The Washington Free Beacon is proud to co-publish this piece with our
friends at Common Sense, where it also appears today.

Thousands of pediatricians convened in Anaheim, Calif., in early October
for the American Academy of Pediatrics�s (AAP) annual conference. The
group, which boasts 67,000 members in the United States and around the
world describes itself as "dedicated to the health of all children."

So some audience members were shocked when Dr. Morissa Ladinsky, an
associate professor of pediatrics at the University of Alabama at
Birmingham, lauded a transgender teenager for committing suicide.

In an address about "standing up for gender-affirming care," Ladinsky
eulogized Leelah Alcorn, an Ohio 17-year-old who, in Ladinsky�s words,
"stepped boldly in front of a tractor trailer, ending her life," in 2014,
after leaving a suicide note that "went viral, literally around the
world."

Ladinsky�s remarks were captured on video by a horrified onlooker, Oregon
pediatrician Dr. Julia Mason, who expressed outrage on Twitter that
Ladinsky was "glorifying suicide," an act she described as "unprofessional
and dangerous."

That isn�t just Mason�s opinion. Technically speaking, it is also the
official stance of the AAP, whose website for parents,
healthychildren.org, explicitly warns that "glorifying suicide" can have a
"�contagious� effect" and inspire others to take their own lives.

Reached for comment, Ladinsky expressed "regret" about her choice of words
and said it was "never my intent" to glorify self-harm.

But how did this esteemed doctor wind up telling a group of physicians
that a teen had, as she put it, "boldly ended her life?"

In any large organization, some members are bound to hold fringe views.
But Ladinsky, who has devoted her career in part to facilitating the
gender transition of teenagers including by challenging state laws that
restrict the kinds of treatment physicians can provide to them, is hardly
an outlier at the AAP. And the AAP is an organization that matters a great
deal.

Founded in 1930 as an offshoot of the American Medical Association, the
AAP is first and foremost a standard-setting body. It outlines best
practices for the nation�s pediatricians, advises policy-makers on public
health issues, and, for many parents, is the premier authority on raising
healthy kids.

In recent years, it has also become a participant in America�s culture
wars. Judges have deferred to the group�s expertise in high-stakes court
cases about children with gender dysphoria, who the AAP says can start
socially transitioning at "any" age. During the height of Covid, schools
masked toddlers�including toddlers with speech delays�based on the
guidance of the AAP. Sports leagues and after-school programs mandated the
Covid vaccine after the AAP strongly recommended it, even as concerns
mounted about its association with myocarditis, or inflammation of the
heart muscle, in young males.

Though the organization�s guidelines are framed as the consensus position
of the AAP�s members, only a handful of physicians had a role in shaping
them. Instead, insiders say, the AAP is deferring to small, like-minded
teams of specialists ensconced in children�s hospitals, research centers,
and public health bureaucracies, rather than seeking the insights of
pediatricians who see a wide cross-section of America�s children.

They also say a longstanding left-wing bias�over two thirds of
pediatricians are registered Democrats�has accelerated, turning the
organization into a more overtly political body that now pronounces on
issues from climate change to immigration. As rates of gender dysphoria
exploded and the Covid-19 pandemic hit, that bias seeped into the
organization�s medical policy recommendations, unchecked by discussion or
debate.

This story is based on dozens of interviews with pediatricians, academics,
and current and former AAP members, including several with leadership
positions in the AAP. It shows how a small group of doctors with virtually
unaccountable power can exert tremendous influence over public policy,
especially when a new crisis�be it moral or virological�gives them an
emergency mandate. A mandate affecting the lives of millions of families.

Covid: �Political Science Over True Science�

In the last week of June 2020, with no end to the pandemic in sight, the
AAP took a strong stance against school closures.

"The importance of in-person learning is well-documented, and there is
already evidence of the negative impacts on children because of school
closures in the spring of 2020," the group said in a statement, which
listed a litany of maladies�learning loss, food insecurity, isolation,
depression, physical and sexual abuse, substance use, suicidal
ideation�that could result from prolonged shutdowns. "[A]ll policy
considerations for the coming school year should start with a goal of
having students physically present in school."

Then, on July 6, then President Donald Trump tweeted: "SCHOOLS MUST OPEN
IN THE FALL!!!"

Over the next week, administration officials from Vice President Mike
Pence to Education Secretary Betsy DeVos cited the AAP in the course of
pressuring local officials to reopen schools.

It didn�t take long for the AAP to buckle. By July 10, the organization
issued a follow-up statement�this one co-authored with the teachers
unions�suggesting that in-person schooling would be impossible without
"substantial new investments" from the federal government. Most European
children, meanwhile, returned to the classroom.

It was a microcosm of the AAP�s handling of the pandemic: From masking
toddlers to boosters for 12-year-olds, the group�s guidelines were
consistently out of sync with those of the rest of the world, but very
much in line with the demands of anti-Trump partisans.

"The AAP cared much more about political science than true science," one
pediatrician said.

When schools began to reopen, at first in red states, the group advised
that every child, including toddlers, should remain masked for the
duration of the day�despite the fact that the AAP had until then stressed
the importance of facial cues for early childhood development�even as most
other Western countries opted against masking young kids.

The organization didn�t just recommend masks; it lobbied politicians to
require them.

In an August 2021 email obtained by Common Sense and the Washington Free
Beacon, the Colorado chapter of the AAP, acting on the policy
recommendations adopted by the national organization, urged members to
contact the state�s governor expressing support for a mask mandate in
Colorado public schools. Three months later, the Iowa chapter submitted an
amicus brief challenging a state law that prohibited school mask mandates.

These moves prompted outrage from many rank-and-file pediatricians,
several of whom contacted AAP leaders with concerns about the group�s
Covid recommendations, emails obtained by Common Sense and the Free Beacon
show. Masks "really hinder speech and socialization for the child
care/preschool set," one pediatrician, who requested anonymity, wrote to
Lee Beers, the then-president of the AAP, in April 2021, noting that for
these reasons the World Health Organization advises against masking
children under six.

Beers forwarded the email to Heather Fitzpatrick, a member of the AAP�s
Covid-19 response team, who thanked the concerned pediatrician for sharing
the perspective but did not follow up on the substance. Other doctors
reported similar stonewalling.

As recently as August 2022, the AAP tweeted that "there is no evidence"
that masks can harm childhood language development.

But prior to the pandemic, the AAP itself had argued that seeing faces is
critical for early childhood development.

According to Developmental and Behavioral Pediatrics, a book published by
the AAP in 2018, visually impaired children "are slower to acquire
adjectives and verbs" than their sighted peers, and, at younger ages, are
less likely to smile because "smiling is learned by seeing others
smile"�findings that raise obvious concerns about masks in schools. In the
August 2022 tweet, however, the AAP asserted that "visually impaired
children develop speech and language at the same rate as their peers."

Another AAP publication, this one geared toward parents and available at
least since 2013, emphasized the link between "face time" and "emotional
health"�only for the document to disappear from the AAP�s website during
the pandemic. An AAP spokesperson attributed the disappearance to a "web
content migration" and said it had "nothing to do with AAP�s mask
guidance," telling Reuters that the document would be republished on a new
platform.

It never was: When Common Sense and the Free Beacon asked to be directed
to the document�s new home, a spokesperson for the AAP said it "was
removed because it was outdated."

The AAP has also been exceptionally aggressive in its promotion of Covid-
19 boosters for children, which have been linked to myocarditis, a
potentially dangerous heart condition, especially in young men. The link
is strong enough, and the risk of pediatric Covid low enough, that most
European countries did not offer healthy adolescents a third shot, let
alone a fourth, while a few stopped vaccinating healthy children against
Covid entirely.

The AAP didn�t stop at advocating a third dose of the original vaccine,
however. In September, it recommended that every child 12 years and older
additionally receive the updated, "bivalent" Covid booster� regardless of
whether they also had natural immunity from contracting Covid, and despite
the fact that healthy children rarely become seriously ill from the virus.

Parents hesitant about the new booster, which was only tested in eight
mice, were told they shouldn�t be. The AAP�s booster recommendations do
not include an exemption for children with a history of myocarditis,
unless the condition was vaccine-related, because, as an article on
healthychildren.org, an AAP publication for parents, puts it: "Compared to
the potential risks of Covid-19 infection in kids, myocarditis appears to
be quite rare."

What the group doesn�t tell parents is that all of these recommendations
were the product of approximately a dozen doctors on an ad hoc "Covid-19
response team," which operated in such an opaque manner that many AAP
members were unaware of its existence.

"I have no idea who made these decisions," said Eliza Holland, a
pediatrician at UVA Children�s hospital. "I wasn�t even aware a Covid
committee exists," another pediatrician said.

There is no record of the Covid-19 response team anywhere on the AAP�s
website, and the organization declined to provide a list of its members.
Even AAP officials who knew about the committee could only name a handful
of people on it, based on sporadic interactions with the group.

One name that kept coming up was Yvonne Maldonado, the former chair of the
AAP�s committee on infectious disease and a professor of pediatrics at
Stanford Medicine.

While not the head of the response team, Maldonado appears to have been in
the driver�s seat on many of its key decisions. She was quoted in AAP
press releases about the pandemic and, from August 2021 to June 2022,
served as the AAP�s main representative on the Centers for Disease Control
and Prevention�s Advisory Committee on Immunization Practices, which draws
up vaccine recommendations for children.

Maldonado, who did not respond to request for comment, also ran clinical
trials of Pfizer�s mRNA vaccine at Stanford�a job for which she would have
been paid, according to the company�s guidelines on clinical trials.

The AAP said that Maldonado complied with all of its conflict of interest
disclosure policies. But her work with Pfizer may help explain why the AAP
and CDC�while notionally separate institutions�have issued nearly
identical recommendations on the Covid vaccine, parlaying the views of a
few academics into a government-wide consensus that has affected millions
of children.

"Very few people are behind these sweeping policies," said Ram Duriseti,
an associate professor of emergency medicine at Stanford Medicine. "Every
public health department aligns with CDC policy�and on kids and Covid, the
CDC is going to defer to the AAP."

Convened in the early days of the coronavirus as a kind of emergency
stopgap, the AAP�s Covid-19 response team had near dictatorial power over
the organization�s pandemic policy. Typically, the AAP will not take a
position without first soliciting feedback from all sections of the group
that might be impacted by it�say, infectious diseases, endocrinology, and
cardiology�to ensure the guidance reflects a thorough cost-benefit
analysis.

That did not happen on the high-stakes issues posed by the pandemic.
Instead, three knowledgeable AAP members said, the Covid-19 response team
issued recommendations without consulting other parts of the AAP, in the
hope of staying ahead of the virus.

"The norms for developing communications and policies are normally very
robust," a former AAP official said. "But the disaster framework subverted
a lot of those norms."

Multiple AAP higher-ups, including an officer in the cardiology section,
which normally reviews all policies related to heart functioning, said
their teams were never consulted about the group�s Covid recommendations,
including the recommendations about the vaccine.

"At this point we knew about myocarditis," the cardiologist said, "but
they didn�t ask for our opinion."

In an email to the Free Beacon and Common Sense, the AAP claimed to have
consulted cardiologists "on a variety of topics" throughout the pandemic,
but declined to specify whether the vaccine was one of them.

For some doctors, the response team�s composition was just as concerning
as its lack of transparency. Several of its members, including Maldonado,
work in children�s hospitals, which by definition see kids who are sicker
than average, including from Covid.

The result, some AAP members said, is that the bureaucrats crafting Covid
policy had a skewed perception of the disease�s pediatric risks, while
rank-and-file pediatricians were seeing the 99.9 percent of kids who
didn�t require hospitalization�at least not for the virus.

"Our psych unit was full the entire pandemic," said Nicole Johnson, a
doctor at University Hospitals Rainbow Babies & Children�s in Cleveland.
"Kids were waiting for beds to open in the psych unit while there were no
kids in the Covid ward."

There was also a tendency, implicit in the response team�s mandate, to
focus more on the effects of Covid than the consequences of lockdowns.
Lockdowns, while not formally endorsed by the AAP, were not vigorously
opposed by it either.

"Primary care physicians see kids gain weight as we try to keep them safe
from Covid," said Todd Porter, a pediatrician from Denver, Colorado who
left the AAP over its Covid policies, adding that some of his patients put
on more than 30 pounds during the pandemic. "But people in medical
bureaucracies just see case counts."

Opposing those bureaucracies�and the Covid policies they formulated�became
a professional risk. One pediatrician said her bosses threatened to fire
her for tweeting critically about the AAP�s vaccine recommendations. "They
hauled me into the office and asked me if I wanted to work there," the
doctor said, adding that she knew of colleagues who were terrified of
speaking out. Another pediatrician described how the president of her
state AAP chapter told her to pipe down about Covid restrictions if she
didn�t want to lose funding for an academic program.

"Had I replied �F you,� I wouldn�t have gotten the grants, and I wouldn�t
have been able to help my program," the pediatrician said.

Trans Health Care: �The AAP says kids under 10 can�t cross the street by
themselves, but they can change their gender�

The pandemic showed how a small group of like-minded doctors, acting with
virtually no oversight, can push extreme policies through the AAP based on
very little evidence. The group�s guidance on gender dysphoria offers a
similar lesson.

In 2016, the AAP established a committee on "LGBT Health & Wellness" to
support "children with variations in gender presentation." Four of the
committee�s six members�Jason Rafferty, Brittany Allen, Michelle Forcier,
and Ilana Sherer�work in pediatric gender clinics that prescribe puberty
blockers to patients as young as 10 and cross-sex hormones to patients as
young as 14.

Those treatments are part of the broader model of "gender-affirming" care
that the AAP endorsed in its 2018 policy statement, "Ensuring
Comprehensive Care and Support for Transgender and Gender-Diverse Children
and Adolescents." The statement, which represents the official position of
the AAP, was written by a single doctor, Rafferty, and does not appear to
have been reviewed by anyone else at the organization: Rafferty
"conceptualized," "drafted," "reviewed," "revised," and "approved" the
manuscript himself, a note at the end of the paper reads. Rafferty did not
respond to a request for comment.

"There was clearly no fact-checking," one longtime AAP member said. "The
AAP thought trans was the next civil rights crusade and got boondoggled by
enthusiastic young doctors."

The 2018 statement was an extraordinary departure from the international
medical consensus. Most European countries do not encourage social or
physical transition until a child�s gender dysphoria has persisted for
quite some time�an approach known as "watchful waiting"�in part because
the dysphoria desists on its own in the majority of cases, particularly
once puberty hits.

Rafferty, however, called watchful waiting "outdated" and endorsed a
"gender-affirming" paradigm, in which transitioning is on the table almost
as soon as a child identifies as transgender. Some of the studies he cited
to support that conclusion�including a practice guideline from the
American Academy of Child and Adolescent Psychiatry�actually undercut it,
arguing that, more often than not, "sex-reassignment" should be deferred
until adulthood.

Though the policy statement conceded that puberty blockers may pose "long-
term risks" to "bone metabolism and fertility," it did not recommend any
prerequisites for obtaining drugs. They could be given out at the earliest
stages of puberty�meaning to children as young as nine�and, Rafferty
insisted, were "reversible."

Since then, the gap between the AAP and the rest of the world has only
grown. Many European countries, including Britain, Finland, Sweden, and
the Netherlands, are now curtailing or entirely eliminating the use of
puberty blockers in children with gender dysphoria, citing both long-term
health risks and a lack of evidence that they alleviate the condition. The
AAP has nonetheless maintained its support for the drugs�which it claims
have the backing of the "most prominent medical organizations
worldwide"�while rejecting calls for more gatekeeping.

"The AAP says kids under 10 can�t cross the street by themselves," one
pediatrician said, referencing the group�s official recommendations on
pedestrian safety, "but they can change their gender. How does that make
sense?"

The contrast points to a broader tension within AAP guidance: On most
kitchen table issues, from diet to screen time to exercise, the group has
long encouraged a kind of safetyism, stressing the need for parental
supervision and the pitfalls of pubescent judgment. Yet on trans issues,
it has done nearly the opposite, suggesting that minors are mature enough
to transition without their parents� knowledge or consent.

"A family may deny access to care that raises concerns about the youth�s
welfare and safety," Rafferty�s statement says. "In such rare situations,
pediatric providers may want to familiarize themselves with relevant local
consent laws and maintain their primary responsibility for the welfare of
the child." It�s a stark departure from the way the group talks about
other forms of body modification: one AAP report recommends that
"adolescents speak with their parents" before getting tattoos, because
they are "permanent," "difficult to remove," and "involve significant
consequences."

By 2019, Rafferty�s guidance was eliciting quiet concern among rank-and-
file doctors affiliated with the AAP. "Normie pediatricians were like,
�what�s going on,�" one doctor said, recalling the hushed conversations
she had in the hallways of the AAP�s 2019 national conference, which
featured a panel on gender-affirming care. Gender specialists, on the
other hand, "considered themselves life-saving heroes."

Rather than promoting dialogue or compromise between the two camps, the
AAP sought to stifle dissent. In October, it urged the Department of
Justice to investigate critics of "gender affirming" care, arguing they
were spreading "disinformation" that puts lives at risk. That move came
after the organization barred the Society for Evidence-based Gender
Medicine, which advocates the watchful waiting approach, from being an
exhibitor at its national conference last year. In August, it also blocked
a resolution calling for a review of the AAP�s current guidance on puberty
blockers, which the head of Boston Children�s Hospital�s gender clinic,
Jeremi Carswell, says are "given out like candy" at her clinic.

The stifling of dissent has created an illusory medical consensus that
nonetheless exerts extraordinary influence over public policy and debate.
Courts have cited the AAP in cases about transgender children�Eknes-Tucker
v. Marshall, for example, in which an Alabama District Court blocked a law
banning puberty blockers, cross sex hormones, and gender reassignment
surgeries for trangender minors (the case is now on appeal). Talking
heads, meanwhile, have invoked the AAP to shut down criticism of childhood
gender transition.

In October, Jon Stewart berated Arkansas attorney general Leslie Rutledge
after her state passed a law similar to Alabama�s, arguing that she was
bucking the AAP�s "peer-reviewed" guidelines. Banning puberty blockers
would be as backwards as banning chemotherapy, Stewart said. He did not
mention that the Swedish National Board of Health and Welfare had, in
February, recommended halting hormonal gender treatment for minors except
in tightly limited circumstances.

The National Institutes of Health has funded one study on the long-term
effects of puberty blockers, which is being conducted by four university-
affiliated gender clinics�including the one at Boston Children�s, the
place that acknowledged prescribing blockers "like candy." The study,
which began in 2015, has yet to report its findings, and the authors have
not declared any conflicts of interests.

The Death of Expertise

At stake in all this, said Marty Makary, a surgeon and public policy
researcher at Johns Hopkins Medicine, is not just lockdowns or puberty
blockers but the credibility of the medical establishment itself.

"The AAP still puts out many important recommendations that parents should
follow," Makary said, citing the group�s support for the measles vaccine
and its guidance on preventing sudden infant death syndrome. "If parents
start to distrust the AAP because of its politicization, I worry we�ll see
more pediatric deaths."

There is some evidence, albeit anecdotal, to justify Makary�s fears. In
particular, several pediatricians said that the AAP�s zealotry around the
Covid vaccine had raised parental concerns about other, more well-
established vaccinations. One reported seeing "a lot more hesitancy around
routine immunizations," including for measles, after schools in her area
started requiring the Covid vaccine based on the AAP�s guidance. Another
said she�d been inundated with requests for a second opinion by parents
who "who don�t trust their own physicians on vaccines," both Covid and
non-Covid.

"I have to tell them the other vaccines are good," the pediatrician added.

Other doctors described families�including families in deep blue areas�who
have developed a reflexive distrust of anything the AAP says.

"I now hear parents mock the AAP over even non-political guidance like
breastfeeding recommendations," a pediatrician in Portland, Oregon said.
"They�re just tuning everything out."

For Vinay Prasad, a professor of epidemiology and biostatistics at the
University of California, San Francisco, it�s hard to blame them.

"The reason to trust modern doctors over ancient healers is that more of
what we tell you to do is justified by well-done studies," Prasad said.
"But how do we hold that perch when we just make stuff up?"

Published under: Democrats, Medical Ethics, Transgender

https://freebeacon.com/coronavirus/the-hijacking-of-pediatric-medicine/