Labrador abuses state power again, seeking to strong-arm medical recommendations | Opinion
Idaho Attorney General Raúl Labrador is yet again abusing the powers of his office, this time by threatening free scientific inquiry when it reaches politically disfavored conclusions. You should be outraged about it, unless you want your doctor to phone a politician before they decide how to treat you.
Last week, Labrador sent a threatening letter and a list of questions to the American Academy of Pediatrics, the largest organization representing doctors who treat children in the U.S.
Along with 20 other Republican attorneys general, Labrador is trying to put pressure on a organization of medical professionals to change its guidelines for the treatment of transgender children and adolescents.
Labrador and the other attorneys general claim that the AAP is subject to — and potentially in breach of — each of their states’ consumer protection laws. The implicit threat is that this medical organization could face a raft of government-backed lawsuits filed all across the country by right-wing politicians if it does not change its treatment guidelines.
The threat comes down to basically one issue: The statement that puberty blockers — medication sometimes given to transgender youth to pause puberty and give them more time to make decisions about their course of treatment or nontreatment — are “reversible,” a claim the AG’s say is “misleading and deceptive.”
But the guidelines do not say “give out all the puberty blockers you want, no problem” or anything remotely like that.
They say: “The decision of whether and when to initiate gender-affirmative treatment is personal and involves careful consideration of risks, benefits, and other factors unique to each patient and family,” and recommend consultation with a team of experts including “the pediatric provider, a mental health provider … , social and legal supports, and a pediatric endocrinologist or adolescent-medicine gender specialist, if available.”
And the guidelines say this team is supposed to weigh the complicated and uncertain risks and benefits: “Pubertal suppression is not without risks. Delaying puberty beyond one’s peers can also be stressful and can lead to lower self-esteem and increased risk taking. Some experts believe that genital underdevelopment may limit some potential reconstructive options. Research on long-term risks, particularly in terms of bone metabolism and fertility, is currently limited and provides varied results.”
They haven’t obscured the risks and uncertainties — they’ve emphasized them.
This is why Labrador’s claim that the organization is misleading people wouldn’t stand up for a second in court. The guidelines say what they mean by reversible: “If pubertal suppression treatment is suspended, then endogenous puberty will resume.”
If there’s any medical evidence to refute that, Labrador hasn’t cited it.
In fact, Labrador cites very little evidence of any real quality.
For example, one of the “scientific” authorities Labrador points to is a blog post published by a conservative think tank with no peer review, in which a man with a Ph.D. in political science reaches conclusions about medicine.
Labrador’s letter treats as the final word a review undertaken by the National Health Services in the U.K., which ultimately led to a decision that puberty blockers would be used to treat gender dysphoria only within clinical trials in the U.K. at present
The Cass Review is a piece of serious scientific work that is taken seriously by doctors. There is also serious scientific dispute about its methodology and conclusions, including a detailed whitepaper by a group of experts published by The Integrity Project at Yale, a forthcoming critique by the British Medical Association and a detailed response by the Royal College of Psychiatrists. All of this is a normal part of the process of debate and inquiry in an emerging area of medicine.
If work like that is going to take place, it has to be free from the threat of political interference, according to Dr. Hilary Cass — the British physician who led the Cass Review that Labrador cites.
“None of this should be decided on ideological grounds from either side of the debate. It should be decided by really carefully working with young people, families, clinicians and academics to try and pick through what is the best clinical approach. That’s all that should matter here,” Cass said in an interview after the findings were published.
What isn’t normal is the government threatening lawsuits and prosecution of scientists for publishing their research or groups of doctors for publishing clinical recommendations.
And Labrador is on shaky legal ground in doing so.
How can a state attorney general claim to oversee the statements of a national medical trade association? Labrador claims it can be done with state consumer protection laws, citing a 2021 case filed in a district court in Tennessee in which a group of for-profit addiction treatment centers (not a state actor) sued the National Association of Addiction Treatment Providers — a lawsuit which both sides agreed to dismiss before it went to trial, has never been reviewed by any appellate court, in no way deals with Idaho’s consumer protection laws and is under the jurisdiction of an entirely different circuit court.
That’s not exactly a solid foundation for standing to file a lawsuit. But prevailing at trial isn’t the only way for the government to apply pressure if those who lead it are willing to abuse their powers.
The threat of having to deal with expensive litigation under 20 different sets of state consumer protection laws is something few groups of doctors would have the stomach to weather. Easier to just shut up.
And that kind of censorship is the point of this shameful exercise.