Troubles in the Reliable Bond of Faith in Childhood Gender Practices
In a surprising turn of events, Bobby Mukkamala was elected as the president of the American Medical Association (AMA) in 2023. However, his tenure has been marred by controversy, with concerns being raised about his understanding of Evidence-Based Medicine (EBM) and his stance on gender-affirming care.
Recently, the AMA has written a letter urging state governors to veto similar legislation that seeks to restrict gender-affirming care for minors. Yet, Mukkamala has refused to discuss why the AMA continues to make claims about gender-affirming care that are negated by systematic reviews of evidence.
One of the doctors recommended by Mukkamala, Jesse Krikorian, has been criticized for his misinformed views on gender medicine research and unfamiliarity with EBM. Krikorian's approach to hormone therapy research inverts the pyramid of evidence in EBM, disregarding the importance of systematic reviews of evidence.
Mukkamala's recommendation of Krikorian raises questions about the AMA president's own understanding of EBM. Furthermore, Mukkamala has made false claims about pediatric gender medicine and demonstrated ignorance of basic concepts in EBM. For instance, he asserted that the suicide rate among people who identify as transgender is between "50 and 70 percent," which is baseless.
Notably, the AMA has passed a resolution promising to protect gender-affirming care procedures. However, the organisation has also joined an amicus brief in a lawsuit challenging a state age-restriction law for these procedures, suggesting a contradictory stance.
Meanwhile, medical associations, including the AMA, are known to buck evidence review when they perceive a threat to their own interests or those of their members. This raises concerns about the AMA's commitment to evidence-based practices in this sensitive area.
On the other hand, health authorities in several European countries, including Sweden and Finland, have begun to prioritise psychotherapy for pediatric gender dysphoria cases. This approach is supported by research suggesting that co-occurring mental-health conditions, common in youth diagnosed with gender dysphoria, likely explain the elevated risk of suicide.
It's important to note that side-effects of these treatments, including vaginal atrophy, clitoral growth, pelvic floor dysfunction, and mood disorders for females, and cancer, cardiovascular disease, and infertility for males, are growing in evidence. Krikorian has been criticised for citing studies with serious methodological problems that render their self-reported conclusions unreliable.
In light of these concerns, it's crucial for the AMA, under Mukkamala's leadership, to reaffirm its commitment to EBM and evidence-based practices in gender medicine. This would help ensure that the organisation's recommendations are based on robust, reliable evidence, rather than personal opinions or misinformation.
