Can You Trust Medical 'Consensus' on Transgender Care for Children or Anything Else?
The Hidden Influence of Nonprofit Organizations on our Heathcare System
As the debate over puberty blockers in children heats up, many might wonder why the U.S. hasn’t conducted a comprehensive study–like the UK's Cass Review –to establish a clear medical standard and depoliticize kids’ healthcare. Those aware of the recent revelation that the Biden administration pushed to remove age limits for transgender surgeries, may cynically chalk that up to activist leadership. If we are looking at hard evidence, that’s fair.
But something many people don’t know is that there are barriers to such definitive action in America. The issue lies in the structure of the U.S. healthcare system, where professional trade organizations and interest groups play a critical role in shaping standards of care without much oversight.
The forces that created this situation spring directly from the country’s founding. Going back to the Whiskey Rebellion, the United States has resisted centralized authority. Given the danger of concentrated power, this makes sense.
But, like everything, it comes with trade-offs.
In healthcare, this means that the U.S. lacks a single governing body like the UK’s National Health Service (NHS) or Canada’s healthcare system. Instead, the U.S. has a complex mosaic of medical professionals, executive branch governmental bureaucracies, insurance companies, and professional organizations like the American Medical Association (AMA).
While this diffuse system prevents one entity from dominating, it is vulnerable to abuse–particularly when professional trade groups become enmeshed with the government. From that vantage point, private organizations become empowered to control the competitive landscape for medical care without corrective mechanisms to ensure patient interests are protected over practitioner interests.
In grossly oversimplified terms, the executive branch of the federal government has a regulatory role in healthcare and the courts also play a large part in hashing out loosely defined ‘standards of care.’ But neither is structured in a way to make broad guidelines that are enforceable and respected.
The result is that any grey areas are left to large non-profit professional organizations that function a lot like cartels. Groups like the AMA hold immense power. They can create clinical practice guidelines, competencies, and standards of care. Their powers can include some regulatory authority, and creating a perceived consensus without performing due diligence testing of results. And they get tax protections to boot.
Even when they don’t have direct authority over practitioners, their recommendations can influence court decisions or licensing boards in supporting a fashionable orthodoxy regardless of whether that position has a solid empirical evidence base to support it.
Given the diffuse power and tremendous complexity of this system, many Americans may not realize that groups like the AMA are in fact nonprofit organizations with multiple layers of conflict of interest.
Looking at the AMA for further example, with over a billion dollars in assets, the AMA has a yearly revenue of around $450,000,000, the vast majority of which is derived from royalties on their Current Procedural Terminology (CPT) codes. These codes, required by the U.S. government to classify medical procedures, come with a price tag from the AMA, effectively creating a revenue stream tied directly to the healthcare system’s operations.
What does the AMA do with this steady stream of tax-protected wealth?
According to their website, their primary goal is advocacy.
To understand what they mean by advocacy the first step is to consult their new strategic plan. This document reveals that much of their advocacy is directed toward social issues, like ensuring, “All physicians are equipped with the consciousness, tools, and resources to confront inequities and dismantle white supremacy, racism, and other forms of exclusion and structured oppression” or “Embed racial justice and advance equity within and across all aspects of health systems.”
The strategic plan continues with a litany of proposals that have less to do with good medicine than with aggressive progressive posturing. Amidst all the collective congratulations it would be easy to forget real problems America is suffering with like the shortage of doctors, a situation the AMA is intimately acquainted with.
It was the AMA who lobbied to reduce the number of medical schools and slash residency opportunities as well as capping the funding for those residencies. They also lobby heavily to prevent other healthcare professions, like nurse practitioners, from taking on some of the duties normally done by physicians. Arguably the doctor shortage serves their members by keeping physician wages high and allowing them to set terms like scheduling appointment times that better suit doctors than patients.
It is much harder to see how their stranglehold on CPT codes and their manufactured doctor shortage benefit patients and the common good, because arguably it doesn’t.
The AMA may be among the most finically successful, non-profits–though that label hardly seems to fit, but it is far from alone in this free-for-all tax-protected sector. A vast number of similar nonprofits also hold sway over bits and pieces of the healthcare pie.
The following list represents a small fraction of the medicalish non-profit organizations that influence how healthcare is done in the United States while keeping enough distance from negative outcomes to maintain plausible deniability should anyone consider using the courts to restrain their power.
American Counseling Association
American Psychological Association
World Professional Association for Transgender Health (WPATH)
For patients and consumers, the problems with this system become a lot more salient when you look at the transgender care issue. In this case, WPATH is the key player, drafting guidelines for transgender care. Other organizations are uncritically following these directives. This creates an illusion of consensus while stifling debate and limiting accountability.
The lack of oversight is particularly concerning given that WPATH is an activist organization and lacks robust empirical evidence for its recommendations. Shockingly, the recent release of the WPATH files shows doctors blindly taking medical ‘guidance’ from untrained activists.
With WPATH writing guidelines for transgender care of children that include puberty blockers, radical mastectomies, hysterectomies, and castrations, at the same time the leader of the U.S. Department of Health and Human Services is pushing to remove the age limit for these procedures, it becomes clear that as currently structured, a tiny well-placed minority can grab the reins of power and quickly make the unthinkable seem normal and even desirable.
In this way, a small but influential group can drive policy without facing the responsibility that should accompany such authority. The system is ripe for reform.
If the entanglement of regulatory authority with advocacy and trade organizations like the AMA and WPATH is alarming, reform is not just necessary–it is urgently needed.
These quasi-regulatory ‘nonprofits’ operate with little oversight and without corrective measures. If these organizations are already comfortable green lighting the sterilization and mutilation of children with minimal to no evidence, left unchecked we can only wonder where does this go from here?
About
Diogenes in Exile began after I returned to grad school to pursue a degree in Clinical Mental Health Counseling at the University of Tennessee. What I encountered, however, was a program deeply entrenched in Critical Theories ideology. During my time there, I experienced significant resistance, particularly for my Buddhist practice, which was labeled as invalidating to other identities. After careful reflection, I chose to leave the program, believing the curriculum being taught would ultimately harm clients and lead to unethical practices in the field.
Since then, I’ve dedicated myself to investigating, writing, and speaking out about the troubling direction of psychology, higher education, and other institutions that seem to have lost their way. When I’m not working on these issues, you’ll find me in the garden, creating art, walking my dog, or guiding my kids toward adulthood.
You can also find my work at Minding the Campus
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Because you have some degree of education in psychology, will you do an substack article where you evaluate the diary of Nashville school shooter Audrey (Aiden) Hale {courtesy the Tennesee Star}?
I would love to know your thoughts about it as I'm still reading through it myself.