Credibility — and How to Lose It

September 28, 2024 • Posted in Blog

by D. Joy Riley, M.D., M.A.

Executive Director

Is the American Academy of Pediatrics (AAP) behaving badly? This is a cogent question. Recently (24 September 2024), the Attorneys General of twenty states, along with the President of the Arizona Senate and the Speaker of the Arizona House of Representatives wrote to the AAP with multiple concerns:

Re: AAP’s Compliance with State Consumer Protection Laws 

. . . When the American Academy of Pediatrics speaks, its 67,000 pediatrician members, the broader medical community, the public, and especially parents are listening. Since its founding in 1930, it has exercised great influence on the practice of medicine and the treatment of infants, children, and young adults. Often, the AAP has exercised its influence responsibly. It has been at the forefront of important advances in the field of pediatrics, and its medical recommendations have been carefully vetted and grounded in a safe and reliable methodology. And for the most part, it has not allowed non- medical considerations to infiltrate its guidance to physicians and parents. 

But when it comes to treating children diagnosed with gender dysphoria, the AAP has abandoned its commitment to sound medical judgment. In 2023, it “reaffirmed” the 2018 AAP policy statement on gender-affirming care. That policy statement endorses treating minors diagnosed with gender dysphoria with puberty blockers, cross-sex hormones, and surgical interventions. And it tells physicians, the public, and parents and their children that puberty blockers used to treat adolescents with gender dysphoria are “reversible.”

That statement is misleading and deceptive. It is beyond medical debate that puberty blockers are not fully reversible but instead come with serious long-term consequences. 

 

The authors of the letter cite, inter alia, the AAP itself as providing evidence of problematic claims:

The 2018 AAP policy statement itself demonstrates that the “reversible” claim is misleading and deceptive. It acknowledges that “[r]esearch on long-term risks, particularly in terms of bone metabolism and fertility, is currently limited and provides varied results.” The AAP has no basis to assure parents that giving their children puberty blockers can be fully reversed. It just isn’t true.

 

The letter’s authors point out that 

1)    statements made by “medical trade associations, like the AAP, are subject to state consumer protection laws.”

2)    “misleading and deceptive statements of medical trade associations are connected to commerce and reach consumers.”

3)    “AAP’s statements and guidance affect how physicians practice medicine and treat children.”

4)    “Because providers rely on the AAP when they make treatment decisions, parents and their children are harmed by the AAP’s misleading and deceptive claim.” (See full document here.)

 

The AAP was provided with a list of 14 questions; their answers are due on 8 October 2024.  The answers would be interesting reading material.

Beyond the 8 October deadline, though, how shall we think of this situation?  It is fitting to consider the character trait of credibility.  Credibility is defined by the Cambridge Dictionary as “the fact that someone or something can be believed or trusted.”  Is the AAP losing its credibility?  If so, far more than the 67,000 members will be affected.  Most, if not all, of those practitioners have patients.  The loss of trust in the governing professional organization will affect the professionals and their patients, as well as their communities.  And it may not be limited to the issue of gender confusion.  If parents cannot trust the AAP and its members to provide sound advice about the treatment of gender confusion, will they trust other advice?   Immunizations are already of concern to parents. Will children’s lives be in danger from lack of immunizations – due to the erosion of the AAP’s credibility? 

The AAP is a significant source of continuing medical education credits (CME), the currency of licensure, as well as the source of many guidelines.  What about the pediatricians who disagree with the stance(s) taken by the AAP?  How free are they to disagree?   These are some other questions it might be wise for the AAP to answer.