The AAFP seems intent on staying the course and continuing its slide away from medical education and best practices and into political and cultural activism. Family physicians should ask themselves whether this organization is genuinely representative of their interests.
Originally published by Do No Harm
Over the last several years, Do No Harm has repeatedly exposed the American Association of Family Physicians (AAFP) for its embrace of DEI and its forays into radical identity politics and activism.
The organization’s 2024 annual conference in September showed that the organization is as committed as ever to its ideological project. The conference was replete with references to DEI, radical policy proposals, and endorsements of gender medical interventions for minors.
Though the AAFP has long endorsed child sex change procedures, the way in which AAFP speakers discuss the issue is very revealing of the organization’s prioritization of agenda over evidence.
For instance, one presentation on so-called “gender-affirming” included claims that are flat-out false, and reveal an ideological commitment.
“There’s no question that it (pubertal suppression and cross-sex hormones) works; there’s no question that it saves lives,” said Molly McClain, MD, a professor of family and community medicine at the University of New Mexico. “The fact that it’s being questioned across this country and across the world is not about medicine and it’s not about evidence. It’s about politics.”
There is, in fact, more than a question as to the efficacy of child sex change interventions. The United Kingdom, Sweden, and Finland have all restricted these interventions. The Cass Review, an exhaustive examination of youth gender treatments within the United Kingdom, determined that the evidence for such procedures is of “poor quality.” Do No Harm recently released a report exposing the serious methodological flaws in the studies most often invoked to support so-called “gender-affirming care for children.”
The presentation also called for “structural belonging” to improve outcomes among youth who believe they are transgender; in other words, a reorientation of society to “affirm” the chosen gender of the child. This includes pronoun use in basically every social setting.
In another particularly bizarre presentation, the face of President-elect Donald Trump was superimposed onto an anthropomorphic Cheeto to represent poor nutrition, with the caption “Cheeto-in-Chief.”
Other presentations included methods of achieving “lactation equity” that invariably involved policies such as “pay equity” and other political reforms.
But also, and more worryingly, the AAFP continued to platform misleading narratives surrounding implicit bias.
Tests used to evaluate implicit bias fail to meet widely-accepted standards of reliability and validity; a 2013 meta-analysis published in the Journal of Personality and Social Psychology found that the IATs were “poor predictors” of real-world bias and discrimination.
“Twenty years of research produced very little evidence that the IAT test predicts any real-world behaviour,” University of Toronto Mississauga psychology professor Ulrich Schimmack, who spent years studying implicit bias, said in 2019. “On top of that, some of the articles that claim it does, on close inspection, fail to show that.”
Nevertheless, the AAFP argues that implicit bias is a pervasive blight on healthcare leading to racial disparities in health outcomes. The presentation includes a video claiming that physicians are less likely to prescribe black patients pain medication, and implies this is due to physicians’ implicit bias.
However, the evidence for this claim is far from convincing. A systematic review of studies on racial disparities in pain medicine prescription published between 2011 and 2021 reviewed 15 cohorts and found that in only seven of them were black patients less likely to receive opioid pain medicine.
“Among 15 cohorts studied, 7 showed that Black patients were less likely to receive opioid analgesia, whereas 1 showed they were more likely to receive opioid analgesia compared to White patients,” the study found. “In the remaining 7 cohorts, there was no statistically significant difference in receipt of opioids between Black and White patients.”
Additionally, in several of the studies finding that black patients were less likely to receive opioid analgesia, the effect disappeared when controlling for socioeconomic status. This phenomenon indicates that socioeconomic status, rather than race, is the factor leading to this disparity.
But of course, that result is much less convenient to support the AAFP’s desired DEI agenda. After all, the AAFP’s Vice President of Medical Education explicitly endorsed racial discrimination in medical school admissions and decried the Supreme Court’s ruling against affirmative action.
The AAFP seems intent on staying the course and continuing its slide away from medical education and best practices and into political and cultural activism. Family physicians should ask themselves whether this organization is genuinely representative of their interests.
