A key witness who testified on behalf of pediatric “gender-affirming” care in the Florida joint medical board committee made a series of false and misleading claims, according to a global group of medical professionals.
The Florida Boards of Medicine and Osteopathic Medicine held a joint meeting last month to evaluate the evidence for “gender-affirming” care for minors in the state, hearing expert testimony from medical doctors both for and against the practice. Dr. Meredithe McNamara, who testified in favor of the controversial protocol, was fact-checked by an international group of more than 100 clinicians and researchers called the Society for Evidence Based Gender Medicine (SEGM).
“Last week, child and adolescent physician Dr. McNamara pledged in front of Florida’s Medical Board to provide a ‘truthful account’ of pediatric gender medicine,” said SEGM in a tweet thread on Tuesday. “She then falsely claimed that a key evidence report the Board relied on was invalid, as it was written by a ‘dentist.'”
McNamara, who treats patients aged 11-25 at Yale School of Medicine and is a frequent promoter of so-called “gender-affirming care” for “gender-diverse youth,” attempted to discredit a key evidence report during her testimony by insisting the lead author was “a dentist” and therefore unqualified.
What McNamara failed to mention, as SEGM pointed out, is that while lead author Romina Brignardello-Petersen does hold a Doctor of Dental Surgery (DDS), she also has a Ph.D. in Clinical Epidemiology and Health Care Research and has published more than 140 peer-reviewed publications on evidence evaluation and clinical practice guideline methods and teaches at a leading center in systematic reviews and clinical practice guidelines development.
“When misrepresenting the authors’ credentials didn’t work to discredit the FL analysis, McNamara changed tactics,” said SEGM. “She asserted that the reason the analysis was invalid [is] because it was done by a Canadian team who ‘violated’ the U.S. standards. This, too, is demonstrably false.”
The “violated standards,” SEGM explained, referred to a misrepresentation of the type of analysis commissioned by Florida. State officials commissioned an “overview of systematic reviews,” which is “an evaluation and synthesis of the already existing systematic reviews,” according to SEGM. McNamara, either knowingly or mistakenly, attempted to discredit a different type of evaluation called a “systematic review of evidence,” which SEGM explained is not the same thing.
“The purportedly violated ‘standards’ don’t apply to the type of review FL commissioned because it was not a ‘systematic review of evidence,'” said SEGM. “Further, the author of the analysis is a methodologist with significant ‘pertinent clinical content area expertise’ which she disclosed.”
The conclusion of Florida’s analysis, finding that the evidence for both benefits and risks is of low quality, echoes the conclusions of every systematic review to date, including Sweden, Finland, and, most recently, England. Health authorities in all three European countries have abandoned the “gender-affirming” model, finding that the costs outweigh the benefits.
McNamara conceded that the evidence grading was of low quality but insisted that using the term “low quality” was intended to scare “nonexperts.” She then used the example of “low quality evidence” that led to a “strong” recommendation to eat fruit to combat childhood obesity. SEGM explained that this comparison is deceptive because the treatment regime of eating more fruits and vegetables is not associated with health risks, while “gender-affirming” care is associated with significant health risks, including sterility and osteopenia.
“Low quality evidence can also result in a strong ‘recommendation AGAINST’ when the treatment is associated with severe risks,” said SEGM. “Puberty blockers and cross-sex hormones have a different risk profile than apples and carrots.”
McNamara made other “questionable” claims during her testimony, such as that pediatric double mastectomy surgeries were as rare as genital surgeries, assuring the Board that she had never encountered a minor patient who wanted or received a mastectomy.
Left-leaning news outlet Reuters analyzed insurance claims in a report last month, finding that between 2019 to 2021, at least 776 mastectomies and 56 genital surgeries were performed on teens with a gender dysphoria diagnosis ages 13 to 17 in the United States. Reuters said this data is a “significant undercount” because it only includes procedures covered by health insurance classified under a diagnosis of gender dysphoria.
A recent journal estimated 1,130 reconstructive chest surgeries were performed on adolescents from 2016 to 2019 using ambulatory surgery data. The adolescents’ ages ranged from 12 to 17, with a median age of 16 and 98.6% being female.
“McNamara’s testimony pleased the crowd but did not impress the Medical Board,” said SEGM. “Her inability to articulate how one conducts differential diagnosis or determines medical necessity of surgery (beyond a teen’s wish), revealed the ‘Wild West’ state of US pediatric gender medicine.“
Ultimately the Florida boards of medicine found the evidence to support the use of pediatric “gender-affirming” care lacking and voted 6-3 to prohibit minors from accessing puberty blockers, cross-sex hormones, and gender-related surgeries statewide, making it the first ban in the country instituted by a state medical board.
“Dr. McNamara is entitled to her opinion on the Florida Boards’ of Medicine decision to curb gender transition of minors,” said SEGM. “What she is not entitled to is her own version of facts. Sadly, misrepresenting facts has become a go-to tactic for many in the field of gender medicine.”
“What’s unclear is why the Endocrine Society, the AAP, and WPATH—the three pillars of pediatric gender affirmation worldwide—failed to show up to defend their work,” poised SEGM.