The Journal of the American Medical Association already on a woke high of intergalactic dimensions has published Standards of Care for Transgender and Gender Diverse People – its full text is below. The document’s contents would until a short time ago have been considered delusional. I don’t wish to discuss the subject beyond saying that the medical care of such people should be the province of psychiatrists rather than pediatricians, endocrinologists, surgeons, internists, or physicians who claim to specialize in ‘gender affirming care’. It’s in the JAMA for a purpose that goes beyond what appears to be its proximate reason for publication.
What’s provoked this document is the limitation of ‘gender affirming care’ – at least for minors – by a number of states. It is quite likely that as many as half the states will pass legislation banning or greatly limiting such treatment for minors. The JAMA’s intent appears to counter such action on the part of states who oppose this addition to the domain of general medicine by proclaiming such treatment a standard of care much the same as is routine blood pressure measurement and treatment of hypertension.
Thus, when a state legislature attempts to proscribe or limit the care described in the publication they will be countered with the argument that such care is beyond discussion as it falls under the category of Standard of Care. It will be difficult for many non-physician state legislators to refute such an argument. Many of our best medical schools have been captured by a lunatic coterie of activists physicians who have cowed doubters with threats, or indeed acts, of punishment for holding dissenting views. Medical licensing boards in ‘liberal’ states have reviewed the credentials of doctors who hold the ‘wrong’ positions on gender. In these states it is truly dangerous to question the revealed wisdom about gender and its medical management.
I think it likely that we will end up with two standards of care for ‘transgender’ and ‘gender diverse people’ – standards based on politics and ideology instead of science. This dichotomy will emerge as there is almost no science supporting those who would medicalize what has been an almost invisible occurrence until just a moment ago. Fringe medical views and quack nostrums have always been part of the profession. The COVID pandemic seems to have unleashed a battalion of weird ideas. Medicine is not the only victim of such deranged thinking. The history of the medical profession, however, is full of practices not based on the foundation of solid science. The current craze will eventually pass as did routine therapeutic phlebotomy.
The proponents of transgender or gender affirming care don’t want these conditions ‘pathologized’. Nevertheless, they think they should be treated with drugs and surgery. Treatment of non-diseases with such modalities seems a contradiction in terms, unless we put them in the same basket as cosmetic surgery. Castrating a child by a doctor who has taken an oath to do no harm is beyond horror. There is no rational argument here. The doctrine of res ipsa loquitur applies.
Until sanity returns it is necessary for physicians who are troubled about what’s happening to the profession to speak up regardless of the risk. If you live in a state like Minnesota, the risk you will suffer is the wrath of many of your colleagues and the likelihood that someone will anonymously denounce you to the state licensing board which will hammer you with a series of queries which even successfully rebutted will exhaust you both physically and emotionally. If you reside in Florida, you will be safe from the government, but you may receive death threats. Both of these scenarios have happened in the states just mentioned. It’s hard to be brave. If it weren’t it wouldn’t be bravery.