Dear Merrick Garland

Please help us hold the medical associations accountable

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The Honorable Merrick Garland
Attorney General
U.S. Department of Justice
950 Pennsylvania Avenue, N.W.
Washington, DC 20530

Dear Attorney General Garland,

Last week, the American Academy of Pediatrics, the American Medical Association, and the Children’s Hospital Association wrote to you, urging you to “investigate the organizations, individuals, and entities coordinating, provoking, and carrying out bomb threats and threats of personal violence against children’s hospitals and physicians across the U.S.”

This is, of course, an important and reasonable request. Bomb threats and threats of personal violence are totally unacceptable, and we should identify and stop the people making them.

But their letter asserts: “The attacks are rooted in an intentional campaign of disinformation, where a few high-profile users on social media share false and misleading information targeting individual physicians and hospitals, resulting in a rapid escalation of threats, harassment, and disruption of care across multiple jurisdictions.”

Please hear me out when I say that I believe that this assertion is in itself part of an intentional campaign of disinformation.

I don’t want to spend much time on the “high-profile users on social media,” because those users—likely Matt Walsh and Libs of TikTok—are doing little more than sharing hospitals’ own promotional information. As far as I know, they have not called for violence (please correct me if I’m wrong), but rather for the government to shut down the provision of gender-affirming care, because they are against it, morally and scientifically. Rather than answer to the morals or the science, these organizations are requesting that you censor their critics. In other words, they are engaging the Attorney General to deny free speech.

That concerns me, but I’m most distressed over their accusation that “false and misleading information” is being spread.

These medical organizations repeatedly call “gender-affirming care”—which includes the psychological and medical transitioning of a child to live as the opposite sex, or, increasingly, neither sex—“life-saving” and “evidence-based.” I don’t think either of those statements can or should be classified as factual.

The AAP has refused to do a systematic evidence review. The World Professional Association for Transgender Health—self-appointed “experts” who have created deeply-flawed guidelines for care—said the evidence was so paltry that they couldn’t perform a systematic evidence review. This is not true. Finland, Sweden, the UK (one on puberty blockers and one on cross-sex hormones) and the state of Florida have all done so. And their conclusions were largely the same:

Sweden: “The scientific basis is not sufficient to assess effects on gender dysphoria, psychosocial conditions, cognitive function, body measurements, body composition or metabolism of puberty-inhibiting or gender-opposite hormone treatment in children and adolescents with gender dysphoria.”

UK:

• Impact on gender dysphoria; Certainty of evidence: very low

• Impact on mental health: depression; Certainty of evidence: very low

• Impact on mental health: anger; Certainty of evidence: very low

• Impact on mental health: anxiety; Certainty of evidence: very low

• Quality of life: No evidence was identified

• Impact on body image; Certainty of evidence: very low

• Psychosocial impact: global functioning; Certainty of evidence: very low

• Psychosocial impact: psychosocial functioning; Certainty of evidence: very low

• Stopping treatment [aka detransition]; Certainty of evidence: very low

Florida: “Available medical literature provides insufficient evidence that sex reassignment through medical intervention is a safe and effective treatment for gender dysphoria. Studies presenting the benefits to mental health, including those claiming that the services prevent suicide, are either low or very low quality and rely on unreliable methods such as surveys and retrospective analyses, both of which are cross-sectional and highly biased.”

Yes, there is evidence that these medical interventions improve mental health for children with gender dysphoria, at least in the short-term, but we must focus on the quality of that evidence. Even the methodology of the original Dutch studies, on which this mode of care is based, has now been questioned.

A study published in JAMA Network Open in February of this year asserted that “receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.” The study was widely publicized in the mainstream press. Yet journalist Jesse Singal pointed out the ample flaws in the study, noting that that data did not show what they claimed. It was later discovered that the communications employees at the University of Washington, where the researcher worked, knew of Singal’s critiques and knew that the media was running wild with a story unsupported by data, and chose not to correct the record because of the “overwhelming amount of positive coverage of the study’s findings.”

This is, in effect, spreading false and misleading information—by researchers, institutions, and the media. And it is endemic to the organizations promoting gender-affirming care. The AAP issued a policy statement in 2018 noting that “There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.” It did not include an evidence review, but cited specific studies to suggest the affirmative approach was the best one.

But psychologist and sex researcher James Cantor, who had for years reviewed the science on treating gender dysphoria, fact-checked the policy statement. His conclusion: “…not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.”

Jack Turban, a sought-after “expert” on gender-affirming care, has published several studies which have also been widely reported on in the press as proof that medical interventions reduce mental health problems for trans-identified youth. But his work, too, has been fact-checked by Singal and Manhattan Institute fellow Leor Sapir, who reports there is “a broader pattern of Turban spreading misinformation and, at times, demonstrating ignorance about the basic facts of studies he cites.”

Meanwhile, some hospital clinics have promoted their gender surgeries for minors, then took down the promotional materials and said they weren’t happening, despite ample evidence that they do indeed occur. Now the message has suddenly switched, from “this never happens” to “it happens, but it’s good.” Were they spreading misinformation when they avowed gender surgeries for minors were a myth?

This is not to say that some young people haven’t felt better after medical and surgical gender interventions, as well as social transition—especially in the short-term. It is to say that the evidence cannot truthfully be called life-saving and/or evidence-based, and that we don’t have enough long-term follow up to draw conclusions about safety and efficacy. We have no reliable data on regret or detransition—or, beyond those concepts, how many people would have benefitted more from time and psychological support than cross-sex hormones and surgeries. Detransitioners penned a letter to you themselves, imploring you to see that “medical safeguarding of children should not be a political issue.” So did FAIR in Medicine, which noted that “investigating, prosecuting, or silencing those who question or disagree with the still very new and rapidly evolving field of gender affirming care will not only risk violating the First Amendment rights of all Americans, but will prevent the medical profession from determining and providing the safest and most effective treatments for gender dysphoric patients.” Meanwhile, official standards of care “must be evidence-based, and not merely based on the evidence” and “must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis.”

I know many adult trans people, who transitioned and feel their lives are so much better for it. Many of them are concerned about the kind of healthcare young people with gender dysphoria are getting, and about the kinds of things young people are being taught about sex and gender in school, and what they’re exposed to on social media, likely helping to fuel this explosion of gender dysphoric youth. I also know many detransitioners, who are literally and figuratively scarred by these procedures, and who are painted as hateful when they try to whistle-blow. Why aren’t clinicians listening to them, rather than spreading the misinformation that detransition is rare (we don’t know) or that these people are bigots, rather than victims and concerned citizens?

Attorney General Garland, I ask you to help those of us trying to spread accurate information, and to help us hold these medical associations to account for their Orwellian, or maybe just Rove-ian, tactics of accusing others of what they’re guilty of themselves.

Those of us doing this work—many of us left-wing—condemn any threats of violence, and do want to stop threats. But we cannot stand by while trusted medical associations spread dangerous misinformation and accuse those of us trying to expose them of doing that ourselves. We are pushing back against Biden, against the major medical associations, against institutions we used to admire, like Planned Parenthood and the ACLU, against schools, against our own Democratic party, against the entire mainstream and liberal media. There are a lot of us out here, trying to draw attention to the untold stories.

I ask this of you as a journalist who has been trying to complicate the media narrative in left and center publications, and who has talked to dozens of families that have been ripped apart by schools, doctors, therapists pushing the affirmative model without adequate evaluation, without investigating the source of the child’s problems, without prioritizing familial connection.

These are just a few of the stories I’ve heard: doctors telling parents, in front of their children, that the children would kill themselves if they weren’t medically transitioned. Children being socially transitioned—a contested psychological treatment for extreme gender dysphoria—behind their parents’ backs, the practice codified into school guidelines across the country. Detransitioners calling the people who altered their endocrine systems or removed their body parts to tell them they regretted, or shouting it to the wind on Twitter, and being denigrated, gaslit, or ignored. I have been trying to share their stories, to balance the media narrative, to get the whole story out, to make sure the left wing is properly educated.

I ask this of you as a mother of two incredible girls, whom I love fiercely. One is hyperfeminine. The other is hypermasculine. I have tried to fortify them against a world that tells them it’s bad and shameful to be feminine, and that being masculine means you’re a boy. I’ve tried to inoculate them against the modern messages of gender which many believe are liberating, and which I believe are constricting.

I’m not calling on you to investigate gender clinics, because I don’t think criminalizing these practices is the best way to get reform in this industry—and, believe me, Big Gender is an industry. I think the best antidote to the threats is transparency, not taking down videos and websites, hiding what’s going on. My ask is a bipartisan committee to gather information from these clinics, and to compel them to engage in rigorous follow-up of patients. My ask is data collection. Let’s gather all the cards and lay them on the table and figure out what to do.

Medical associations are asking you to be complicit in silencing critiques of gender-affirming care. I’m asking you instead to listen to those critiques.

With hope and belief in gender diversity,

Lisa Davis

Picture from Grandview.