Science and False-Hoods in the Modern Age Part II: Medical Advice from Harvard Law?!?!?

One of my professors in graduate school once told us all “Politicians use research the way a drunk uses a lamppost-more for support than illumination.” In the years since then, I have continued to reflect upon this humorous pearl of wisdom and have found it to be a truism. False-hood/ “The Tobacco strategy” have been so effective that it has become nearly ubiquitous. As such, it should come as no surprise that these tactics have been implemented in the “debate” over the validity of Trans identities. I have had several friends and family members, and sometimes strangers on the internet ask me to help them navigate their way through one article or another that they have found concerning social contagion, side effects of puberty blockers, conversion therapy or any other litany of Trans related “hot topics.” Some people are genuinely well meaning and seeking out my expert guidance as they try to figure things out. Others utilize these false-hoods as support for their anti-trans opinions. The use of these counterfeits (false-hoods) as if they are real science is an affront to me as a scientist. I find that it takes a great amount of energy to explain to people why their “scientific study” lacks the authority of a statement by the American Psychological Association or the American Academy of Pediatrics. When I do take the time and energy to explain to people that their apocryphal sources carry little to no weight those people tend to regard me as an arrogant academic and part of the “leftist conspiracy” against their beliefs. I seldom find it worth my time.

 It is my hope to utilize this blog entry to once and for all address both the well intentioned truth seeker and the self-assured warriors for “truth/God”. If you have not read the first part of this I strongly encourage you to do so as it lays out why I am using the term “false-hood” and “Tobacco Strategy.” It also enumerates why I see these attempts at disproving prevailing science as fundamentally unscientific. In this part of the blog, I would like to specifically examine how these ideas apply to the topic of Trans rights. Today I will be focusing on puberty blockers but hope you can extrapolate the principles I am discussing and apply them to a wide range of topics.

For the sake of argument I am going to include a link to an article someone sent me as a refutation to a statement by the American Academy of Pediatrics. I will review and compare each of these sources to demonstrate exactly why this is in no way a real debate between scientific points of view, rather it is an attempt to refute established science by claiming scientific authority for empirically “validated” theology; false-hoodism at its highest. I will show how this is part of the Tobacco strategy utilized by the anti-trans lobby.

I will begin by establishing what scientific consensus/authority ought to look like. I will do this by discussing/reviewing the statement by the American Academy of Pediatrics. Here is a link to the statement.  https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for?fbclid=IwAR32l2tqieLGTAI2jJ3dX6PQA9ZYenf7DbWbTt5HPAFhVrkGjspwJo04fUs?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000.

I’d like to draw your attention to a few things to start out with. First, notice the header at the top of the article that denotes that this is a Policy Statement from the American Academy of Pediatrics (AAP). This is not a single study or a single author’s opinion this a statement intended to speak for the AAP. This is a sort of “state of the science” address intended to inform and guide care. This is a snap shot of what the scientific consensus is at this moment in time. THIS IS SETTLED SCIENCE --- the jury is no longer out. This organization is willing to stake its reputation and authority on the following statements. I would also like you to notice the list of authors. This includes 3 different committees and 19 individual MDs. This is not a single opinion of a lone scientist, this is a statement that has been through multiple committee processes and reviewed by several leading experts in various different fields of medicine. This is scientific consensus formed by a large group of professionals – leading experts willing to stake their careers on what is to follow. Notice also that at the start of the article there is a clear statement regarding conflicts of interest – these authors are not motivated by money. I’d also like you to notice the title of the Journal that this is published in, Pediatrics Volume 142 issue 4. If anyone is counting that means this a professional journal that has been existence long enough to put out 142 multi issue volumes. The impact factor for this journal the year this statement was published (2018) was 5.51. For those of you who do not know impact factors are a statistical measurement of how much a journal is sighted – it is and empirical way of stating how much the scientific community is discussing the things a journal publishes. The higher the impact factor the more important a journal is, anything over 2 or higher is generally believed to be good. If you are really curious here is a YouTube video https://www.youtube.com/watch?v=_d64lokTeqw. Also take note there are 94 articles that are referenced in this one article – that is 3.5 pages worth of references all from reputable peer reviewed journals. The authors are supporting their claims with past research. This statement is being made on the foundation of the Orthodox Cannon of the field of pediatrics.  All of this is to say that this statement is soundly within the scientific mainstream. We can safely assume that what is written here is an authoritative statement that is meant to represent the consensus of leading professionals in the field of pediatric medicine.

As a final point. I’d like to explore who the American Academy of Pediatrics is. Here is a link to a full history https://www.healthychildren.org/English/Pages/About-AAP.aspx#:~:text=History,needs%20was%20a%20new%20one. In brief, AAP was founded in the 1930 by a group of physicians who believed that children had unique medical needs that should be considered through a developmental lenses. It has grown to a multinational organization with approximately 67,000 members. Full fellowship in the organization is granted to Board Certified Specialists in Pediatric medicine, meaning you must be a medical doctor with specialized training in pediatrics who has passed a written and oral exam proctored by other board certified physicians. This is truly an organization of experts.

Now some comments on what this paper actually says. First off, I would like you to notice that the authors take a very broad and systemic approach. Examining epidemiology and mental health and discussing the effects of culture and cultural disparities. Also, they identify several interventions to assist with gender dysphoria. This starts with social affirmation and works its way through puberty blockers, cross gender hormone therapy, affirmative surgeries and finally legal affirmation. While discussing all of these options, the authors are open and honest about the limitations of their data noting that they are drawing the best conclusions they can. They also strongly encourage practitioners to take into account individual factors such as development and family support. There is not a one size fits all recommendation. They do not say that all children must be given medical care. On the subject of puberty blockers this is what they have to say:

“Gonadotrophin-releasing hormones have been used to delay puberty since the 1980s for central precocious puberty.‍56 These reversible treatments can also be used in adolescents who experience gender dysphoria to prevent development of secondary sex characteristics and provide time up until 16 years of age for the individual and the family to explore gender identity, access psychosocial supports, develop coping skills, and further define appropriate treatment goals.‍”

 “Pubertal suppression is not without risks.‍ Delaying puberty beyond one’s peers can also be stressful and can lead to lower self-esteem and increased risk taking.‍60 Some experts believe that genital underdevelopment may limit some potential reconstructive options.‍61 Research on long-term risks, particularly in terms of bone metabolism62 and fertility, 63  is currently limited and provides varied results.‍57,  64,  65 Families often look to pediatric providers for help in considering whether pubertal suppression is indicated in the context of their child’s overall wellbeing as gender diverse.”

I have heard many critics say that “the bad people” are pushing puberty blockers for all gender diverse kids without any thought of the side effects. This quote from an authoritative source would make it seem otherwise. These authors are clearly considering side effects and encoring pediatricians to make careful and informed decisions.  Also, note we have a history of this drug being used to treat precious puberty for approximately 50 years. That’s pretty decent data. Every drug has side effects. Why is it we are so particularly wary of puberty blockers? Finally, be aware that puberty blockers are being recommended not as a cure or a primary treatment but as a temporary measure to provide children and family further time to make decisions. If we are genuinely concerned that this is just a phase or that someone will change their mind than offering more time to try things out and make decisions ought to be considered a good thing.

Here are the authors’ final recommendations:

“1.‍ That youth who identify as Trans/Gender Diverse(TGD) have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;

2.‍ That family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;

3.‍ That electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;

4.‍ That insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender affirming interventions;

5.‍ That provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;

6.‍ That pediatricians have a role in advocating for, educating, and developing liaison relationships

7.‍ That pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;

 8.‍ That the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and

9.‍ T,hat the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD.

These are generally fairly conservative and uncontroversial recommendations. I want you to notice things here. No one is advocating to cut parents out or go behind their backs. In fact, it is recommended to include families and schools in this process. The recommendations are suggesting that development and safety be taken into consideration. This does not appear to be agenda driven, careless or anti-parent, even though these are all accusations I have heard hurled at those who recommend gender affirming care.

Now let’s turn our attention to the “other side” of this “argument.” Here is a link to a statement that a friend of a friend brought up to me when I was discussing the importance of affirming adolescents’ identities. https://acpeds.org/transgender-interventions-harm-children?fbclid=IwAR0c83MNTtz4JIUVPztfwmJDpPopgRg806beOeo-nOgOA7IsdpOurC8R_Uw

The first thing I notice here is that this a website and not a professional journal article or official statement of any kind. A few other things that appear glaringly obvious to me. This website has a clear agenda it is written more like a newspaper headline or clickbait than an actual professional statement. Big bold letters “Transgender Interventions Harm Children”; this feels and looks alarming. This big headline is followed by terse stamens of “facts” about “transgender Interventions.” Also notice that term – “transgender interventions” --- what does that even refer too? Within serious medical circles we discuss gender affirmative care. This webpage reads like the back of a dime store novel – “The Best Horror Novel since ‘IT.’” There is no actual argument here. Rather it feels like a collection of soundbites written down especially prepared for today’s low attention audiences. The truth is this is a thinly veiled appeal to other people’s authority. “World renowned Swedish psychiatrist Dr. Christopher Gillberg said …”. There is no real logical argument here or explanation of a position, they are simply quoting other people’s opinions on the issue. Perhaps the most glaring omission in all of this is an author and a reference section. Whoever wrote this does not have the integrity to take responsibility for it. Nor do they cite their sources. There are lots of studies and opinion pieces being referenced but I have no idea where to find them or how credible these sources really are.

This splashy page links to two other pieces. The first one titled “Deconstructing Transgender Pediatrics” the other “The Myth about Suicide and Gender Dysphoric Children.” Notice immediately these titles are again catchy and sensational- they are also firmly rooted in fighting against something. This organization wants you to think they are “pro-child, pro-health and pro-science” – These statements are fairly “anti” something – the headlines are not positively stated such as “delaying or forgoing gender affirmative care improves mental health”. Nope, they are firmly against something here regardless of their “pro” something statements.

The first article, “Deconstructing Transgender Pediatrics”, continues the trend of omitting an author. At least this time there is the inclusion of citations and references. There are a sum total of 18 citations, about half of which are peer-reviewed professional sources. The rest are websites and news articles. The body of the “article” continues with bold sweeping statements and fearmongering with little rational argument or discussion. This is very one sided. One of my favorite statements is “the AAP’s pro- transition policy has been discredited as a gross misrepresentation of science by gender identity psychologist Dr. James Cantor” – the opinion of one psychologist here is meant to override the well-argued and reasoned opinion of 3 committees and 19 board certified pediatricians. Furthermore, they do not take the time to summarize the esteemed doctor’s argument. We are meant to simply take his word for it. This is a prime example of The Tobacco Strategy. The author/authors? (who on earth knows?) are/is creating the appearance of professional discord by finding a few dissenting voices. Thus, seemingly discrediting “mainstream science” and creating room for enough doubt that people can say “the science isn’t settled.” This article tells us what to think; it does not present facts, it gives opinions connected to authoritative people and organizations and asks us to trust the authority. One final point on this article is that the vast majority of “expert opinion” they refer to are outside of the USA – an interesting choice for the American College of Pediatricians and also something difficult to justify when the topic is something as culturally bound as gender.

The second article is “The Myth about Suicide and Gender Dysphoric Children.” Again, note the nomenclature games here. They have created their own label, much like the Same Sex Attraction label used by the conversion therapy community.  At last, we finally get a list of authors here! We have to really look hard to find the authors but they are there. Jan W. Robbin’s Esq. and Vernadette R. Broyles, Esq. – a pair of Harvard trained lawyers.  People who have no expertise or background in medicine. Also notice by the author’s names there is a seal at bottom corner for Child and Parental Rights Campaign. According to the official Child and Parental Rights Campaign website they are a “non-partisan, non-public interest law firm.” Their purpose is as follows: “Children are being led to believe a powerful untruth – that they could be “born in the wrong body”. It is our mission to defend the rights of children and parents against this dangerous ideology and to restore the rights of parents to direct the care, education, and upbringing of their children. Together we must fight to engage the culture in meaningful ways in order to secure the future of our children and families.” I ask you dear reader can you trust this as an objective source? To me it feels like a fairly agenda driven organization with a clear bias from the outset.

This article has 31 citations. About half of them are form non-academic sources, with several of the articles coming from one particular website, 4thwavenow.com – which touts itself as “a community of people who question the medicalization of gender-atypical youth”. Again, more nomenclature games and more biased sources. This website even goes so far as to state – “The purpose of this site is to give voice to an alternative to the dominant trans-activist and medical paradigm currently being touted by the media. Preference is given to commenters who are also gender-skeptical”. They aren’t even pretending impartiality at this point. Also, note by their own admission they are outside of the “medical paradigm” – it is difficult to site this as a credible medical reference when the organization itself is open about being different from the medical establishment.

Now that we have examined the product let’s examine the organization itself. According to their own website, The American College of Pediatricians (ACPeds) started in 2002, and as you may recall this was a very interesting time in our nation. I remember it clearly, it was the year I graduated high school and started college.  Gay marriage was the hot topic of the day. States across the nation had started amending their constitutions to define marriage as existing solely between a man and a woman. I personally had just finished “fighting the fight” in Nevada and was gearing up to campaign for the same amendment in Utah. This organization’s second listed objective in their “about us” page is “To promote the basic father-mother family unit as the optimal setting for childhood development” and their principles define “the fundamental mother-father family unit, within the context of marriage, to be the optimal setting for the development and nurturing of children” Hopefully, most of us recognize that these statements are more political/ideological than they are scientific or medical. In fact, there is good data to the contrary at this point.  This organization consists of a non-descript conglomeration of people interested in this agenda, or as they prefer to state it “membership is open to qualifying healthcare professionals who share the ACPeds' Mission, Vision and Values”. The same mission, vision, and values sighted above with clear political purpose.  A trip to their frequently asked questions section will also show you that the organization promotes conversion therapy, or as they describe it “ethical talk therapy and counseling techniques in order to identify and address issues that may underlie the undesired attractions and behaviors.” As an interesting side note, their FAQ also makes mention of the fact that the Southern Poverty Law Center has labeled ACPeds as a hate group. Of the two organizations ACPeds and AAP you judge which one has an agenda? Which one is an objective scientific /medical organization? Which one would you trust to make medical decisions for you and your family?

Hopefully at this point it has become clear why it is frustrating/insulting when people come at me with this garbage. Indeed “False-Hood” is the kindest thing I can think to call this pseudo-science. Hopefully, I have shown that this kind of “science” is not credible to those who know what they are looking at. One of these articles is produced a large body of board certified pediatricians who claim their work and ground it in the scientific literature. The other is a set of documents produced by Harvard lawyers and other unnamed authors. It reads like Fox New headlines and talking points and cites an echo chamber of likeminded conservative interest groups in its citation section. One of these is legitimate academic work the other is someone’s politically motivated fan fiction. Indeed, I have to say the most convincing thing about ACPeds and company is that they lend a facade of academic/scientific credibility to a non-scientific idea that aligns with people’s theology. Methinks the drunk has found a lamp post. If you are curious, this is exactly what the Tobacco strategy looks like.

At this point, I laid out the philosophy related to this issue and provided a real world of example of how the philosophy plays out. My next installment will be titled “Listening to the Other Turtle.” I’m going to dust off my bible see what Christian scripture has to say on the topic. So stay tuned dear reader, some of you will see the “old me” return. Others will get to know another side of me you may not have known existed.

Thanks For Reading -- MJ