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A pediatrician's manifesto for the modernization of gender medicine

A Pediatrician’s Manifesto for the Modernization of Gender Medicine

Postmodern medicine may superficially resemble Modern medicine, yet it seeks to dismantle its underlying philosophy.

Postmodern medicine may superficially resemble Modern medicine, yet it seeks to dismantle its underlying philosophy.


ERICA LI JUN 21 2023

The ethical abuses and lack of respect for science that occur in contemporary gender medicine clinics have long been the subject of intense discussion. In this essay, Dr. Li describes eight cases in which the practice of medicine in current American gender clinics is quite abnormal. She then explains the behavior of practitioners in these clinics using the doctrine of critical social justice, and demonstrates that the ideology and doctrine of postmodernism influence and determine the behaviors of gender medicine practitioners.

Dr. Erica Li is a pediatrician in Washington State. She attended medical school at UC Davis and trained in general pediatrics in Los Angeles. She currently teaches medical students in three medical schools and interns in four residency programs. Board-certified in pediatric hospital medicine by the American Board of Pediatrics, Dr. Li is a subspecialist who identifies as a generalist. She is passionate about helping trainees approach clinical problems by establishing a chain of cause and effect, so that each node in the chain can be examined as a potential opportunity to interrupt pathology.

Stop calling my profession "Western medicine"

"He received his painkillers and psychological medication," said the nurse. During a shift change at a children's hospital, the outgoing nurse provides a report to the incoming nurse on the patients in her care. "The psychology team will see him and determine whether he needs to be hospitalized in the psychiatric unit for attempting suicide. And..." the nurse pauses. "I just gave her a tampon for... it's such a weird thing to say. She had her period today."

This is a paraphrase of an actual conversation I overheard. I'm a pediatrician who specializes in caring for hospitalized children. One of the most common reasons a transgender teenager is hospitalized is attempted suicide by drug overdose. My seven years of rigorous medical school training and pediatric residency were steeped in the principles of modern medicine. However, I am increasingly confronted with the feeling that my profession is drifting away from its modernity. I believe that medicine is becoming queer, that is, postmodern. Allow me to clarify this point. There are various meta-narratives on health and healing around the world. The mainstream of allopathic medicine, generally referred to as "Western medicine", is presumably opposed to "Eastern medicine" or other alternatives. This categorization suggests a parity between "Western" and "Eastern" or "alternative" medicine, implying that all these metarecits are equally valid. However, I would argue that it is more accurate to classify medicine as it is practiced worldwide into three categories: "premodern", "modern" and "postmodern". The distinction should be based on underlying philosophy rather than geography or ethnicity. Premodern medicine encompasses practices such as attributing diseases to witchcraft, consuming tiger penises to increase virility or cannibalizing albino body parts to obtain health and good fortune. These practices, based on superstition rather than empirical evidence, were once common throughout the world, including the Western world, and still exist today in various forms. In contrast, modern medicine, usually practiced in your local hospital or clinic, is a product of the Enlightenment, which gives priority to reason, science and individual sovereignty. It transcends geographical boundaries and ethnic divisions, for the benefit of humanity as a whole. Postmodern medicine seems to be particularly well established in the West, particularly in the USA, where it has become institutionalized. It is relatively new, but has taken root in many American medical schools and societies. Although it uses the same technologies as modern medicine, thus superficially resembling it, it fundamentally seeks to dismantle the underlying philosophy of modern medicine. As postmodern medicine is propagated in American medical schools through the bureaucracies of diversity, equity and inclusion, nothing exemplifies postmodernity better than the gender ideology that underpins the American "gender-affirming" model of care. I wish to strongly defend modern medicine and urge readers to resist the ideological move toward postmodernization or "queering" of my profession. It is essential to make clear that I am a strong supporter of LGBT civil rights, just as I support the civil rights of all Americans, and that I strongly advocate high-quality modern medical care for sexual minorities. However, I reject the over-medicalization of children propagated by many gender activists. At heart, postmodern medicine is as far removed from modern medicine as witch burnings. It poses serious risks to patients' well-being and must be vehemently opposed.

Challenging the norms of modern medicine What does it mean to queer an academic field or profession? It means disrupting, deconstructing, criticizing and ultimately dismantling its norms. Renowned queer theorist David Halperin asserts that "queer is by definition anything that is at odds with the normal, the legitimate, the dominant. There is nothing particular to which it necessarily refers. It's an identity without essence. Like young people with gender dysphoria, modern medicine is grappling with its own identity and trying to preserve its Enlightenment essence. Transgender medicine, as currently practiced in the U.S., has dismantled and corrupted many of the norms of modern medicine.

Medical science in reverse One of the fundamental norms of medicine is standardized treatment of common ailments, based on established guidelines. Quality of care depends on consistency. I've corresponded with people who were satisfied with the gender care they received, describing it as judicious and unhurried. But it's wrong that only some patients receive good care. Adherence to guidelines helps to reduce discrepancies and promote consistent quality of care. These guidelines do not simply encompass empirical evidence, but require a systematic review of the scientific literature to avoid confirmation bias. In other words, guideline authors are not allowed to select studies that merely confirm their preconceived ideas. Subject-specific practice guidelines are published by leading medical societies such as the American Academy of Pediatrics (AAP), which have consistently provided valuable advice on conditions such as bronchiolitis and urinary tract infections. Guidelines always assess the strength of the evidence, then make action-oriented recommendations. Every recommendation in these guidelines is meticulously evaluated, and all considerations and value judgments are explicitly stated. Despite what the mainstream media suggests, the AAP and other major U.S. medical societies have not published guidelines on transgender care. In fact, AAP leaders have refused to commission a systematic study on the subject, despite petitions from their own members to do so. At the 2022 national meeting in Chicago, AAP leadership did not allow Resolution 27 to be voted on by its own members. As a result, the PAA has no basis for creating practice guidelines. Instead, the AAP has issued "statements" on transgender care that echo activist rhetoric and are then propagated by organizations like GLAAD, claiming that "the science is settled." This is not normal.

One of the main aims of modern medicine is to determine the cause of a patient's symptoms. When I teach medical students and interns, I almost always start by asking, "What is a diagnosis?". I define a diagnosis as "an adequate explanation of the patient's signs and symptoms". Most of the time, this process requires obtaining multiple objective data through testing to confirm that a particular explanation is correct, and test results that don't confirm that explanation are respected. I explain that there is often a chain of causality leading to the patient's presentation, and that our responsibility is to identify every causal node we can intervene in.

After carefully documenting the patient's signs and symptoms, we categorize the diagnosis. Is it mild, moderate or severe? Chronic or acute? Type 1, 2 or 3? This nuanced classification enables us to adapt treatment and provides relevant information on prognosis. If the disease is not progressing as expected, based on follow-up, it's up to us to reassess our initial diagnosis or classification. We may have had the wrong explanation, or overlooked a complication. In other words, reality holds us to account.

Curiously, when it comes to gender dysphoria, the search for causality seems to be regularly overlooked or considered unimportant. At present, there is no standard distinction between inherent gender identity disorder and secondary gender dysphoria. Nor is there any objective data that can be obtained by testing to overturn the diagnosis of transgenderism. Whatever the adolescent's biological sex, history of family dysfunction or sexual trauma, age of onset of transgender identity, potential social contagion or autism, the prescribed treatment remains the same: puberty blockers and transsexual hormones. When I attended the 2023 Gender Symposium, co-sponsored by Seattle Children's Hospital and Sweden, I listened to 7 hours of content devoted to treatment options, with no time allocated to discussion of diagnostic criteria, classifications or confirmatory tests. In postmodern medicine, doctors accept a child's self-diagnosis, which gives no indication of cause and prognosis and cannot be discredited, and yet prescribe high-risk treatment anyway.

This is not normal. Modern medicine goes to great lengths to discuss the relative and absolute contraindications of all treatments. For example, before prescribing estrogen in the form of contraceptive pills, doctors screen for risk factors such as migraines, smoking and coagulation disorders. Those who screen positive may be offered other contraceptive options. Even advocates of medical transition of children would have to agree that it is essential to screen out potential victims of Münchhausen disease by proxy and patients with conversion disorders. Unfortunately, this is not always the case. Jamie Reed and clinicians at Tavistock have witnessed cases of Munchhausen by Proxy, but the victims were still deemed eligible for transition. Reed also documented a case where a patient with conversion disorder, who identified as blind despite being able to see, was deemed suitable for medical sexual transition.

This is not normal. Finally, modern medicine distinguishes between false positives and false negatives (Type I and Type II errors), considering that false positives are much more damaging because they can lead to harmful interventions. In normal medicine, we consider certain errors to be "unprecedented events", such as the amputation of the wrong limb. Such an error is totally unacceptable, however rare it may be. When such an event occurs, every step in the care system is meticulously scrutinized to ensure patient safety. This is not an infringement of the rights of amputees. We are not committing "genocide" against disabled people. It is simply a necessary precaution to ensure that only the right procedures are applied to the right patients. If we could identify with certainty those who would undoubtedly benefit from medical transition and exclude those who would not, medical transition might be a reasonable course of action. However, given the serious risks of treatment, the very existence of a single detransitioner should sound the alarm that current diagnostic criteria produce too many false positives. These false positives are due to the artificially inflated prevalence of social contagion and the non-specific nature of the diagnostic criteria. We need to re-evaluate these criteria in order to eliminate false positives, even if this means producing a few false negatives. This is the essence of the "do no harm" principle. It is an ethical imperative that applies to individuals, not groups. For treatments with a high risk of morbidity, we must avoid treating a minority of false positives, even if this means treating fewer true positives.. Medical ethics at the crossroads

Modern paediatric care places great emphasis on collaboration with parents and guardians. Like any pediatrician, I occasionally encounter disagreements with my patients' parents. When we work with adolescents, we strive to maintain family cohesion, even if the parents don't seem so reasonable to us. It's unthinkable to deliberately drive a wedge between an adolescent patient and her parents, let alone emotionally blackmail the parents with statements like "Would you rather have a living son or a dead daughter? It is unthinkable to pit a divorced mother and father against each other, using the parent most willing to have their child transited as leverage against the reluctant parent. It is unthinkable that pediatricians should treat parents who do not consent to the administration of puberty blockers "as if the parents were abusive, uncultured and ready to harm their own children". This is not normal. Modern medicine consists of morbidity and mortality (M&M) conferences, with self-examination and self-flagellation, every time a case goes wrong. Patient abandonment is strongly condemned. When young adults, like Chloe Cole, detransform and face serious complications following a double mastectomy and the administration of transsexual hormones, any responsible doctor would sincerely apologize and take responsibility for his or her actions. "You're still my patient," he would reassure. This would usually be followed by a conference aimed at refining his practice. Instead, when a tragic outcome like Cole's occurs, postmodern medicine plays with words. At the 2023 Gender Symposium, co-sponsored by Seattle Children's Hospital and Sweden, I was told I shouldn't use the word "detransitioner" because it was "detrimental to the community". Instead, I was asked to say "people who have changed their gender goals". Postmodern medicine is strangely comfortable abandoning detransitioners like Cole. "My surgeon doesn't know what to do with me," she confessed in an interview with Jordan Peterson. As Hannah Barnes revealed in her book Time to Think, gender clinics often lose track of detransitioners, leaving their numbers largely unknown. You know what I'm going to say. Modern medicine, on the other hand, is reluctant to give patients false hope. I have cared for many pediatric patients with serious prognoses, both in intensive care and in the oncology department. The conversations around poor results and death are heartbreaking, but it's our duty to tell families the truth. I can't recall a situation where it seemed appropriate to use the image of a rainbow unicorn during such serious conversations. Queer medicine uses these images to proselytize and "educate" children facing family dysfunction, autism, sexual trauma and complex psychiatric comorbidities that manifest as severe body dysmorphia. These cases are complex and difficult, and it's reprehensible to promise that everything will improve once their bodies align with their "gender identity". Finally, there's the issue of children's capacity to provide informed consent, a topic that has been widely debated. In the course of my training and practice, I have met dozens of pediatric cancer patients. For them, chemotherapy can truly be life-saving. However, even in these cases, we don't consider children capable of giving their own consent to chemotherapy. We do not place the burden of assessing uncertainty and risk on children; only adults have the responsibility to manage such outcomes. Modern medicine has evolved standards for good reason. Although horrors have been committed in the name of modern medicine, standards serve as vital self-correcting mechanisms. They act as checks and balances, ensuring that our attempts to improve health and life don't turn into disasters rooted in utopian visions. The encroachment of postmodern ideologies on modern medicine threatens to erode these standards. It pursues its aims by intimidating doctors who would dissent, while using deceptive language to mislead the public. It won't stop until we stop it. To put a stop to it, we need to understand why these abuses occur and how such a harmful ideology has infiltrated our medical institutions. Ideology and behavior : Why do abuses happen? Ideas have consequences. All the abuses mentioned above can be explained by the doctrines of postmodern critical social justice ideology. Science must fall Postmodernism postulates a moral universe in which science and objective reality must eventually collapse. Bret Weinstein attests that during the collapse of Evergreen State College in 2017, a black student was accosted by radical left-wing students and prevented from going to her lab. This kind of militant behavior and the blatant attempt to dismantle science in gender clinics fall under the same postmodern doctrine. Postmodernism is difficult to define, but some of the key principles it encompasses are "skepticism about objective reality, the perception of language as the constructor of knowledge, the 'making' of the individual, and the role played by power in all this". The Encyclopedia Britannica expands this definition by adding "a general suspicion of reason". According to James Lindsay and Helen Pluckrose, within the framework of postmodernism, "the scientific method... is seen not as a better means of producing and legitimizing knowledge than any other, but as just another cultural approach, as corrupted by biased reasoning as any other".

Science, the product of Western thought, is seen as an oppressive structure that supports and disseminates white supremacy, and its domination over "other modes of knowledge" is therefore deemed illegitimate. The absence of individual prejudice The postmodern perspective on ethics sheds light on the behavior of some American practitioners of gender medicine. Fervent advocates of cultural constructionism and relativism, postmodernists express deep skepticism about the existence of universal ethical norms. They have also declared that the idea of the sovereign individual is a construct of oppressive Western culture. Robin DiAngelo, author of White Fragility, and his co-author Ozlem Sensoy assert that "the ideal of individual autonomy that underpins liberal humanism (the idea that people are free to make independent rational decisions that determine their own destiny) has been seen as a mechanism for keeping the marginalized in their place by obscuring larger structural systems of inequality." Once the concept of the universal and the individual is set aside, modern medicine's concerns about morbidity, mortality, false hope and patient abandonment disappear. What becomes paramount is the trajectory of transgender people as a class, a group and a concept. Will this group gain power? According to gender ideology, there is no such thing as individual dignity, so there is no harm to be done to individuals. There is only collective social justice. In postmodernism, language wields immense power. This is evident in gender clinics, where clinicians are instructed to replace the term "detransitioner" with "people who have changed their gender goals". The existence of detransitioners represents a medical malpractice catastrophe, but in a postmodern world, language itself constructs reality. By manipulating language, for example by avoiding the use of the word "detransitioner" and claiming that its use harms "the community", a postmodern practitioner conveniently avoids acknowledging individual harms, blaming instead the child seeking medical transition and the consenting parent(s). Constant analysis of power dynamics Postmodernists obsessively examine power dynamics, granting privileges to groups they perceive as powerful. This privilege is seen as a sin, and belonging to an oppressed class is considered a virtue. Consequently, transgender people, seen as more oppressed, are endowed with moral and epistemic authority. Their status as an oppressed group endows them with a unique and unassailable knowledge, which cannot be derived from any objective method or falsified by reality. Critical literature on social justice is rife with auto-ethnographies (i.e., subjective opinions drawn from the author's personal experience) that claim to represent legitimate knowledge about society. In modern medicine, however, even "my clinical experience" does not trump evidence from systematic reviews of the scientific literature. The priority given to subjectivity over objectivity explains why many American gender clinics have no objective tests or diagnostic criteria to confirm or refute the diagnosis of gender dysphoria. In this context, the patient's knowledge, derived from her inner feelings, is absolute and infallible. The blurring of borders Postmodernism is allergic to categorization. The blurring of boundaries is one of its key themes. It abhors all hierarchies and priorities. As a result, practitioners behave as if there were no meaningful distinction between trans identities that began in infancy or adolescence, those that result from social contagion or autism, or between real and factitious cases. More radically, they believe that there is no boundary between biological men and women at all - they consider biological sex to be a social construct, just like "gender". Judith Butler writes: "If the immutability of sex is contested, perhaps this construct called 'sex' is as culturally constructed as gender; indeed, perhaps it has always already been a gender, with the result that the distinction between sex and gender turns out to be no distinction at all." Currently, queer theorists are striving to dismantle the cis-trans binary. One radically queer idea might be that there's no difference between helping or harming patients. Children can consent The main target of queer theory - cis-heteronormativity - is the predominant mode by which humans reproduce and form families. Birth families are therefore seen as a source of oppression, and the idea of the nuclear family must be deconstructed. In a remarkable academic article published in the journal Curriculum Inquiry about Drag Queen Story Hour, queer theorists Harper Keenan and Lil Miss Hot Mess note: "DQSH may be 'familial' in the sense that it is accessible and inviting to families with children, but it is less a sanitizing force than a preparatory introduction to other modes of kinship" (editor's italics). Traditional pediatric medicine generally regards the intentional fracturing of families as taboo. However, whistleblower Jamie Reed's claims that some gender clinics systematically undermine the role of natural parents aligns with queer theory's aspiration to create alternative family structures and parent figures. Queer Theory also promotes the notion of children guiding their parents and the adults around them. This corresponds to what Lindsay and Pluckrose call "the postmodern political principle", which they describe as "the belief that society is made up of systems of power and hierarchies, which decide what can be known and how it can be known". These systems of power and hierarchy are perceived as arbitrary and illegitimate. In the current system, children generally have less power than adults and are placed lower in the social hierarchy. American psychiatrist Chester Pierce, known for having invented the concept of "microaggressions", considers this to be a manifestation of "childism", a discriminatory practice akin to racism, but directed against children by adults. If there is to be true social justice, the hierarchical relationships between adults and children must be redefined or reversed. The postmodern physician, according to this perspective, has a moral obligation to facilitate this process by elevating children's capacity to consent to medical procedures and eliminating parental objection. Conclusion I described the abuses committed in certain American clinics specializing in sex treatment, which defy the basic principles and standards of modern medical science and ethics. I have also briefly explained the postmodern theoretical framework that fuels these abuses. Today's doctors have to deal with postmodern queer theory as a supremacist ideology that manipulates people's inherent tendency towards compassion. It has definitely taken root like a parasite in our medical institutions. Unlike modern medicine, postmodern medicine lacks both a self-correcting mechanism and a limiting principle. It is essential that we do not allow this predatory ideology to undermine the integrity of modern medicine and the public's trust in it. While postmodern medicine may superficially resemble its modern counterpart due to access to contemporary technologies, it is fundamentally opposed to them.

If you're a doctor, you need to speak out, educate those around you and dedicate yourself to serving our patients and upholding the standards of our profession.


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