CMDA's The Point

The Misuses of Professional Medical Journals

February 3, 2020
02032020POINTBLOG

by Mike Chupp, MD

I came across two journal articles in November that grabbed my attention. One was in The Lancet, while the other was in the Journal of the American College of Surgeons (JACS), which is my general surgery specialty’s journal. These articles further opened my eyes to the pollution of medical science by political ideologies. Some of you may be thinking, “Hey, Chupp, where have you been?!”

In the case of The Lancet, a global health journal with a remarkably progressive slant, the attention on LGBTQ+ issues isn’t anything new. If you have been paying attention to The Lancet’s table of contents for the last few years, you will have seen numerous editorials and studies focused on LGBTQ healthcare and rights. On the other hand, JACS has traditionally been devoted to excellent, evidence-based studies with original, scientific articles that aim to test a hypothesis. The “usual” article relates to improved patient care outcomes or the training of surgeons or the professional life and well-being of surgeons.

That legacy appears to have changed with the publication and cover promotion of “Financial Impact of Gender Confirmation Surgery” in the November 2019 JACS with authors hailing from Oregon Health and Sciences University in Portland, Oregon. (The full title of the article is “Providing Gender Confirmation Surgery at an Academic Medical Center: Analysis of Use, Insurance Payer, and Fiscal Impact.”)

The italicization of “Confirmation” in the title reflected on the cover is my doing, as this is the first time I have seen the language engineering of the transgender movement go this far in impacting an article in my specialty’s journal! The evolution of this verbal engineering is remarkable. Gender transitioning procedures done in the 1960s and 70s, especially at Johns Hopkins University, were primarily referred to as “sex reassignment surgery.” This language is somewhat complementary with the now commonly used phrase “sex assigned at birth.” (I still have yet to hear any OB/Gyn tell me they ever told the delivery room nurse to “assign” this bundle of joy to the boy category or girl category.) The descriptive phrase used more recently has been “gender affirming treatment or surgery,” but apparently affirmation isn’t good enough. Now surgeons should “confirm” an innate sense of gender in their patients, all without a blood test or imaging study or anything other than patient reporting. Not a single reference out of 28 in this landmark article dealing with gender transitioning surgery even remotely resembles a controlled trial of gender confirmation surgery. This paper cites references from JAMA Surgery and the New England Journal of Medicine in the last three or four years, both known to be flagship publications of politically progressive medicine.

So what is the conclusion of this first-ever gender confirmation surgery article published in JACS? According to the article, gender confirmation surgery is “profitable for both the surgical department and the hospital system. This suggests such a program can be a favorable addition to academic medical centers in the U.S.” This article is not about surgical indications or patient outcomes, including morbidity or mortality (which are not even mentioned in the article). Instead, it is about the profitability of this arena of surgical care. I am waiting for an article to be published on the morbidity and mortality of what these authors euphemistically call “top surgery” and “bottom surgery,” as verbal reports from surgeons in the field is that they suffer many complications.

The Lancet article from November under the heading of “The art of medicine” was entitled “The misuses of ‘biological sex’” by Katrina Karkazis, an attorney with the Global Health Justice Partnership at Yale. The author tries to convince us how complicated biological sex really is and that “scientists and medical professionals came to accept sex as inherently “knotty,” beginning with Dr. John Money at Johns Hopkins in the 1950s. (In light of the JACS article above, his name is rather ironic, in my opinion.) By “knotty,” she means it is far more complicated than the U.S. Department of Health and Human Services’ definition, which “appears to directly prioritize genitals yet gives chromosomes a role too.”

After reading this article, I was listening to a surgery audio program I use to earn CME credits and heard the nationally known lecturer describe the difference in incidence of anal cancer between men and women. The speaker had no need to explain to the listening audience of general and oncology surgeons that she was referring to traditional and biological definitions of men and women, but this is what Karkazis views as “obsolete thinking.” The author ridicules officials with the International Association of Athletics Federations for their exclusion of some “women” (my quotes), inaccurately deeming them “biological males” (her quotes) after studies showed that measuring testosterone did not reliably differentiate transgender women with a disproportionate XY muscle mass. She goes after the Trump administration and the Pentagon for “misusing” biological sex in screening of personnel to serve “in their biological sex” by such ridiculous standards as “chromosomes, gonads, hormones, and genitals.” Her final plea in the editorial was that medicine and science are long overdue in abandoning traditional notions of biological sex because those notions can cause harm to people. She goes as far as suggesting we should consider abandoning sex designation completely except for acknowledging that individuals have testes and prostates or a uterus and ovaries. Remember, this article in a professional medical journal was written by an attorney, not a doctor.

I shared this editorial with a number of highly esteemed bioethicist colleagues, and one of them wrote this in response: “We must make sure that we remain steadfast in adhering to biological reality, and clearly distinguish it from political goals, philosophical sophistry, and deliberate bioethical misuse of language, and take every opportunity to articulate that. Any editorial board that does not publish a counter editorial clearly distinguishing these things has disgraced their publication and invalidated that publication as a legitimate scientific and medical (to the extent that medicine remains an endeavor based in biological reality) voice.”

I couldn’t agree more. We must remember who our enemy truly is as we read such nonsense. He is the sultan of sophistry and the dean of deception, and these days he seems to be majoring in the misuses of professional medical journals.

8 Comments

  1. Rodney Lovett on February 3, 2020 at 5:55 pm

    Mike, Right on. Can you or another in medical ethics please write a response to these journals. I think it will become increasingly necessary for someone to work full time answering these terrible infiltrations of our medical literature with subtle innuendos having evil intent.

  2. Larry Allen on February 3, 2020 at 6:08 pm

    I appreciated this article and could not agree with you more. Only a type of dark deception can be behind the warped arguments made by educated people in this ‘gender is a choice’ movement. It is hard to believe these things are being published in ‘medical’ journal. Thanks for your perspective. I think we all need to support our colleagues to speak the truth in love about gender. Specifically, that gender is ‘assigned at birth’ based on the reality of a person’s genetic make up, and that there is morbidity and mortality at many levels that result from people denying their gender.
    Thanks for sharing your observations.

  3. Jerry Wittingen on February 3, 2020 at 7:27 pm

    Mike

    I am thankful to be retired. However it is disheartening to watch previously rigorous journals degenerate to publishing propaganda. I thought your blog was erudite and well written.

  4. Harold on February 3, 2020 at 7:49 pm

    I too am thankful that I am retired and do not need to deal with these unrealistic and unnatural arguments. One cannot change their genetic code simply by changing the exterior covering.

  5. James Brown on February 4, 2020 at 2:18 am

    Mike,

    Well said, and timely. But this topic is not just in medical journals. The same erosion of the use of language and the denial of biological reality is taking place in surgical textbooks and topics at national meetings.

  6. Mike Chupp on February 4, 2020 at 8:03 am

    Thank you for all the above supportive and thoughtful comments. In response to Rod: my predecessors, Dr. David Stevens and Dr. Gene Rudd have tried for many years to get their editorials posted in the New England Journal of Medicine but were never successful in getting them to publish their letters of dissent against the politically correct views of healthcare espoused by that publication. I think that our time and energies can be invested better by continuing to publish biblical principles of healthcare within the church and in our culture using publications that will consistently allow a diversity of opinions, whether we agree with them or not. I’m reminded of what Jesus said to Saul on the road to Damascus: “Saul, Saul, why do you kick against the goads?” Trying to get a traditional and biblically consistent view on any issue in healthcare published in either JAMA or the NEJM is like “kicking against the goads” in my opinion.

  7. James M. Kedrow on February 4, 2020 at 2:40 pm

    It seems even peer reviewed medical journal are deceiving many to believe any type of feeling as real and the physical as irrelevant. So many falsehoods being treated in the media as only truth and calling those with intelligent arguments against falsehoods as deniers or worse. Sad to see even some believers being deceived. The “politically correct” media is great at “framing” their messages as truth. Hopefully I will learn how to frame the real truth with asking questions to influence the oppositions messages and beliefs.

  8. Christopher J. Lisanti, M.D. on February 8, 2020 at 10:53 am

    Hi Mike, you are very correct in the publication bias against a traditional conception of medicine one that is based on science, objectivity and the purpose to treat and prevent disease. I have experienced first hand the amazing bias if not completely closed mindedness of reviewers of publications and the editors who wish to completely stifle any dissenting opinion regardless of how well it is written or pertinent to many broad and important issues within medicine. One reviewer from a journal stated this in response to an article that I wrote “While authors attempt to educate readers about their views, no argument will ever justify their concepts they are defending.” I expected some bias regarding an article critical of abortion, but this reviewer’s comment and the fact that the journal editors passed this along without question was absolutely alarming for a respected journal. I subsequently challenged them, and the journal, to their credit, admitted that they had bias. There are some journals that are more open to traditional arguments and ones that run counter to the prevailing wisdom. We need to continue to write in these journals and continue to proclaim the truth for the betterment of our patients, the good or our profession and the glory of God. Finally, the business aspect of medicine is truly a cancer that is eating away at our profession. This approach is resulting in consumer medicine that is transforming the traditional physician-patient relationship into a vendor-customer one without any specific goal in mind except to give the customer what they want. We are no longer making our patients healthy or even making them happy (in the best sense of the word), but merely making another satisfied customer while lining the pockets of physicians who have now become businessmen.

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