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The Catholic Medical Association (CMA) is responding to a letter sent to Attorney General Merrick Garland in which several secular medical groups called for an investigation into threats against providers of “evidence-based gender-affirming care.” In their open letter, the CMA calls into question the merits of existing evidence, and brings attention to a lack of discussion on said merits.
The original letter – penned jointly by the American Academy of Pediatrics (AAP), American Medical Association (AMA) and Children’s Hospital Association (CHA) – urged the Justice Department to take steps to investigate and prevent threats of violence against providers of gender-affirming care. They went on to suggest that social media platforms should do more to censor “rhetoric” against their practices, which they consider to be a “coordinated campaign” meant to spread disinformation.
CMA response
The CMA, which wrote on behalf of seven religious-based medical organizations, began its response by whole-heartedly agreeing that threats of violence must stop. It wrote that “tactics of harassment, intimidation and threats of violence” are never justified and they noted that this is not a problem unique to providers of “gender-affirming care”:
“Many of our members have been the recipients of these same tactics of harassment, threats, intimidation, and job loss in efforts to bring attention to the major deficiencies in current data on the safety and efficacy of 'gender affirming' medical interventions,” the CMA wrote.
After noting their commitment to providing the highest quality evidence-based medical care to patients with gender dysphoria, the CMA noted that there is “a profound difference between eminence-based medicine and evidence-based medicine.” Furthermore, it lamented the lack of discussion on the merits of the evidence:
“We see ongoing active efforts to suppress any discussion of the merits of the existing data used to support gender affirming medical interventions to adolescents seeking to alter the appearance of their body to conform to their perceived gender identity. Such approaches are not only violative of the principle of scientific inquiry, but also of constitutionally protected free speech.”
The CMA went on to note that current appeals policies and practice guidelines are set by “small committees of self-selected advocates.” These committees, the CMA argues, only represent the views of a small percentage of medical professional, which the CMA feels falls short of the bar required to “claim a strong evidence base.”
Furthermore, the CMA called into question the decision of the AMA, APP, and CHA to ignore concerns other countries have expressed about the strength of the data. The letter pointed to Finland, Sweden, the United Kingdom, France, and other countries that have questioned the safety and psychological outcomes of the gender-affirming care model in recent months. In particular, these countries are reevaluating the administration of GnRH agonists and sex incongruent sex-steroid hormones to adolescents with gender dysphoria.
Discussion needed
Finally, the CMA reiterated that voicing concerns over a system it perceives as flawed cannot be viewed as harassment. It notes that discussion is a key factor to the improvement of medical care:
“Furthermore, expression of concern over the ability of youth to understand and consent to irreversible surgical interventions that result in loss of fertility and adult sexual function does not constitute harassment or intimidation. The posing of these questions and concerns reflects the normal process of scientific and medical dialogue. Respectful debate and disagreement provide a basis for furthering scientific inquiry that leads to genuine improvement in medical care to the patients we serve.”
The letter concluded with a call for all medical organizations to reexamine the merits and limitations of current scientific evidence in the field of transgender medicine.
"The integrity of the scientific method and adherence to true evidence-based medicine depend upon genuine efforts to recognize and minimize bias, avoidance of contamination by ideological agendas, and a continual striving to elevate knowledge to the highest standards of excellence.”
