe that conflict-related sexual violence occurred.”

Semafor’s Max Tani recently reported that The Intercept “is running out of cash,” and that Grim and Scahill had suggested that its board resign and turn operations over to them and the remaining staff. But the publication’s skeptical coverage of the war has apparently been a bright spot for its financial health. “The Intercept’s unapologetically hostile view of Israel’s post-Oct. 7 military operation in Gaza has galvanized its readers and supporters,” Tani wrote, “who have responded by helping the publication set internal records for small-dollar donations.”

Grim refused to say whether he believes that Israeli women were raped on October 7 and, if so, whether any of these assaults were committed by Hamas members. (His two co-authors did not respond to any questions.) Instead, he said he had “addressed these questions repeatedly” and pointed to an interview in which he had said that “the idea that there would be no sexual assault is not taken seriously by pretty much anybody who understands war and violence.”  

Considering the overwhelming evidence that sexual assault took place, despite the inherent challenges in collecting such evidence in wartime, it’s difficult to fathom why so many on the anti-Israel left continue to deny that it occurred or cast doubt on its significance.

The most obvious explanation is that by questioning what happened on October 7, activists hope to undercut the rationale for Israel’s military campaign in Gaza. Showing that systematic sexual abuse didn’t happen would, they believe, demonstrate that Israel is engaged in a mass public deception to justify killing Palestinians.

But some experts I spoke with see other factors at play.

The charge that Jews have exaggerated and weaponized their suffering has long been the basis for Holocaust denialism, said Amy Elman, a professor of political science and Jewish studies at Kalamazoo College who has written extensively on anti-Semitism and women’s rights. Now that same claim is being used by anti-Semites to portray efforts at justice for October 7 as “part of a larger nefarious scheme to harm Palestinians.” “Rape denialism is absolutely consistent with Holocaust denialism,” Elman said, and “this rape denialism is another form of anti-Semitism.”

One of the more troubling aspects of the left’s response to October 7 has been to cast the struggle between Israelis and Palestinians in simplistic terms: Palestinians are the oppressed, dark-skinned minority population; Israelis are the white oppressors. Never mind that Israel is a diverse, multiethnic society. (Most American Jews trace their origins to immigrants from Europe, but the majority of Israeli Jews descend from those who came, most often as refugees, from the Middle East and North Africa.) This reductionist binary has also made it easier to explain the conflict to a younger generation unfamiliar with Arab-Israeli history but well versed in the American civil-rights movement.

Natalia Melman Petrzela, a historian at the New School, says that this black-and-white framing has led to a distorted view of what happened on October 7—one that is informed by a reductive view of modern feminism. “There is a very powerful and understandable resistance on the left,” she told me, “to centering ‘white feminism’ or white womanhood in understanding the experiences of women and the purpose of feminism, domestically and internationally.” By this logic, white feminism is inherently “problematic”—and because many on the left see Israelis as white, she says, they “see any defense of Israeli women as some sort of capitulation to ‘white feminism.’”

Moreover, claims of sexual assault against white women have historically been used to justify racial violence, which has, according to Elman and Petrzela, led some pro-Palestine activists to compare Hamas to Emmett Till, who was accused of whistling at a white woman in the Jim Crow South before his brutal murder. It’s “unhinged,” Petrzela said, “but in some ways totally predictable.”

Jonathan Freedland, a columnist for The Guardian, suggested to me that left-wing rape denialism is, in effect, a refusal to believe that Hamas could stoop so low as to engage in sexual violence. On the surface, this sounds bizarre. Hamas massacred more than 1,100 Israelis, the majority of whom were civilians, and has a long history of massacring Jewish civilians, including children. How could any crime be considered worse than murder? But Freedland says that there are leftists who are prepared to countenance “armed resistance” but cannot do the same for sexual violence. “You can see why it would be essential for them to say that Hamas was ‘only’ guilty of killing and not guilty of rape.”

Freedland noted that Hamas itself has consistently denied that its fighters committed sexual crimes, perhaps in an effort to retain its standing among devout Muslims. “Hamas would be nervous of being seen not as warriors for Palestine but as a bunch of rapists who bring shame on Islam,” he said. Indeed, as Sulitzeanu pointed out to me, some Israeli Arabs who have stood in solidarity with the victims of October 7  have also refused to accept that their Palestinian brethren could commit such heinous, un-Islamic crimes.

Frankly, none of these efforts to whitewash the carnage of October 7 makes much sense. You can acknowledge Hamas’s barbarism while still condemning Israel’s military response or criticizing Israel’s prime minister, Benjamin Netanyahu. Indeed, many have done precisely that, including the Biden administration and Senate Majority Leader Chuck Schumer. You can raise questions about specific rape allegations—as the UN report did—while still accepting the overall weight of the evidence.

[Read: Netanyahu is Israel’s worst prime minister ever]

Instead, many on the left seem determined to justify what happened on October 7 as a legitimate act of Palestinian resistance. “The images from October 7 of paragliders evading Israeli air defenses were for many of us exhilarating,” one American professor recently wrote. But acknowledging Hamas’s atrocities doesn’t invalidate Palestinian demands for self-determination. You can still embrace Palestinian nationalism and, unlike Hamas, advocate for a two-state solution while also acknowledging that Hamas’s actions on October 7—including the systematic rape of Israeli women and girls—are simply not defensible. Leftists who genuinely support Palestinian statehood do that cause, and themselves, no favor by denying the overwhelming evidence of sexual violence.

The rape denialists might think they are winning a near-term public-relations battle against Israel, but denying Palestinians agency, and accusing Israel of fabricating allegations of mass rape, does far more harm than good.

Above all, it denies reality, perpetuates misinformation, and feeds the empathy gap that separates the two sides. When Israelis and Palestinians look beyond the walls—both real and metaphorical—that separate them, few see fully formed individuals with legitimate grievances and fears that are worthy of their sympathy. Instead, they glimpse caricatures.

As pro-Palestinian activists rightly demand that Israel come to grips with how its policies breed humiliation and desperation among Palestinians, so too must supporters of the Palestinian cause face the reality that rejectionism and terrorism have contributed to Israeli fears that peaceful coexistence is not possible.

When such activists surrender their ideals and dismiss the evidence that sexual violence took place on October 7, they feed the already overwhelming belief among Israelis and Diaspora Jews that those who advocate for the Palestinians and witheringly criticize Israel’s actions are simply not interested in their humanity.

Any solution to the Arab-Israeli conflict must start by recognizing not just the lived reality of Jews and Palestinians, but the abundant feelings of trauma and fear that have made reconciliation so difficult to achieve. Rape denialism pushes Israelis and Palestinians further apart. It isn’t just wrong; it doesn’t just diminish the trauma experienced by Israeli women on October 7—it makes the pursuit of peace and genuine reconciliation impossible.

The Jews Aren’t Taking Away TikTok

The Atlantic

www.theatlantic.com › ideas › archive › 2024 › 04 › antisemitism-conspiracy-theories-tiktok › 678088

“The entire world knows exactly why the U.S. is trying to ban TikTok,” James Li declared on March 16 to his nearly 100,000 followers on the social-media platform. His video then cut to a subtitled clip of a Taiwanese speaker purportedly discussing how “TikTok inadvertently offended the Jewish people” by hosting pro-Palestinian content. “The power of the Jewish people in America is definitely more scary than Trump,” the speaker goes on. “They have created the options: either ban or sell to the Americans. In reality, it’s neither—it’s selling to a Jewish investment group.”

Li, who calls himself an “indie journalist” and subsequently posted another video blaming Israel for the assassination of President John F. Kennedy, got more than 160,000 views for his TikTok theory—and the video was one of the poorer-performing entries making similar claims on the platform.

What prompted this outburst? On March 13, Congress advanced a bill that would give TikTok’s Chinese parent company six months to sell it or be banned from American app stores. The legislation passed 352–65, with overwhelming bipartisan support, and the rational observer will have no trouble understanding why.

The United States has a long history of preventing foreign adversaries from controlling important communications infrastructure. Washington spent more than a decade, under Democratic and Republican presidents, leading a successful international campaign to block the Chinese telecom giant Huawei from Western markets. Donald Trump attempted to force a TikTok sale back in 2020. The reasons are straightforward: The app has access to the data of some 150 million American users—nearly half the population—but it is owned and controlled by the Chinese company ByteDance. Like all companies in the country, ByteDance is effectively under the thumb of the Chinese Communist Party, which regularly punishes and even disappears business leaders who displease it. A former ByteDance executive has said that the CCP had “supreme access” to the company’s data, and used the info to track protesters in Hong Kong, for example.

[Read: Beijing is ruining TikTok]

Recent polls show robust public support for TikTok’s ban or sale, and for years, Gallup has found that Americans see China as the country’s greatest enemy. In short, Congress has strong electoral and political incentives to act against TikTok. But spend some time on the platform itself, and you’ll discover a very different culprit behind all this: Jews.

“We were all thinking it: Israel is trying to buy TikTok,” the influencer Ian Carroll told his 1.5 million followers last month. The evidence: Steven Mnuchin, the former Trump Treasury secretary and Goldman Sachs executive, has sought investors to purchase the app. “He’s not Israel, right?” continued Carroll. “Well, let’s peel this onion back one layer at a time, starting with just the fact that he’s Jewish.”

Carroll’s TikTok bio says “do your own research,” and he certainly had research to share. “The censorship is not about China on TikTok,” he explained. Rather, “as a TikTok creator who gets censored all the frickin’ time, I can tell you that the things you get censored about are the CIA and Israel.” Carroll did not address why Israel would go through so much trouble to acquire TikTok if it already controlled the platform, or why the Semitic censors somehow missed his video and its more than 1 million views, not to mention the several similarly viral follow-ups he posted.

In truth, far from suppressing such content, TikTok’s algorithm happily promotes it. I purposely viewed the videos for this piece while logged out of the platform, and it nonetheless began suggesting to me more material along these lines through its sidebar recommendations.

Characteristic of anti-Semitic online discourse, these videos and others like them interchangeably reference individual American Jews, American Jewish organizations like the Anti-Defamation League, American pro-Israel lobbying groups like AIPAC, and the state of Israel, as though they are all part of one single-minded international conspiracy to take down TikTok. When a commenter asked Carroll to “look into universal studios pulling their music from TikTok,” a reference to the Universal Music conglomerate’s dispute with TikTok over royalties, Carroll replied, “Universal CEO is a Jewish man.”

“A foreign government is influencing the 2024 election,” the leftist podcaster and former Bernie Sanders Press Secretary Briahna Joy Gray declared on X in March. “I’m not talking about China, but Israel. In a leaked recording, ADL head Jonathan Greenblatt admitted that Israel had a ‘TikTok problem.’ Suddenly, a divided Congress agrees on one thing: A social media ban.” Greenblatt is an American Jew, the ADL is an American organization, the bill isn’t a ban, and the push for a forced sale predated the Gaza war, but other than that, Gray was on the money.

[Yair Rosenberg: Why Facebook and Twitter won’t ban antisemitism]

“Banning TikTok became a crucial emergency because what they saw was a bunch of young individuals, essentially people that are going to be the future leaders of America, who were not pro-Israel,” the far-right commentator Candace Owens claimed in March on her popular show at The Daily Wire. She then issued an implied threat: “If TikTok is in fact banned, there is no question that Israel will be blamed, AIPAC will be blamed, the ADL will be blamed, Jews are going to be blamed … You can see that sentiment building.” (Owens left The Daily Wire a week later following a string of anti-Semitic incidents, which included claims that Jews were doing “horrific things” and “controlling people with blackmail,” as well as her favoriting a social-media post that accused a rabbi of being “drunk on Christian blood.”)

At this point, it’s not uncommon to find videos about the TikTok legislation that do not even mention Jews or Israel—like this one with 1.5 million views—yet are flooded with hundreds of comments, garnering tens of thousands of likes, accusing “Zionists,” “Jews,” or AIPAC of being behind it, despite years of national-security reporting on concerns over the platform’s Chinese owners. That alleged Jewish malefactors are being assailed on TikTok even when they are not invoked explicitly in a video illustrates how widely the meme has spread.

Like many conspiracy theories, the notion that Jews are out to ban TikTok contains a grain of truth. Jewish and pro-Israel groups have raised concerns about TikTok’s failure to moderate anti-Semitic content for years, including when it pertains to Israel, but they have never called for the app to be shut down. After the TikTok sale legislation was proposed, the Jewish Federations of North America said it “appropriately balances free speech and individual rights with regulatory action” while asserting that “our community understands that social media is a major driver of the rise in antisemitism, and that TikTok is the worst offender by far.” (Presumably, the organization arrived at this conclusion by spending 10 minutes on the app.) Researchers have found that pro-Palestinian content dwarfs pro-Israel content on TikTok, likely reflecting the platform’s young and international demographic.

But no conspiracy theories or appeals to recent geopolitical developments are necessary to understand why U.S. politicians wouldn’t want one of the most-trafficked social-media networks in America to be run by Communist China via a black-box algorithm. Just this past December, researchers at Rutgers found that anti-China posts on topics like the Hong Kong protests or the regime’s brutal repression of Uyghur Muslims were dramatically underrepresented on TikTok compared with Instagram.

TikTok’s response to allegations that it could function as a foreign influence operation have not exactly allayed concerns. Shortly after the Rutgers study was published, the app restricted access to the tool used by academics to track its content. Last month, it sent multiple alerts to its American users falsely warning that Congress was about to ban TikTok and urging them to contact their representatives. In fact, the bill seeks to force a sale to new ownership, much as congressional scrutiny over data privacy led the dating app Grindr to be sold to non-Chinese owners in 2020.

Simply put, none of what is happening to the social-media platform is new. Neither is the tendency to blame Jews for the world’s problems—but that doesn’t make the impulse any less dangerous. Many understand anti-Semitism as a personal prejudice that singles out Jewish people for their difference, much like other minorities experience racism. But anti-Semitism also manifests as a conspiracy theory about how the world works, alleging that sinister string-pulling Jews are the source of social, political, and economic problems—and this is the sort of anti-Semitism that tends to get people killed.

[Yair Rosenberg: Why so many people still don’t understand anti-semitism]

Consider recent American history: In 2018, a far-right gunman who blamed Jews for mass immigration murdered 11 people in Pittsburgh’s Tree of Life synagogue. In 2019, assailants tied to the Black Hebrew Israelite movement attacked a kosher supermarket in Jersey City, killing three; one of the shooters had written on social media about Jews controlling the government. In 2022, an Islamic extremist took an entire congregation hostage in Colleyville, Texas, and demanded that a rabbi get a convict released from a nearby prison. These perpetrators—white supremacist, Black extremist, radical Islamist—had essentially nothing in common other than their belief that a Jewish cabal governed world affairs and was the cause of their problems.

The reality is the reverse: Jews constitute just 2 percent of the American population, and although they exercise influence like any other minority, they frequently disagree among themselves and do not dictate the destiny of the majority. Politicians voting against TikTok are pursuing their conception of the national interest, not being suborned to serve some nebulous Jewish interest. Remove the Jews from the equation, and the situation will be the same.

Conspiracy theorists typically claim to be combatting concealed power structures. But as in this case, their delusions make them unable to perceive the way power actually works. Thus, conspiratorial anti-Semitism hobbles its adherents, preventing them from rationally organizing to advance their own causes by distracting them with fantastical Jewish plots.

“Anti-Semitism isn’t just bigotry toward the Jewish community,” the Black civil-rights activist Eric Ward once told me. “It is actually utilizing bigotry toward the Jewish community in order to deconstruct democratic practices, and it does so by framing democracy as a conspiracy rather than a tool of empowerment or a functional tool of governance.”

Anti-Semitic conspiracy theories won’t safeguard TikTok from the bill that’s currently moving through the U.S. legislature. But the more people buy into them, the more they will imperil not only American Jews but American democracy as well.