Pediatric Association Placing Its Own Members at Risk?

For all its faults, the American legal system has an international reputation for ensuring that victims of injustice get their day in court. In recent weeks, two young women filed lawsuits against the American Academy of Pediatrics (AAP) and some of its affiliated doctors, arguing that the doctors harmed them irreversibly by subjecting them to “gender-affirming” hormonal treatments when what they needed was mental-health support. One plaintiff argues that the medical group has defrauded the public and its own members in contravention of state deceptive-practice provisions.

Among the defendants are some of the leading advocates of “gender-affirming care.” One is Michelle Forcier, a professor of pediatrics and assistant dean at Brown University’s Warren Alpert Medical School, who gained notoriety last year after appearing in Matt Walsh’s documentary What Is a Woman? Walsh, a Daily Wire journalist, asked Forcier why she uses “assigned sex at birth” for humans but not, say, for chickens. The doctor responded: “Does a chicken have gender identity? Does a chicken cry? Does a chicken commit suicide?”

Another high-profile physician defendant is Jason Rafferty, a mentee of Forcier’s and author of the AAP’s 2018 policy statement on “gender-affirming care” that has become the U.S. medical community’s touchstone. Rafferty, who describes “gender-affirming care” as an approach that uses “a child’s sense of reality” as the “navigational beacon to orient treatment around,” allegedly approved one plaintiff for puberty blockers after only one visit. He did so, states the complaint, despite the patient’s suffering from multiple-personality disorder and having been hospitalized at the time for a suicide attempt.

Perhaps not coincidentally, the plaintiffs announced the new lawsuits on the opening and closing days of the AAP’s annual conference, which ran from October 20 to October 24 in Washington, D.C. According to Carrie Mendoza, a physician and director of the nonprofit FAIR in Medicine who helped set up a booth at the conference to bring awareness to the problems of gender medicine, “the vast majority of AAP members with whom we engaged in discussion either shared our concerns or had no knowledge of gender medicine and wanted to learn more. Unfortunately, those who agreed that something has gone wrong with how we help kids with distress over their bodies said they fear the personal and professional repercussions of voicing their concerns.”

Her group’s “major takeaway from the conference,” Mendoza said, was “that there is a broken chain of trust in the field of pediatrics.” The AAP’s members “reasonably trust their professional association to adhere to scientific methods” and “reasonably trust that the AAP will convene committees to issue statements and guidelines based on the best available evidence,” she said. But “when the chain of trust is broken, it can take time before members notice dysfunction.”

An example of that dysfunction played out on the convention center’s second floor, just above Mendoza’s booth, where Ilana Sherer, a pediatrician and gender clinician from California, led a panel on gender and sexuality. Sherer asked that the session not be video-recorded, and “deputized” audience members to enforce her request. One of the attendees took an audio recording of the session and, through a mediator, shared it with me.

Sherer began by insisting that pediatricians practice “personal disclosures . . . in any kind of professional setting,” and disclosed that she is “a queer, cisgender, white, able-bodied woman” who lives and works “in the Bay Area, which is unceded Ohlone territory.”

She then suggested that pediatricians not wait until their patients are adolescents to talk to them about “gender care and sexual health” but instead start conversations about “sexual identities” in “childhood.” She also recommended using “updated language,” which pediatricians can learn from their patients. For girls who want male bodies, that new language includes “innie” and “front hole” instead of vagina; “dicklet” and “T-penis” instead of clitoris (a side effect of testosterone injections is clitoral growth, which can be extremely painful); and “chesticles” instead of breasts. For boys who want female bodies, Sherer mentioned “outie,” “junk,” “strapless,” and “bits” as replacement words for penis.

Sherer’s recommendations for dealing with kids who feel discomfort with their bodies or their sex directly contradicts the guidelines the AAP published in April. The guidelines, “10 Tips for Parents to Teach Children About Safety and Boundaries,” are meant to help parents and caretakers protect children against sexual abuse and assault. “Use appropriate language,” the first recommendation, instructs parents to “Teach children proper names for all body parts, including their genitals: penis, vagina, breasts and buttocks. Making up names for body parts may give the impression that they are bad or a secret and cannot be talked about.”

Sherer also discussed sexuality, noting that the term bisexual “assumes that there are two genders,” whereas the term “pansexual . . . recognizes multiplicity of gender.” She encouraged audience not to “assume that LGBT-identified youth are . . . only having sex with certain genders.” Sherer’s presentation included a visual aid to help fellow AAP members grasp the new concepts of gender and sexuality. It was a “cute” image of a “gender unicorn,” complete with a “little rainbow brain.”

“I see a couple of confused faces,” Sherer promptly admitted. Perhaps the attending pediatricians had overlooked the unicorn section in their biology textbooks in medical school. 

When discussing pronouns, including “they/them,” Sherer admitted that “it’s hard,” but said that kids can educate their doctors. “One of my young patients told me: pretend there’s a hamster in my pocket, and you’re talking to both of us. So, if you’re struggling with they/them pronouns, imagine the hamster. Okay? They are a doctor. I like them. This is their stethoscope. Hamster with a stethoscope. Think about it.”

In 2018, participating in a panel hosted by the organization Gender Spectrum, Sherer said that she saw “lots and lots of kids” who “don’t have [gender] dysphoria, that really don’t have mental health issues, and so to say to them ‘you have to go get a letter from a mental health provider’ feels challenging to me. And so what we’ve started to do in our clinics is have someone like Diane [Ehrensaft, a leading proponent of the gender-affirmative model] . . . go in and do brief assessment, and give their rub—I know you [addressing Ehrensaft] said you don’t rubber-stamp, but basically in my mind that’s what it feels like, and so then we can move on and say ‘OK, now we can talk about what you’re actually here for”—that is, hormones.

Which brings me back to the lawsuits.

That the AAP gave Sherer a stage is further evidence that the organization has abandoned science in pursuit of political fashion. (Neither Sherer nor the AAP could be reached for comment.) Mounting evidence suggests that U.S. pediatric gender clinics are not practicing differential diagnosis—that is, attempting to identify other potential conditions or causes of a patient’s distress—and instead are pushing hormonal and surgical options on kids. Just yesterday, Finland’s top gender clinician and researcher, Tampere University Hospital’s Riittakerttu Kaltiala, claimed in the Free Press that American medical societies are “actively hostile” to gender clinicians and researchers who raise concerns about the “affirmative” approach. “Medicine, unfortunately, is not immune to dangerous groupthink that results in patient harm,” she observes.

As public knowledge of this scandal grows, lawyers will try to go further and further upstream in the referral pipeline to hold providers accountable. In the U.S. legal system, courts play a leading role in crafting standards of medical liability; given their independence, American judges are known to offer novel and creative interpretations of the law. It is only a matter of time before judges become skeptical of pediatricians who referred vulnerable teenagers to facilities that they knew or should have known were unsafe.

It is not news that the AAP has endorsed novel theories about sex and gender in defiance of empirical evidence. What is increasingly clear, and what was confirmed at the conference last weekend, is that the AAP is too shortsighted to protect even the interests of its own members. By deceiving them about the science of gender medicine and infantilizing them with unicorn-themed propaganda, the AAP is not only undermining the public’s trust in its authority as a scientific organization. It is also creating legal risk for pediatricians who, perhaps in good faith, rely on its guidance.

Leor Sapir is a fellow at the Manhattan Institute.

https://www.city-journal.org/article/is-the-aap-placing-its-own-members-at-risk