Questionable Medicine: Concerns about the 2018 AAP Policy Statement on Gender-Affirmative Care

Описание: The 2018 AAP Policy Statement "Ensuring Comprehensive Care and Support for Transgender and Gender Diverse Children and Adolescents" endorses an Gender Affirmative Care model for pediatric patients with gender dysphoria. It is frequently cited as a Standard of Care representing the view of the 60,000 membership.

There are issues.

The document is not a standard of care or guideline - it contains none of the systematic review of evidence or evidence grading required by such a document and includes a disclaimer that it should not be considered a standard of care.

The statement cites standards of care previously published by WPATH and the Endocrine Society - but those standards are based on low quality evidence.

The document was authored by a single physician in his first year out of residency and was not subject to public review, comment or debate prior to being published as an official policy statement.

The statement dismissed the long standing watchful waiting approach to these patients as outdated and fringe and equates it with "conversion therapy" for sexual orientation, while citing references that directly contradict those conclusions.

The policy statement should be eligible for revision or retirement in 2023. Watch this video and see what you think - should it be revised?

CHAPTERS:
00:00 Rafferty and the AAP Statement
00:12 Origin of the Policy Statement
02:02 Authorship of the statement
03:27 Standard of Care
03:57 Gender Affirming Model of Care
04:27 Where do the Protocols Come From?
04:43 How is Evidence Graded?
06:51 WPATH & GRADE
08:03 Endocrine Society & GRADE
10:43 Important Acknowledgements
11:16 AAP Statement
11:35 Watchful Waiting vs Conversion Therapy
12:30 Misleading Citations
12:54 #1 Irrelevant Citation
13:54 #2 Contradictory & Misleading
15:06 #3 Contradictory & Misleading
16:31 #4 Contradictory & Misleading
17:40 #5 Contradictory & Misleading
18:56 #6 Opinion
19:52 Conclusion

REFERENCES:
AAP Statement: https://publications.aap.org/pediatri...

Jason Rafferty on Story in the Public Square
   • Jason Rafferty on Story in the Public Square  

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29. Adelson SL; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012;51(9):957–974 https://archive.org/details/aap-citat...

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