The Misuses of Professional Medical Journals
February 3, 2020
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.