Interviews from Publishing Coalface: Gerald Posner

How bestselling journalist and author Gerald Posner's investigation into gender medicine led to a change in agents

SEEN in Publishing delighted to welcome award-winning journalist and New York Times bestselling author Gerald Posner. Posner has a reputation for detailed and thorough investigative journalism which has resulted in bestsellers on JFK, the opioid crisis, and the Vatican’s finances. His 2023 piece in the Wall Street Journal, “The Truth About Puberty Blockers,” was the first time a mainstream media newspaper in the US had published any detailed analysis challenging the accepted wisdom of medicalized gender affirmation in children.

You have a history of examining a wide variety of controversial subjects such as the shooting of JFK (Case Closed) and the role of Big Pharma in the US’s opioid crisis (Pharma). What draws you to the kind of detailed and forensic investigation that you do?

My interest in investigating complex and often controversial subjects comes from when I was practicing law and volunteered my time to represent some surviving twins who had been experimented on by Auschwitz’s notorious doctor, Josef Mengele. Those twins wanted either the German government or the Mengele family to pay the costs of their ongoing medical treatment to deaden the pain from Mengele’s experiments. That legal case was unsuccessful. It is very difficult to sue a foreign government in a U.S. Court, and at the time (early 1980s), I did not yet have the conclusive evidence of how the Mengele family had enabled the fugitive’s life on the run. My four years of research eventually turned into my first book, Mengele, co-authored with a British journalist John Ware. On one trip back from Paraguay on the Mengele research, I told my wife and collaborator, Trisha, that I had met in Asunción a group of Corsican heroin dealers who had found sanctuary from European prosecutors. They did not talk to me about Nazis but regaled me with stories about the heroin trade they had been in during the 1960s and 1970s. According to them, the heroin trade was “once an honourable business that had been ruined since Chinese Triads had taken control.” I asked Trisha if she wanted to investigate that as our next book, and she was willing. After Mengele was published in 1986, we went off to Hong Kong, Bangkok and the heroin fields of Southeast Asia’s Golden Triangle. That resulted in Warlords of Crime in 1988.

By that point, we both had decided this was the type of work we liked, and it pretty much set the template for all subsequent projects. Follow the evidence, wherever it leads. I like to go through the primary material: documents, contemporaneous records, court filings, interviews with people who were there, and the forensic details that tend to get overlooked once a storyline hardens. The appeal of these complex subjects is that it allows me to test assumptions rather than simply repeat them. In the case of the Kennedy assassination, decades of speculation had accumulated without many people systematically reconstructing the evidentiary record. With Pharma and the opioid crisis, the challenge was different but related—following the documentary trail inside companies and regulatory agencies to understand how decisions were made and why warning signs were often ignored.

Investigative reporting at that level is painstaking and often slow, but it is also deeply satisfying. When you spend years immersed in a subject, patterns begin to emerge that are invisible in the daily news cycle. My goal in those projects has never been to confirm a preconceived theory, but to build the most evidence-based account possible, even when the conclusions challenge popular beliefs or powerful interests.

Many times, the subject that Trisha and I tackle next is one where we have no idea where the research will take us. That was true in both the finances of the Vatican and the investigative history of the American pharmaceutical industry.

Why did you first become interested in gender ideology’s medicalization of children?

Trisha and I often influence each other when it comes to the subjects we investigate. She had started watching Genspect videos on YouTube and kept telling me how shocked she was by what appeared to be happening to minors under the banner of “gender-affirming care.” Around this same time, I had a female cousin who, as a minor, started identifying as a boy. That soon led to cross-sex hormones and a double mastectomy, all of which she chronicled on Facebook.

My earlier reporting for Pharma had also given me a background that turned out to be relevant. In that book I examined the extraordinary latitude American physicians have to prescribe FDA-approved medications for off-label uses—conditions for which the drug was not originally approved. Nearly half of all annual prescriptions in the United States are written off label. Many blockbuster drugs—including Rogaine, Botox, and Viagra—were born through off-label prescribing.

Based on what Trisha was seeing in the Genspect interviews, and what I was observing in my cousin’s experience, I began doing some research. None of the puberty blockers prescribed as an initial treatment for children diagnosed with “gender dysphoria” had been approved by the FDA for that purpose. It was in that research that I discovered also how much false information was in the public record and repeated frequently. One of the most popular was that puberty blockers were completely reversible and harmless. Even Health and Human Services claimed they were easily reversible. I discovered in my reporting that was false. Those very powerful drugs had a long list of side effects, many of which are documented in thousands of adverse event reports filed with the FDA.

My first piece on the subject in 2023 was for The Wall Street Journal and was titled “The Truth About Puberty Blockers.” It was the first time a mainstream outlet had published something challenging so directly one of the accepted “truths” by gender activists, and which had been falsely promoted to families and children. The response to that piece—from parents, clinicians, patients, and fellow journalists—was immediate and intense, and it prompted me to pursue a much deeper investigation into the subject.

With the Fox Varian medical malpractice lawsuit win, do you thinking we are reaching the tipping point where the scandal truly breaks?

I hope so. But it is only a start. The Fox Varian verdict is significant, but not because a jury was asked to decide far-reaching ideological questions about gender medicine. That was not the issue in the courtroom. The case focused narrowly on whether the clinicians involved exercised appropriate medical judgment in her care. The jury concluded they did not. Jurors heard evidence that a parent initially opposed the surgery but ultimately consented out of fear that refusal might lead to self-harm. They heard testimony that clinicians lacked full knowledge of her doubts and psychological history, that key records were not obtained, and that the professionals involved failed to meaningfully consult with one another.

Those are precisely the kinds of facts that successful malpractice litigation turns on. That distinction matters legally. But the implications extend far beyond a single plaintiff.

In my reporting about the prescription opioid epidemic in Pharma, I discovered that one of the key factors that helped bring an end to it was the volume of private lawsuits and class actions. That avalanche of litigation pushed Purdue Pharma into bankruptcy and forced the Sackler family to commit billions of dollars in settlements.

Litigation is a blunt instrument, but it is frequently the only one left when an industry loses its ethical bearings. It is why the Fox Varian verdict is a shot across the bow of the paediatric gender industry.

A single verdict rarely transforms an entire medical field. But once trial lawyers recognize a viable path to liability, the number of cases can grow quickly—and when insurers begin reassessing the risk, the practice itself can change almost overnight.

At a time when many journalists were afraid to mention the potential for scandal in this area, why did you feel compelled to raise your head above the parapet?

I never thought of it as raising my “head above the parapet.” Trisha and I chase the subjects on which we believe something important is being missed. There is nothing that creates more urgency for investigative work than the possibility that wrongdoing is affecting the lives of large numbers of people—especially children.

I saw that first hand in Pharma. What ultimately put us on fire in that investigation was not just the documents or the regulatory failures, but meeting families who had lost loved ones—often their own children—to opioids. Hearing their stories gave the reporting a human dimension that statistics and files alone could never capture. Something similar happened in this case. As I began reporting on paediatric gender industry, I met parents who felt as though they had lost their children to what they described as a powerful social contagion, followed by a medical system that moved quickly and uncritically toward irreversible interventions. Those conversations were often heart-breaking. They added a personal dimension to our research.

Never did I think that what I uncovered was wildly controversial. Even when I reached the finding that “paediatric gender care” is probably the biggest medical scandal since lobotomies, I thought of it simply as my fact-based conclusion grounded in extensive reporting. As with other subjects, I present the evidence. If someone disagrees, I will debate them. Of course, I quickly discovered that the advocates for gender interventions on children are not interested in a debate on the merits. It is an ideology for them, a quasi-religious fervor that means disagreement is done through personal attacks. After years of writing about controversial subjects, that was all right. I never take it personally. That seems ever rarer in an era in which many people seem offended or triggered by even constructive criticism.

Has there been any personal costs to you taking the stances that you have?

Yes, there have been some professional costs. When I submitted a book proposal about following the money behind the paediatric gender medicine industry to my long-time New York literary agent, it effectively ended my representation with that agency. I had not yet done the full reporting for the book, but the agents felt the subject had become a third rail in traditional New York publishing and they did not want to represent that project.

Trisha and I later found new representation with the long-time UK-based agents of J.K. Rowling. They were willing to take on the project, but despite considerable effort they were unable to place the book with a traditional publisher. Since Trisha and I earn our living by writing, we ultimately had to put that project on hold while we completed other work that could be published. So, the cost has not been personal in the sense of social pressure or criticism. It has been more practical: certain topics can close doors in parts of the publishing industry, at least for the moment.

How did your upbringing give you the moral courage to take on controversial subjects?

I have never really thought of it in terms of moral courage. My parents raised me to trust my sense of what is right and to follow it, regardless of the consequences. That was good advice for investigative reporting, which by its nature, often leads into controversial territory.

If anything, I am sometimes surprised by how many people who have a public voice choose to silence it out of concern for professional repercussions, social standing, or criticism. Those pressures are real, but they come with the territory.

In my view, someone probably should not be in the business of investigative reporting if they must first ask themselves whether it is worthwhile to pursue a subject because it might be controversial. The job is to follow the evidence wherever it leads and report it honestly. Everything else is secondary.

What qualities do you feel are necessary for an investigative journalist to possess?

The most important quality is intellectual independence. An investigative journalist must be willing to challenge accepted narratives and confront powerful interests when the facts demand it. Trisha and I have relentless curiosity. That helps us dive into one challenging subject after another. Closely tied to that is patience. The kind of work I do often takes years. It involves going through primary documents, court records, interviews, and huge tranches of archival material. Only with time do patterns emerge that are not otherwise visible. Scepticism is also essential—not cynicism, but a healthy scepticism toward official explanations and widely repeated claims. Journalists must be willing to test what everyone else assumes is true.

And finally, persistence. Many important stories exist precisely because institutions prefer that certain facts remain buried. Investigative reporting requires the willingness to keep digging long after most people would move on to something easier.

What changes have you witnessed with regards to freedom of expression, civic activism and publishing in recent years?

In recent years I have seen a noticeable chilling effect on freedom of expression, particularly among professionals whose jobs or social standing can be affected by what they say publicly. So-called cancel culture has made many people—journalists included—more cautious about raising questions on controversial subjects.

Civic activism has also changed. Grassroots activism once tended to grow organically from communities. Today much of what passes for activism is heavily influenced by well-funded special interest groups and large donors who are trying to shape and control the public conversation. That does not mean every cause is insincere, but the financial incentives behind some movements are impossible to ignore.

Publishing has changed as well. Mainstream publishing houses have become increasingly risk-averse, especially on politically or culturally sensitive topics. When institutions become reluctant to take those risks, the public often ends up receiving a filtered version of events rather than the full story.

What do you think poses the biggest threat to freedom of expression in publishing? What steps can be taken to combat this?

The biggest threat to freedom of expression in publishing today is not government censorship. It is self-censorship inside institutions. Editors, publishers, and even authors are increasingly aware that certain subjects can trigger intense public backlash, internal disputes within publishing houses, or organized campaigns online. As a result, many controversial topics are avoided before the reporting or writing even begins. That kind of caution has a corrosive effect on journalism and public debate. If publishers become reluctant to take risks on difficult subjects, entire areas of inquiry gradually disappear from mainstream discussion.

One way to combat that trend is to diversify the publishing ecosystem. Independent publishers, Substack-style platforms, podcasts, and other direct-to-reader models have created alternative routes for investigative work that might not pass through traditional editorial gatekeeping. Those outlets cannot fully replace major publishing houses. They do, however, provide important space for reporting that might otherwise struggle to find a home.

What are you working on currently?

I’ve got some projects with Trisha in the works. One is an investigative history about how Nazi-stolen plunder was used in part after World War II to fund the beginning of Palestinian resistance groups like the PLO and PFLP. We are also doing the texts and captions for a photo book about Miami. And we are working on an ambitious project in which AI tells its own story, the machine writing in a voice not fully human but so close that it is quite unsettling. And then, of course, there are the projects on the wait list: the book about the paediatric gender industry and one about the history of antisemitism through a post-October 7 lens. One or more of those will keep us busy for a few years, in addition to new subjects that catch our attention and set our investigative genes on fire.

Gerald Posner can be found on Substack at Just the Facts with Gerald Posner.

Tales from Publishing’s Coalface is an interview series on courage and cancellation in the publishing industry. Our previous interview was with feminist, activist, and author Trisha Posner.