Tuesday, August 8, 2023

Part I

---

Medicine and Politics Collide In Transgender Revolution: American Academy of Pediatrics Doubles Down on Support for Transgender Procedures — But Is the Group Hedging its Bets?

We often speak of the deep confusion of our age, but at times, we really need to step back and understand the confusion is even deeper than we might’ve been able to understand just a short time previously. On the issue of gender and especially the non-binary transgender debate that has increasingly intersected with children, we really are looking at a division in this country that isn’t just a division over a policy issue, it’s not just a division over medical ethics and medical treatment. It’s basically a division over biology, over ontology, which is, to say, reality.

We’re talking also about something that eventually does take the form of policy. And in the case of medical policy, the most important policies are those that are established by the medical profession itself and even by the subdivisions, the specializations of the medical profession. When it comes to pediatrics–the care of young people and teenagers primarily–the official organization that has dominant voice is the American Academy of Pediatrics. The organization has been around for a very long time. It is also a very big organization that has vast influence. That influence, of course, has to do with the practice of medicine, and in this case, the specialization of pediatrics. The AAP helps craft what are the best practices, ethical guidelines, and treatment procedures.

You consider the fact that we as a society are, to use a sociological term, a very regulated and also a very rationalized society. By rationalized, people have to think through policies; by regulated, those policies are put into something with regulative force. Indeed, we often refer to them as regulations. So, when you consider the field of pediatrics, it’s pediatricians themselves in an officially sanctioned professional organization who tend to establish best practices and thus guidelines.

But the impact of the American Academy of Pediatrics doesn’t stop there. The rise of the professions and the self-regulating authority of the professions means that other professions and other institutions basically give way to the professional judgment, in this case, of medical doctors who have a specialization in the treatment of children and young people. So for example, the schools, greatly influenced in terms of the policy schools set, the public schools in particular by the pediatricians. Also, when it comes to law, as you’re looking at what the law recognizes as what’s right and wrong, well, the American Academy of Pediatrics has a lot to say when it comes to children and young people.

Just imagine the authority of the profession such that a legislator stands up and says, “Well, my policy is endorsed by, encouraged by the American Academy of Pediatrics.” That carries a lot of authority. It’s not just there. When it comes to the actual state regulation, the state often basically defers to the professions. Now, that’s not just true of pediatricians, it’s also true of architects and pharmacists.

But there’s something else at play here, and this often doesn’t get due consideration. When you’re looking at something like the American Academy of anything–and here you could say interior design in one sense as well as pediatrics or the American Bar Association for lawyers–those organizations also have a vested interest in protecting their terrain, which also means that they have a vested interest in keeping other people off of their terrain.

There’s something else. They also have a very important interest in making certain that they and their practices are well funded. This gets even more interesting and worthy of consideration when you consider the what’s often referred to as plastic reconstructive and aesthetic surgery. That surgical specialization has a lot to gain financially by an expansive definition of what kind of reconstructive procedures will be covered by insurances or state funds because these procedures would be deemed medically necessary.

If you can get your particular service, you can get your practice, you can get your specialization, you can get an expansive number of treatments covered, well, you’re going a long way towards paying your bills. And make no mistake, that has a lot to do with why the professions guard their own terrain so zealously.

So you may be wondering what would be a concrete example of that. Why would a commercial or a financial interest, make its way into something as substantial as a major policy change on something as substantial, let’s just say, as homosexuality. That’s the term that was actually used. And in that case, you’ll go back to the early 1970s, to the years 1972 and 1973.

The American Psychiatric Association and the American Psychological Association both changed their policies when it came to the issue of homosexuality. Just to give one example, the American Psychiatric Association had basically agreed that homosexuality in virtually every form, even the inclination, was some form of disorder. And on the other hand, you had a lot of pressure coming from the homosexual rights movement to normalize that behavior.

And let’s just put it another way. If you wanted to bring about a revolution in sexual morality, particularly on those issues, one giant obstacle was the fact that both of the APAs–the American Psychological Association, the American Psychiatric Association–said that homosexuality was or was evidence of some form of psychiatric or psychological disease. It’s hard to overcome that.

But those particular professions in their annual meetings basically did a U-turn, one one year and one the next. Now, change is one thing, but a U-turn is something else.

But here’s where the issue of the funding comes in. Those who were both psychologist and psychiatrist wanted to continue to be able to code payments for insurance coverage when it came to people who said they needed counseling or medical treatment related to either, say, homosexuality or a struggle with homosexuality. And so before the APAs would change their policies, they had to come up with a way that they could code for insurance coverage so that they could get paid regardless of whether they were in position A on homosexuality, say in 1972, and in the reverse position in 1973. The funding had to continue.

Now let’s step back to the American Academy of Pediatrics and what happened just in the last several days. And I want to say that the funding issue is probably not paramount, but it is also not insignificant. And we are talking about the fact that the professions are important in another crucial way, not just medicine, not just law, but virtually all the professions taken together. If indeed you want to bring about a realignment of society, if you want to bring about a new morality, the professions are not only where you have to get, the professions in many ways are where you would start.

Also, as you’re looking at moral liberalism, progressivism, and secularization, we all know that the rates of how those movements have moved forward among the elites in society, well, it’s faster than what’s taken place in the rest of society. And by definition, the professions are in the elites.

But what did happen in the last few days? Well, the most important action by the American Academy of Pediatrics to be discussed today on The Briefing is the fact that last week, the AAP, as the New York Times said, “Backed gender-related treatments for children, reaffirming its position from 2018 on a medical approach that has since been banned in 19 states.”

Now, I wanted to read how the Times introduced the issue there, because you’ll notice it was medicine and it was politics all wrapped together. You had the states that have outlawed transgender procedures, and then you had the pediatricians who, last Thursday, said they’re for it. But the headline news is a little more complicated than that. For example, The Times’s own headline is this, “Doctors back youth gender treatments, but call for review of data.” In this case, the review is what is formally known as a systematic evidence review. The AAP and other similar groups often adopt policies, and they put a sunset clause in, usually something like five years, 10 years, such that the policies have to be reviewed.

In itself, that’s probably a very good thing. But if you’re looking at this, you need to recognize that the American Academy of Pediatrics’ position is very enthusiastic in one sense, certainly endorsing so-called transgender treatments for transgender children and youth. Well, that was adopted in 2018. So you might say, five years later, it’s coming up for review. But it’s not just a five-year review. It’s also that there have been massive developments. One of those is the fact that around the world, and in particular in Europe, many nations are rolling back access to transgender treatments for minors, indeed moving exactly in the opposite direction that has been the case in the United States.

Britain’s National Health Service actually closed its very well-known Tavistock clinic, which was basically devoted to these kinds of treatments when it came to children and teenagers who claim some kind of transgender identity. And yes, this did include, in some cases, surgery. It included, in many cases, hormones. And in both cases, and beyond that, the British medical community at least had the courage to say, “This doesn’t appear really to be helping young people. As a matter of fact, it may be hurting them. So let’s just stop it for now.”

So Britain’s National Health Service is basically backed off of this, even closed its clinic. It is interesting that in defending and continuing its current policy, we’re told that all 16 board members of the American Academy of Pediatrics voted to reaffirm the 2018 guidelines last Thursday. Then we’re told, “The vote comes at a time of intense political pressures on transgender people and the doctors who care for them.”

Now, immediately it goes into efforts at the state level. And of course this is immediately politicized. It’s Republicans, we’re told, at the state level who are trying to pull back on the authorization, the funding, even the allowance of these kinds of procedures. There is, we should note, enormous public support for that certainly within those states and a good deal of concern all across the nation. Nonetheless, there’s no doubt that the LGBTQ revolutionaries, especially here, have been incredibly successful in at least intimidating the professions, and also beyond them, state legislators, supreme courts, bureaucracies at the federal and state level in many, if not most of the states, to maintain the policies that they want to see in place.

It is the states that are changing those policies who are actually moving more in alignment with Britain and European nations that have the ire of the left in the United States. But you’ll notice the big news here is not just that there was a reaffirmation of the 2018 policy. The bigger news might be that the American Academy of Pediatrics actually said, right out loud, they’re calling for a very large, very major review of their own policy. It’s known as a systematic evidence review, and it also requires external authorities to be a part of the investigation.

So in one sense, what you could say is that the American Academy of Pediatrics stands by its policy and simultaneously said, “Well, we stand by it for now. We’re not really so sure about it. We think we need to study it. And we’re going to have to have a proof that this particular policy is actually serving the needs and the health of young people.” That’s going to be a very interesting process. In one sense, the American Academy of Pediatrics appears to be buying some time, and perhaps even trying to hedge itself against future criticism.

One of the things that motivated some of the authorities in the United Kingdom and in Europe was the fact that they feared that there would be a growing number of people who had received so-called transition treatments as children and teenagers who would later come back and say, “That didn’t help me, that harmed me. And furthermore, they’re irreversible. You have caused me harm.” Now, again, you can’t take the finances out of this. Some of those young people might be coming with very large lawsuits against medical professions, institutions, hospitals, and medical centers who had been involved in their treatments.

The legal refuge for the medical community and for most professions is operating within the best practices established by those associations, societies, and professional organizations. For the American Academy of Pediatrics, to make a statement, they’re standing by their policy of 2018 is news–sad news. But the fact that they’re submitting that policy to this systematic evidence review, in the light of history, that might turn out to be bigger news. And it might turn out, in one sense, in a fallen world, to be good news.

At the same time, there’s something else that’s quite interesting here. I’m talking about the coverage in the New York Times. Again, the headline read, “Doctors back youth gender treatments, but call for review of data.” Azeen Ghorayshi is the reporter in this case. The article goes on to state pretty much what you’d expect to find in the New York Times. For example, “The AAP has roundly condemned the legislative bans as a dangerous intrusion into complex medical decisions between doctors and families, and has filed amicus briefs to support the many legal challenges brought against the bans by civil rights groups.”

Well, then however, later in the article, we find something else. For one thing, a contrary view. In this case, coming from Dr. Gordon Guyatt, a clinical epidemiologist at McMaster University. We are told he helped to develop the field of evidence-based medicine. He said that what the APA has done, the pediatricians, he said, have put the cart before the horse. Then the New York Times reports this, and it’s very significant that the Times offers this analysis: “Based on previous systematic reviews, Dr. Guyatt said, the AAP’s report will most likely find low quality evidence for pediatric gender care. ‘The policies of the Europeans are much more aligned with the evidence than are the Americans.'”

The Times goes on. “In June, England’s National Health Service announced that it would restrict the use of puberty blockers to clinical trials because, ‘there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment.'” Last year, we are told, “Sweden’s national healthcare oversight body similarly determined that on the basis of its systematic review, ‘the risks of puberty-inhibiting and gender-affirming hormone treatment for those under 18 currently outweigh the possible benefits.'”

Why is this so important? You knew that already if you’ve been listening to The Briefing. What makes it important is that that news makes its way along with argument into this coverage in a news story by the New York Times. Put in the context of August of 2023, I think it’s fair to say it’s not just the pediatricians who want to cover their bases here in order to have some safer ground on which to backtrack, maybe at least some in the mainstream media are trying to do the same.

Part II

---

Pope Francis’s Journey to Portugal: ‘Non-Judgmentalism’ and the Pope’s Strategy on Gender and Sexuality

Well, next, we’re going to shift to a very different story, and this is one that concerns Pope Francis. Pope Francis made a journey to Portugal where he spoke to a world conference of young people gathered on behalf of the Catholic Church. And we are told that what he said, in some ways, made less news than what he didn’t say. What didn’t he say? Well, the most notable thing he didn’t say is that Russia had invaded Ukraine and that Ukraine deserves the prayers of the church, and that Russia was the aggressor and was doing grave evil on the world scene. The Pope made no reference to that whatsoever.

That’s something that is confusing and it’s the cause of consternation among many Catholics because of the incontrovertible reality of Russia’s evil and its continued atrocities in Ukraine–crimes that include atrocious acts against Ukrainian families and even children. You look at all of this and you recognize that you would think that if you did invent, say, the office of the papacy, you would at least expect that the Pope would speak in terms of moral judgment to something like that. But the Pope did not. Why didn’t he?

Well, I’ll just give you what I believe, which is the historic Protestant answer: the papacy is an unbiblical office. Another part of the problem of the papacy is the fact that it basically claims to be something of a diplomatic organization–the Vatican claims to be a state with the Pope as the head of state of that state.

The bigger problem for Protestants are the theological claims, the claims of doctrinal authority and ecclesial authority made on behalf of the Pope and the papacy throughout the centuries.

But it is very important for Protestant evangelicals to understand that popes remain important on the world scene. Furthermore, many people around the world assume that the Pope, in some sense, speaks for Christianity. That’s at least not an insignificant concern.

But the reason I’m talking about the Pope is not because of what he didn’t say about Ukraine in a public prayer. I want to discuss the signals Pope Francis sent about sexuality and gender. Indeed, once again, the Pope indicated that he does not intend to support the Roman Catholic Church’s historic and continuing teachings on the issues related to the LGBTQ revolution.

This pope, Pope Francis, has been at great pains even as he took the papal throne in 2013, to try to create distance between himself and his two immediate predecessors. Especially on issues of gender and sexuality, the Pope has often spoken of a certain form of non-judgmentalism. He’s actually asked the question in an interview on these issues, “Who am I to judge?” Now, an evangelical Protestant would look at the claims of the Roman Catholic Church about the papacy and say, “Well, we thought you’re the one who’s supposed to say for the Roman Catholic Church.” You say, ‘who am I to judge?’ Well, at least we thought that’s what the Pope was for the Roman Catholic Church.” And by the way, the Catholic catechism and Catholic ecclesiology actually says that.

If you want to bring about a change in official Roman Catholic doctrine, that’s going to take time. And so what Pope Francis is doing is sort of what happened also in more liberal Protestant districts, and that is, you don’t just go back and say, “We’re going to change the doctrine explicitly. We’re just going to stop applying the doctrine in the name of inclusivity. We’re just going to embrace people. We’re not going to make the judgements that our doctrine calls for us to make.” By the way, the current catechism, the official doctrine of the Roman Catholic Church says that any and all homosexual inclination or actions are objectively disordered. You’re not going to hear that kind of Catholic doctrine from Pope Francis who’s supposed to be the top doctrinal officer of the Roman Catholic Church.

But I’m not raising this, in this case, just to criticize Pope Francis or just to speak about the papacy. That’s not actually my bigger point. My bigger point is that this should serve as a warning to all Christians, that you basically have only two positions here. You’re either going to say, “We believe that the Scripture makes clear a divinely ordained and designed pattern of human beings as male and female, of marriage as the exclusive union of a man and a woman for a lifetime, of the natural family as that man and the woman and the covenant of marriage with the children that come to them, to the conjugal union or adoption. And when it comes to, let’s just say, the entire LGBTQ spectrum, it is recognized that those behaviors and relationships come under direct scriptural condemnation and the historic doctrinal judgment of the church.”

You’re either going to hold that position or you’re going to hold a very liberal position in which you basically say, “Okay, we’ll redefine marriage. We’ll redefine sexual ethics. We’ll redefine our understanding of gender. We’ll redefine male and female. We won’t have, say, ordained men anymore. We won’t even just have ordained men and ordained women. We’ll have ordained people, like we’ll have pregnant people.” My point is, there’s actually nothing lasting or credible in between those two positions. You’re going to be in one position or the other.

Clearly, Pope Francis wants to move the Catholic Church in a more liberal direction, but he may have made the judgment that he lacks personally the time to bring that about formally so he will do it effectively and then leave it to his successor or successors to make it real in policy. It’s interesting again that Jason Horowitz of The New York Times says this, “As pope, Francis has sought to draw more people into the church by making it more welcoming and close to its people and less focused on rules and abstractions, power and rank.”

Now, that’s a pretty ideologically loaded sentence for a news report there, but it’s not exactly wrong when it speaks to what Francis is trying to do. It’s important actually that that’s acknowledged in the nation’s most influential secular newspaper. We’re then told, “Francis has steadily filled his hierarchy with prelates in his image, but has also balked at opportunities to make concrete changes to church policy.” The newspaper basically then goes on to make its own argument that it’s a matter of time.

Now, my point in raising this is to say that, first of all, it’s a matter of truth. The Christian Church and the Christian understanding of truth comes down to two things. Most importantly, it comes down to biblical authority, which helps us to see whether or not something is true, and how in the world we would know what the gospel is and what God’s intention for human beings would be. And the answer to that, certainly for Protestant evangelicals, as for the historic church, is Scripture. And as the Protestant reformer is made very clear, that means scripture alone, in terms of soul, final authority.

The second thing is what is sin, and thus, what is the good news of the gospel of salvation from sin? If we confuse what sin is, we confuse the saving work of Christ, we confuse the gospel itself. We’re not just saved as in move from position A to position B. We are redeemed from being sinners under the just judgment of the wrath of God to being the redeemed people of God saved by the blood of Christ, who are then adopted as if we are sons and daughters of Christ himself. That is not merely a position from, say, status A to status B. That’s the difference between being dead and alive.

Part III

---

What Gets the World’s Approval?: The Temptation to Abandon Historic Christian Doctrine on Gender and Sexuality in the Name of Inclusivity and Tolerance

But finally, I just want us to note what gets the world’s approval. The world’s approval would most likely come enthusiastically if those of us who hold the biblical convictions would simply reverse like the American Pediatric Association or the American Psychiatric Association in the early 1970s. We could just have a conclave and say, “We’re just going to change this sexuality and gender and marriage stuff and just join the revolution.” We would get enthusiastic support from the larger secular world for that.

But on the other hand, if we’re unwilling to do that, or if the practicalities are that we can’t get that far right now, then that same world will at least give us some level of applause if we just say, “We’re going to stop talking about that and we’re just going to stop applying those principles, doctrines, and rules and commandments.” We’re just going to say, “In the name of inclusivity, well, who are we to judge?” I just want all of this to serve as a warning, as fresh as this week’s headlines, about what that really is and what the consequences would be.