Friday, July 7, 2017

Hate Group Leader: "I’m a Pediatrician. How Transgender Ideology ..."

Once someone uses the phrase “transgender ideology” you know that they are a religious zealot.
Michelle Cretella
Michelle Cretella is president of the American College of Pediatricians — not to be confused with the real professional peer group, the American Academy of Pediatrics.

“Pediatrician?” Not if you consider board certification a prerequisite. Not only is Cretella not certified by the American Board of Pediatrics but she is not certified in any field according to the American Board of Medical Specialties. In fact she doesn't even seem to be a currently licensed physician.

Thus she is a poseur and the leader of a tiny Christian anti-LGBT hate group. Yet the Heritage Foundation seems to think that Cretella is a responsible spokesperson. The full title of her post to Heritage's blog reads: “I’m a Pediatrician. How Transgender Ideology Has Infiltrated My Field and Produced Large-Scale Child Abuse.” What field would that be? Hate group leadership?

Once someone uses the phrase “transgender ideology” you know that they are a religious zealot. The phrase was coined by the current pope. We don't expect the pope to understand gender dysphoria. After all he is just a theologian. However, we can reasonably expect a doctor to know better. Apparently not.

We begin:
Just a few short years ago, not many could have imagined a high-profile showdown over transgender men and women’s access to single-sex bathrooms in North Carolina.

But transgender ideology is not just infecting our laws. It is intruding into the lives of the most innocent among us—children—and with the apparent growing support of the professional medical community.
The intent is to suggest a current fad. The medical fact (and she should know this) is that ten years ago, the psychiatric community treated gender dysphoric children differently than they do today. Then the approach was to prevent children from becoming trans in the hope that they would grow out of gender dysphoria. Today, after much research, the generally accepted methodology is to permit gender affirmation to reduce the anxiety and depression. Therefore, the number of kids with gender dysphoria is about the same but, admittedly, we have more trans youth. As I said, Cretella should be aware of this.
As explained in my 2016 peer reviewed article, “Gender Dysphoria in Children and Suppression of Debate,” professionals who dare to question the unscientific party line of supporting gender transition therapy will find themselves maligned and out of a job.
First of all that is an opinion piece, in contrast to research, and could not be subjected to peer review. It is published to the Journal of American Physicians and Surgeons. That is not exactly the New England Journal of Medicine. The Association of American Physicians and Surgeons claims that vaccines cause autism and that abortions cause breast cancer. It is a very small group that, most notably, opposes Medicare and Medicaid. It publishes a physicians' guide to opting out of Medicare. In fact, it opposed Social Security. On their website they actually claimed that Obama was using a “covert form of hypnosis” to get people to vote for him in 2008. Oh, and Cretella's piece clams that she is a board certified pediatrician. That is a lie.

Click on the image to enlarge
Getting back to the Heritage piece, she admits to leaving clinical practice in 2012 and then:
For the last 12 years, I have been a board member and researcher for the American College of Pediatricians, and for the last three years I have served as its president.

I also sat on the board of directors for the Alliance for Therapeutic Choice and Scientific Integrity from 2010 to 2015. This organization of physicians and mental health professionals defends the right of patients to receive psychotherapy for sexual identity conflicts that is in line with their deeply held values based upon science and medical ethics.
ACPeds and NARTH. I am impressed. Researcher? Exactly what research has ACPeds ever published to a respected scholarly journal? Apparently she believes in reparative therapy which is unsupported by any research published to a mainstream journal. The disdain of Cretella's colleagues (if she actually had any) is well deserved. It would be the antipathy reserved for crackpots who push unscientific theories into practice in an attempt to conform medicine to their irrational religious beliefs.
I have witnessed an upending of the medical consensus on the nature of gender identity. What doctors once treated as a mental illness, the medical community now largely affirms and even promotes as normal.
The consensus changed. It is formed by clinicians (mostly psychiatrists) who specialize in the treatment of gender dysphoric children. They work with these kids every day. I can understand why Cretella would consider that upended.  Cretella has not practiced medicine in more than five years.
In 2014, there were 24 of these gender clinics, clustered chiefly along the east coast and in California. One year later, there were 40 across the nation.

With 215 pediatric residency programs now training future pediatricians in a transition-affirming protocol and treating gender-dysphoric children accordingly, gender clinics are bound to proliferate further.
So what? She objects to more care available for children?
Last summer, the federal government stated that it would not require Medicare and Medicaid to cover transition-affirming procedures for children or adults because medical experts at the Department of Health and Human Services found the risks were often too high, and the benefits too unclear.
That is a deliberate misstatement. According to a June 6, 2016 proposed policy memo from CMS:
Currently, the local Medicare Administrative Contractors (MACs) determine coverage of gender reassignment surgery on an individual claim basis. The Centers for Medicare & Medicaid Services (CMS) proposes to continue this practice and not issue a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria.
In other words Medicare did not stop coverage but continued to provide coverage for seniors on a case by case basis. Moreover, the memo calls for more research in order to make a National Coverage Determination. Medicaid coverage is generally determined on a state-by-state basis. Some do and some do not. That should change.
Undeterred by these findings, the World Professional Association for Transgender Health has pressed ahead, claiming—without any evidence—that these procedures are “safe.”

Two leading pediatric associations—the American Academy of Pediatrics and the Pediatric Endocrine Society—have followed in lockstep, endorsing the transition affirmation approach even as the latter organization concedes within its own guidelines that the transition-affirming protocol is based on low evidence.
There were no “findings” and the memo is limited to Medicare recipients. According to at least one American Academy of Pediatrics voice (an important read):
While rates of depression are two- to three-times higher in transgender youth as compared to non-transgender individuals, a recent study published in Pediatrics showed that children who undergo a social transition in order to present in the gender they identify with have rates of depression comparable to non-transgender children. Other studies have shown that most of the psychiatric disorders in transgender adolescents derive from discrimination, peer rejection and lack of social support. The best predictor of positive psychological outcomes, according to research, is parental support.
The entire piece is worth reading. The author did not provide a link to the piece in Pediatrics. To suggest that there is no evidence or insufficient evidence is misleading. More research is required to follow more children into adulthood. Furthermore, I have been unable to find current research that rejects gender affirmation. More importantly, Cretella hasn't done any real research. She hasn't worked with trans kids and is out of her depth (which is limited to the kiddie-pool to begin with).
They even admit that the only strong evidence regarding this approach is its potential health risks to children.

The transition-affirming view holds that children who “consistently and persistently insist” that they are not the gender associated with their biological sex are innately transgender.
Cretella never provides any links to back up her claims. Every medical intervention carries with it some risk. Taking aspirin is known to cause ulcers. That doesn't mean that we shouldn't treat our headaches. Speaking of headaches, Cretella is a carrier.

Cretella is mischaracterizing the risk/reward ratio. There is certainly more research to elaborate the risks of taking puberty blockers and hormones than research regarding their effects on children who have gender dysphoria. The risk/reward ratio is not comparable to the amount of research for each. Cretella is further misleading because she doesn't consider the risks of self-harm that occur without gender affirmation. Those risks are on the other side of the ledger for consideration. They undermine her argument.
(The fact that in normal life and in psychiatry, anyone who “consistently and persistently insists” on anything else contrary to physical reality is considered either confused or delusional is conveniently ignored.)
I think psychiatry accepts the fact that gender dysphoria is contrary to the physical reality of genitalia. Call it whatever you like. Calling it gender delusion doesn't change anything with regard to the kids who have it. 0.3% to 1% of the population is not asserting that they are George Washington. However, in that percentile range, people are extremely distressed that their gender is not congruent with their natal sex. Cretella never mentions that distress; the anxiety and depression. Again, that undermines her argument.
There are exceptions to this movement, however, in addition to the American College of Pediatricians and the Alliance for Therapeutic Choice. These include the Association of American Physicians and Surgeons, the Christian Medical & Dental Associations, the Catholic Medical Association, and the LGBT-affirming Youth Gender Professionals.
Except for the last, those are all conservative Christian organizations with a religious objection (to exactly what I am uncertain). The last, those Youth Gender Professionals aren't professionals at all. It is comprised of parents who cannot support a trans child. That is not “LGBT-affirming.” We have no idea whatsoever who is behind an anonymous blog. I looked at one post. It liberally links to 4thwavenow which is another anonymous blog written (supposedly) by a mother who refuses to accept the science. She has compared gender affirming therapy to lobotomies. Medical professionals don't cite non-medical anonymous sources.
Twin studies prove no one is born “trapped in the body of the wrong sex.”
They prove no such thing. She cites Milton Diamond's study. She even provides a link. According to Diamond:
The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.
Even if there were no genetic correlation, that doesn't mean that gender dysphoria isn't real. I helped raise identical twins. To this day I have some difficulty telling them apart but they are very different people in so many ways.
Gender identity is malleable, especially in young children.

Even the American Psychological Association’s Handbook of Sexuality and Psychology admits that prior to the widespread promotion of transition affirmation, 75 to 95 percent of pre-pubertal children who were distressed by their biological sex eventually outgrew that distress.
The APA Handbook of Sexuality and Psychology is $395.00 so I'll pass. Yet, according to the APA:
Parents may be concerned about a child who appears to be gender-nonconforming for a variety of reasons. Some children express a great deal of distress about their assigned sex at birth or the gender roles they are expected to follow. Some children experience difficult social interactions with peers and adults because of their gender expression. Parents may become concerned when what they believed to be a “phase” does not pass. Parents of gender-nonconforming children may need to work with schools and other institutions to address their children’s particular needs and ensure their children’s safety. It is helpful to consult with mental health and medical professionals familiar with gender issues in children to decide how to best address these concerns. It is not helpful to force the child to act in a more gender-conforming way. Peer support from other parents of gender-nonconforming children may also be helpful.
In any event, the 75% to 95% outgrowing gender dysphoria is fiction. It seems to stem from a circa 1980 “Sissy Boy” study which conflated sexual orientation with gender identity. Cretella does not provide a reliable cite to support her claim which, by the way, admits (if you read it closely) that the APA does not consider outgrowing gender dysphoria to be at those rates or even relevant.
Puberty blockers for gender dysphoria have not been proven safe.
They are recommended by the Endocrine Society. Cretella cites that blog post to New Atlantis by Paul McHugh et al. It's rubbish.
There are no cases in the scientific literature of gender-dysphoric children discontinuing blockers.

Most, if not all, children on puberty blockers go on to take cross-sex hormones (estrogen for biological boys, testosterone for biological girls). The only study to date to have followed pre-pubertal children who were socially affirmed and placed on blockers at a young age found that 100 percent of them claimed a transgender identity and chose cross-sex hormones.

This suggests that the medical protocol itself may lead children to identify as transgender.
No, that is nonsense. This (study from the Netherlands) undermines the 75% to 95% BS that Cretella promoted earlier. Otherwise, these kids would be suffering from another form of gender dysphoria. That, by the way, is the conclusion of Dr. Jack Turban who is a pediatric gender dysphoria specialist.
Cross-sex hormones are associated with dangerous health risks.
True. So is aspirin. Clinicians have determined that the risks of self-harm outweigh those associated with these hormones.
Neuroscience shows that adolescents lack the adult capacity needed for risk assessment.
True but irrelevant. Experienced clinicians help guide these kids and their parents. By the way she has just undermined the entire field of pediatric psychology.
There is no proof that affirmation prevents suicide in children.
Untrue. There is the aforementioned study in Pediatrics and the Dutch study that she mischaracterized. I am sure that there are others.
Over 90 percent of people who commit suicide have a diagnosed mental disorder, and there is no evidence that gender-dysphoric children who commit suicide are any different. Many gender dysphoric children simply need therapy to get to the root of their depression, which very well may be the same problem triggering the gender dysphoria.
That disorder is depression which is prevalent with people who have gender dysphoria and who are not properly treated. Note the lack of a cite. That is because there is no research to support a therapeutic intervention. At least none that is current. Again, Cretella is out of her depth. The people who are experts and who actually work with these kids know that therapy doesn't work — “been there, tried that.” As previously cited at APA, gender affirmation relieves the anxiety and depression.
Transition-affirming protocol has not solved the problem of transgender suicide.
She is citing that Swedish study of adults. I have traded some email with one of the authors (I'll bet that Cretella has not). Gender affirmation does not solve all of the problems because trans people still subect to the effects of the Meyer Minority Stress Model. Discrimination (and crackpots like Cretella) cause them needless marginalization and anxiety.
Bottom Line: Transition-Affirming Protocol Is Child Abuse
Not according to the real experts and I would bet that Cretella has never treated a child with gender dysphoria. It is obvious from all of the misstatements, mischaracterizations and affiliations that Cretella has an irrational religious objection to gender affirmation.

Faith is not medical science and medicine is not faith. Cretella should realize the difference between the two and act accordingly. Yet, her superstitions prevail. In the process she looks like an idiot. I am not a physician and can tear her apart. Imagine what a clinical expert could do with these preposterous assertions.

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