An Earthquake Rattles the American Academy of Pediatrics

An Earthquake Rattles the American Academy of Pediatrics

I wrote recently about my optimism that tort law would provide, in the not distant future, a corrective to the current madness of trans medicine.  That includes the too-quick determination that children should be, on the basis of questionable science, slip-streamed into taking puberty blockers, cross-sex hormones and later, irreversible surgery.  Civil litigation will likely put the brakes on trans medicine; in the U.K., it’s doing just that.

But perhaps the main obstacle U.S. litigants face is the American Academy of Pediatrics that, in a 2018 position paper, stamped its enthusiastic imprimatur on medical transitioning.  How can a plaintiff prevail against a physician who points to the “best practices” endorsed by the most respected body in the land regarding children’s medicine?

Well, we’re now beginning to learn just how fragile the AAP’s “consensus” on trans medicine is.  This Quillette piece and this one in the Daily Mail give us the latest.

Members of the 67,000-member organization are beginning to sharply question the AAP’s stance on transitioning and are finding their questions stonewalled by AAP leadership.  In short, much as in the U.K. and elsewhere, the foundations of trans medical practice are trembling due to an earthquake within.

The more we learn, the worse it looks for the AAP.

First, we now know that the AAP’s position paper on sex transitioning was authored by just a single person, Dr. Jason Rafferty of Brown University.  You’d think an organization as prestigious as the AAP would assemble an interdisciplinary group to write its paper, in part to add heft to its position and give at least the appearance that the issue had been studied from several angles.  Nope.

More importantly, Rafferty’s paper looks shoddy.

Back in 2018, AAP leaders might have been seen as credible when they declared, through their policy statement, that there’s a medical consensus to the effect that affirmation is the only ethical response to gender dysphoric youth. But this position is no longer tenable. In truth, it was no longer tenable even back in 2019, when the AAP refused to engage with a peer-reviewed critique offered by University of Toronto professor James Cantor, Director of the Toronto Sexuality Centre. His article, Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policydemonstrated that many of the claims made by Dr. Rafferty in his 2018 AAP policy statement were completely at odds with the information contained in the sources he’d cited.

Now, the AAP’s positions on medical issues are developed via proposals made either by individual members or by its regional affiliates.  Those are then voted on once a year and the positions altered accordingly or not depending on the vote.  But only about 0.2% of all members vote on the proposals, meaning that a majority of about 130 members can effectively set policy on any given issue.  In other words, perhaps as few as 70 AAP members can set the organization’s position on any given issue.  In the case of the increasingly important issue of how best to treat gender dysphoric kids, what looks from the outside like the backing of a large organization, may in fact be only that of a few zealots.

If you think “zealots” is too strong a word, consider this:

Dr. Kerry McGregor, gender affirmative psychologist from the Gender Multispeciality Service in Boston Children’s Hospital, tells us that “a good portion of children do know [that they’re transgender] as early as seemingly from the womb.”

Then there’s Dr. Diane Ehrensaft on whom Rafferty’s position paper relies heavily.

According to Dr. Ehrensaft, a baby girl tearing barrettes out of her hair repeatedly is supposedly sending a “gender message” about her true identity as a trans boy.

But, if a tiny minority of AAP members making organizational policy is alarming, its treatment of apostasy is even more so.  At this year’s AAP meeting, proposal #27 urged the organization to conduct a thorough review of the science on puberty blockers and cross-sex hormone therapy, seemingly not an unreasonable thing to do.  But a funny thing happened on the way to consideration of that proposal – the parliamentary rules on proposals changed.  And guess what.  Of the 40 proposals up for consideration, only one was kicked out due to the rule change.  Care to guess which one that was?

This is all occurring at a time when medical authorities in the U.K., Sweden, Finland and France are closing trans clinics and sharply cutting back on “gender affirming” care.  Unsurprisingly, there’s a small civil war brewing in the ranks of the AAP, started by doctors who are alternately concerned for the well-being of vulnerable patients subjected to what looks like experimental medicine and outraged at the organization’s use of dicey science and stonewalling of dissent.

This Wall Street Journal article features a back-and-forth between dissenters and AAP president, Dr. Moira Szilagyi.  First, Dr. Julia Mason and Manhattan Institute fellow Leor Sapir:

The AAP has stifled debate on how best to treat youth in distress over their bodies, shut down efforts by critics to present better scientific approaches at conferences, used technicalities to suppress resolutions to bring it into line with better-informed European countries, and put its thumb on the scale at Pediatrics in favor of a shoddy but politically correct research agenda. Its preference for fashionable political positions over evidence-based medicine is a disservice to member physicians, parents and children…

To which Szilagyi replies,

The American Academy of Pediatrics advises pediatricians to offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. This care is nonjudgmental, includes families and allows questions and concerns to be raised in a supportive environment. This is what it means to “affirm” a child or teen; it means destigmatizing gender variance and promoting a child’s self-worth. Gender-affirming care can be lifesaving. It doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite…

Mason and Sapir, again:

We are thrilled that the American Academy of Pediatrics (AAP) agrees that the “vast majority of children” who get “gender-affirming care” shouldn’t be treated with hormones and surgery, and in fact, need “the opposite.” Today, however, when pediatricians refer gender dysphoric minors to gender clinics for assessment, they are effectively sending them to be medically transitioned.

Which brings us back to the prospect of litigation.  Tens of thousands of those who’ve transitioned now regret having done so and say they were strongly influenced by practitioners in the very ways president Szilagyi claims the AAP rejects.  If she’s right, those doctors can hardly defend their conduct by claiming that their trade organization approves of their behavior.  Its president says otherwise.  And its 2018 position paper doesn’t contradict her.

In short, there may be a gap between what the AAP considers best practices and what’s actually being done.  Consider one woman’s statement from the Quillette piece:

In my early 20s, I became depressed and gender dysphoric after years of obsessing over identity issues. Finally, I thought I saw my route forward: the total transformation of medical transition, to live as a man. I had the most supportive possible environment for transitioning: easy access to hormones, an affirming community and insurance coverage. What I didn’t have was a therapist who could help me scrutinize the underlying issues I had before I undertook serious medical decisions. Instead, I was diagnosed with gender dysphoria and given the green light to start transition by my doctor on the first visit. I started my transformation with cross-sex hormones injections. Four months later, I had my breasts removed in the masculinizing surgical procedure known as “top surgery.” The day I got my first testosterone shot, I wept with joy. I thought I had discovered my path to self-actualization as a transgender man. One year later, I would be curled in my bed, clutching my double-mastectomy scars and sobbing with regret.

Countless people say much the same – diagnosed and greenlighted for transition after a single visit, breasts removed four months later and, permanently disfigured, sobbing with regret after a year.

What would a jury think of that woman’s story or one like it?  I predict we’ll soon begin to find out.

This article originally appeared at The Word of Damocles.

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