Plastic Surgeons’ Rejection of Unscientific Consensus Inspires Hope ‘That Other Organizations Will Wake Up’

The Washington Stand | Joshua Arnold - August 14, 2024

The American Society of Plastic Surgeons (ASPS) broke with the dominant transgender ideology last month when, in response to a media inquiry, they declined to endorse “any organization’s practice recommendations for the treatment of adolescents with gender dysphoria,” due to the “considerable uncertainty as to the long-term efficacy” and “low quality/low certainty” evidence. This reverses the organization’s previous position; in 2021, the ASPS “actively opposed [state] legislation seeking to criminalize actions by physicians and guardians when minors receive gender affirmation surgery,” according to their website.

“I think the move says that the organization membership is beginning to realize that [the organization] might be being run amok by a small group of activists in their midst,” said Dr. Quentin Van Meter, member of the executive committee of the American College of Pediatricians, on “Washington Watch.”

With 11,000 members, accounting for more than 90% of all plastic surgeons in the U.S. and Canada, the ASPS is the first mainstream, nationwide medical organization to depart from the pro-transitioning consensus (although the Indiana State Medical Association did so in 2023). “Our hope is that other organizations will wake up,” Van Meter said.

“Professional societies have a really strong purpose,” Van Meter explained. “Many of these organizations require a board certification in that specialty. And so being a fellow so-called in these organizations is an honor. It shows that … you’re well-trained. You’re certified in your field.” So, membership in the group is “all about improvement. It’s all about keeping up with science. It’s all about providing educational guidelines, overseeing the medical curriculum, or helping develop medical curriculum for medical schools, graduate certification programs, etc.”

Unfortunately, “politics have invaded” America’s professional medical organizations, lamented Van Meter. “Slowly but surely … administrative staff take over … the organization so that member physicians can practice their [medicine] and not have to worry about admin duties. And then, as politics move in and money flows in … the core administrators tend to take over and introduce [their own] ideas as policy from these organizations.”

“That’s what’s happened with the Endocrine Society, with the American Academy of Pediatrics, with the Plastic Surgery Society,” Van Meter added. These groups “came forth with a rubber stamp of, ‘These are the guidelines.

This is what we’re told. This is the science behind this. Let’s go ahead and endorse this.’”

But then “the membership [began] to be a little more agitated about what’s being said because the science is not in support of these transgender affirmation tactics,” Van Meter continued. Plastic surgeons “are physicians at heart,” and “their whole purpose is to do no harm,” he said. “Their purpose is not to gloss over [problems] with something that’s touted to be a cure, but which they really know is not a cure.”

Plastic surgeons are in a “unique position of having to be very well versed in mental health” and consider “the whole human being,” Van Meter continued. The ethics of their profession demand that they clarify the patients’ expectations up front and not promise to do the impossible, he said.

“The plastic surgeons, amongst themselves, decided, ‘No, we’ve looked at the science. It’s blatantly not there to support removing healthy organs and trying to transform a body to the appearance of the opposite sex from the biological sex.’ And so they just stood up and said … ‘We’re not going to endorse this anymore,’” Van Meter described. Treating gender dysphoria with gender transition procedures, in hopes of producing better health outcomes for minors is “not based on fact. It’s based on hopes and whims. And it’s experimental to do these things to children.”

The ASPS recognition that evidence for gender transition procedures is “low quality” means “that there is no scientific, proven evidence that what they’re recommending actually is beneficial,” he explained. “This takes politics out of the picture and says, ‘Let’s just go back down to the basics.’”

Van Meter illustrated this through a humorous example. “If you put mayonnaise on your nose, is that going to cure cancer?” he asked. “The likelihood is that the evidence is very low. … Therefore, we should not recommend, as an organization, that you put mayonnaise on your nose to cure all of the cancer that might be in your body. … It’s not whether or not you’re leaning left or leaning right. It’s like, ‘Wait a minute, let’s just look at the science.’”

“Medicine needs to progress with evidence … that looks at potential harm versus benefit and balances that fairly and does not fall into an ideology,” argued Van Meter. “So, the low basis for certainty should essentially put a screeching halt to recommendations for interventions such as surgical manipulation or excision of healthy organs.”

Van Meter believes this depoliticization of gender transition procedures is evident in European countries that have backed away from an aggressive, affirming approach. “Europe tends to be progressive politically. … In many of the countries, [they have] essentially socialized medicine” and “they have been in the business of working with gender dysphoric patients, both children and adults, for about 10 years more than the United States,” he said.

But European countries “started looking, actually, at 10-year and 20-year outcomes, because … if you’re going to provide a treatment, you want to be sure that 20 years out … people … are much better off in the long run. And they found that that wasn’t the case,” he said. So European countries are “putting on the brakes,” he explained, and only allowing gender transition procedures for minors to proceed “on a tightly based, scientifically pure protocol,” hoping “that in 30 or 40 years [it] may have the answer.”

Van Meter hoped American medical organizations would experience a similar about-face and openness to consider the scientific evidence. “I hope to see that the organizations that have been so stalwart here in the United States will actually open a dialogue,” he said, “and at their annual conferences, will open the room to discussion from one end to the other, in front of everybody, so that the membership doesn’t feel like things are being done behind their backs or at a higher level.”

Topics:Gender Identity, Puberty Blockers, Health Care, Good News

Joshua Arnold is a senior writer at The Washington Stand.