By Laurel Duggan - 2 october 2024 - UnHerd
Members of the American Academy of Pediatrics who have pushed back against the organisation’s official endorsement of cross-sex medical treatments for minors have been met with a culture of secrecy and intimidation from the leadership, according to AAP insiders.
Ahead of its annual conference this past weekend, the AAP denied a press pass to journalist Benjamin Ryan, and denied trans-sceptical organisation, the Foundation Against Intolerance and Racism, the opportunity to host an exhibit. A group of detransitioners — individuals who underwent medical transitions in adolescence but now seek to live as their birth sex — hosted a booth at this year’s conference, and were ultimately kicked out of the event by security. The conference’s LGBT affinity group session, slated to last more than five hours, did not allow recording, required attendees’ electronic devices to be shut down, and requested that attendees not share the content of the programming with outsiders, Ryan reported. Even the session’s agenda was password protected.
The secretive attitude surrounding this year’s conference is in keeping with the AAP’s treatment of transgender issues in recent years. In December 2023, the AAP sent an email to its members in leadership roles urging them to use personal email addresses for AAP communications to “keep internal communications under the control of the AAP and its member leaders… including in response to subpoenas or Freedom Of Information Act (FOIA) requests.”
Dr. Julia Mason, an American paediatrician, AAP member, and vocal critic of the AAP’s handling of the trans issue, reached out to various members requesting a copy of the email. A week later, she received an email from AAP CEO Mark Del Monte which she characterised as “vaguely threatening”.
“If, in the future, you have questions about AAP operations or policies, please feel free to reach out to me directly. I will provide you whatever information I am able to share,” the email read. He did not, however, share the email Mason had been seeking.
This secrecy, and the organisation’s eagerness to stifle dissent on the gender issue, impedes the scientific process, according to Dr. Patrick Hunter, a paediatrician and AAP member, who spoke in his own capacity and not on behalf of the Florida Board of Medicine, of which he is a member. “They are not interested in dialogue and discussion which, in the past, was an integral part of science and academic progress,” he told UnHerd. “Through the years I have emailed Mr. Del Monte and AAP presidents, Sandy Chung and Moura Szilagyi. I have left voicemails with Mr. Del Monte on several occasions. I have never had a response.”
Hunter resigned his AAP membership in the late 2010s over his objection to their handling of the transgender issue, but has since rejoined “to have a voice in the organisation.” Annual dues for AAP membership exceed $600, a motivating factor for some gender-critical doctors to leave the organisation.
An issue that arose repeatedly in interviews with AAP members was the sense of mystery surrounding the organisation’s policy on youth transitions. A 2018 paper by Dr. Jason Rafferty, which represents the official position of the AAP, supports “comprehensive gender-affirming care” for youth, to include “medical, psychological, and, when indicated, surgical gender-affirming interventions”. The policy was adopted despite a lack of consensus among members and a lack of empirical evidence supporting these medical procedures. The AAP’s policy is a cornerstone of the perception of consensus within the medical community, and is frequently cited by opponents of legal restrictions on youth medical transitions.
Numerous systematic reviews have found insufficient evidence for cross-sex medical interventions for minors. The AAP pledged last August to conduct its own systematic review of the evidence on cross-sex medical interventions. The organisation has not released any new information on the review in the year since, and did not respond to a request for comment on the issue. “There was such a sense of relief when they said they would look at the data,” one paediatrician and AAP member, speaking anonymously, told UnHerd. “And now, a year later, they still haven’t published the inclusion criteria.”
The World Professional Association for Transgender Health (WPATH) similarly pledged to commission a systematic review in 2020, and emails that have since been made public reveal they found “little to no evidence” to support cross-sex treatments for minors. WPATH then blocked researchers from publishing the findings and continued to publicly endorse the procedures.
The AAP now finds itself in a difficult position, as international evidence increasingly weighs against their longstanding position of support for irreversible cross-sex treatments for minors. A policy reversal or a refusal to update their policy both risk damaging doctors’ trust in the institution, whose medical guidelines serve as the gold standard for paediatric medicine in the US.
“You cannot overstate the importance of the AAP to paediatrics,” the anonymous paediatrician told UnHerd. “It’s difficult to function without their role, because they give us the guidelines for everything, and they’re supposed to be evidence based.” Medical guidelines typically follow the Chain of Trust, in which information travels from university researchers to medical societies to practitioners. In the case of the AAP and gender medicine, the doctor argued, this trust has been broken. “The quality of evidence needed to justify these life changing, irreversible, harmful interventions is just not there.”
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