Apostate From Institutional Consensus And On Behalf of Normative, Evidence Based Practice

Julia Mason MD and the Politics and Aesthetics Of Apostay, Part 1

It matters perhaps more than it should to the issue in which she has come to be embroiled that Dr. Julia Mason looks like a minor character on Portlandia. The imposing red mane flowing down her back with its white roots showing at her hairline; the saffron-hued Indian smock dress with floral designs stitched in white; the eclectic braided bead necklace accented by large turquoise, orange, and lime green beads: Mason could parachute in to play the hippie elder stateswoman leading the collective that runs the feminist bookstore with no changes in her personal wardrobe, hairdo, or deportment.

She looks, in other words, like someone who has been installing the latest progressive software updates as they were pushed out for many decades, as indeed she has been. When I asked her about the politicization of the American Academy of Pediatrics, the medical society that has come to regard and treat her as a gadfly whose motions seeking to hold them to account to evidence-based standards of research must be thwarted through parliamentary legerdemain, she ran through a list of prior statements made by the academy with which has she found herself in enthusiastic agreement.

"I've always thought the AAP was on the right side of things," she told me, speaking in the hallway of a conference room in which a group of protesters had assembled at a cheap Anaheim hotel catty corner to the far more luxurious hotel hosting the AAP's annual conference.

"I'm a lifelong Democrat, leaning liberal. The AAP is for more gun control, and I'm for more gun control. The AAP is for better funding for women, infants and children. And I'm for that. And the AAP said the gay couples could adopt. And I'm like, ‘Yes!’ I agreed with all these positions. And this a very uncomfortable position for me right now, to feel like an apostate."

Such listing of liberal bona-fides, meant to ward off the easy dismissal that partisan identification in the wrong side of the culture war enables, has become a routine part of journalistic profiles of progressive dissenters and the target of mockery of partisans of both the right and left. The former churlishly scoff at such figures, portraying the gestures at dis-identification from the right as futile pleas for mercy from a cancel mob that the apostate had once putatively been happy to join. The former portray all the prior positions once supported by the apostate as inevitably culminating in the present subject of apostasy. The latter churlishly scoff at such figures for deploying the signifiers of progressive tribal identity in a bid to “platform” the toxic agenda of the right in a manner even more threatening, (because more insidiously appealing to those within the consensus,) than the open antagonism of the right itself.

These stereotyped views are often totally untethered from the specifics of the cases of apostasy to which they are applied. But they do capture certain important social dynamics endemic to ideological succession. Quirky lib aunties like Dr. Julia Mason really do have a crucial margin of forbearance to operate within progressive settings. They also are a reminder that before ideological succession captured a broad range of American institutions, it established its disciplinary power over left activist spaces first, perfecting within them the methods of institutional capture through emotional blackmail and accusations of racial and gendered "violence" that seized American institutions at scale during the Trump years. It is in the settings where progressives rule where the new dogmas have been implemented and immunized from scrutiny or dissent for the longest — and where the harms and wrongs that they sometimes generate are most vividly felt.

And it is thus in those settings, which alas, encompass most of our medical establishment, where apostates who look like minor characters on Portlandia become especially relevant as beacons of resistance to groupthink and institutional diktat. Such figures made up a significant portion of those attending the Do No Harm protest of the annual conference of the American Academy of Pediatrics.

And it is those people operating within the institutions who are testing a crucial hypothesis that must be tested: We must see whether the institutions can reform themselves from within through appeals to their own normative practices and institutional values by making those appeals through approved channels first before seeking other means to bring them to heel.

Mason's apostasy concerns nothing more or less than petitioning an institution whose authority she has long recognized to hew to the very normative practices that serve as the basis of its claim to authority -- that of providing of rigorously tested, evidence-based guidance to its 67,000 members. For that organization, the American Academy of Pediatrics, has joined many others across institutional America in carving out a zone of exception from standard practices obtaining in every other domain in its purview with regard to one special subject in which everything we know about child development defers to a powerful new dogma.

The subject of Mason's apostasy concerns a dramatic uptick in the number of transgender identitying girls she began seeing in 2018, and the treatment protocol to which those girls were subjected when she began sending them to gender clinics in Portland.

"Prior to 2018, I had maybe one trans patient. This is a thing that occurred in two out of 10,000 children. This is a thing a pediatrician could go their entire career and never see," Mason told me.

Mason had seen one transgender identifying patient in the twenty years prior to 2018. In 2018, she began seeing one every few months. The pace increased from there.

"The first time I had a patient who told me that ever since they were two or three, they knew that they were actually a boy, I was like, oh, that's that's transgender. I've heard of that. You know, there's a gender clinic over at the Children's Hospital. I'll send you. And that's how it was. But then there was another one. And another one. And another one."

Mason had been sending those children to the hospital clinics as a matter of routine protocol under the assumption that the gender clinics would bring their specialized expertise to bear in diagnosing and treating sufferers of gender dysphoria. But she began to notice that every single patient she sent was quickly placed on puberty blockers or cross hormones, usually at the first visit. A 12-year old patient of her was offered puberty blockers at her very first visit.

"I started to get worried that they weren't acting like a proper sub specialist clinic where they're doing a significant evaluation and figuring out 'Is this kid really going to benefit from this treatment? Or does this kid have something else going on?' As soon as I figured out that, that is not what was happening. Then I didn't want to send anybody to the gender clinic anymore."

The clinical change corresponded to a change in public rhetoric about youthful sufferers of gender dysphoria who had recently been declared "Trans Kids" -- a question-begging label that assumes the very thing that is meant to be investigated. The label both determined the diagnosis and dictated the course of treatment. Mason was thus observing the conjoined effects of a marked change in the wider culture resulting in a dramatic upsurge in transgender identifying youth, alongside an equally dramatic shift in the treatment of such young people toward implementation of what is known as the "affirmative care model," in which clinicians are enjoined to accept at face value the transgender identification of young patients and instantly put them on puberty blockers or cross-sex hormones without any other exploration of mental health issues that could be manifesting as a transgender identification. The results she was personally observing were not encouraging.

"I've been following some of these cases for a few years. And that's another one of my concerns is, for the majority of them, they are not thriving."

Seeking answers to this dramatic change, Mason attended a presentation by several gender doctors at the 2019 national meeting of the AAP. The session was in a packed double sized conference room, where she witnessed a mini-preference cascade that she herself had set off with a skeptical question. "The doctors were all thrilled because they that thought we were all wanted to be gender doctors as well...but after I asked a question that was somewhat skeptical, and then I got mobbed by other pediatricians, I think most of them were like. They wanted to know: what is this? What's going on? Where did this come from?"

"So we didn't learn what we wanted to learn...because that presentation was just talking about how you too, can be a life saving hero. And you know, none of us actually know what we're doing. So if we can do it, you can do it and...go for it."

— First in a series