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When Medicine Is the Opposition Party

Can scientists and clinicians be political just some of the time?

This week’s elections have me thinking about the role of professional biomedical societies in American politics. Presumably because politics in this country have been leaning right for a while, and because many of the most vocal scientists and clinicians lean left, a number of scientific and medical societies have been setting themselves up, in the last eight years, as the opposition party. Take, for example, the American Psychological Association’s formal condemnation of the torture of “enemy combatants.”

One could argue that the APA’s condemnation was nonpartisan; presumably the APA would be outraged about torture whether it occurred under the Bush Administration or the Obama administration. Yet it’s obvious that the torture debate has been largely partisan. To weigh in as the APA did, with righteous and formal language on a partisan issue, is surely to act in a partisan fashion.

You’d think the APA would have learned its lesson from the Rind affair. For those of you who aren’t familiar with it, here’s a thumbnail sketch: In 1998, Psychological Bulletin, an APA journal, published a peer-reviewed meta-analysis by Rind et al. showing that, although “many lay persons and professionals believe that child sexual abuse (CSA) causes intense harm,” in fact college students “with CSA were, on average, [only] slightly less well adjusted than controls.”

Once the right-wing talk show circuit got a hold of this story in 1999, all hell broke loose. The APA was accused of apologizing for – even promoting! – pedophilia. Various members of a Republican-majority Congress, fresh off their disgust with the Lewinski scandal and their failure to fully bring down Bill Clinton, ended up investigating the paper and the APA. All this led to an unprecedented formal Congressional condemnation of the peer-reviewed paper… and, more disturbingly, to the APA cowering in fear of losing their nonprofit status, walking about with their tail between their legs.

There is no way Congress could have successfully threatened the APA if the APA did not occasionally act in an actively partisan fashion. The APA knew Congress might actually have the ability to undo the APA’s core institutional structure; that’s why they were scared. And yet here we are, just a few years later, with what amounts to a  hand-wringing condemnation of the Bush administration from the APA – a partisan act by a nonprofit organization.

Should professional medical and scientific societies and their members just stand by and watch political decisions that run counter to evidence, including political decisions that are really hurting people? Not at all. But if these societies want people to view biomedicine as essentially scientific – essentially apolitical, with a notion of truth that is based on the value of scientific evidence – then they cannot choose when they will be scientific and when they will be political. Because the average congressman cannot distinguish those instances.

You can’t be openly political just some of the time.

A somewhat better model than the APA’s antitorture resolution, it seems to me, is the approach that the American Academy of Pediatrics (AAP) took on the issue of same-sex marriage in 2006. Presumably disturbed by the anti-gay-marriage referenda springing up around the country, representatives of the AAP looked at the evidence on the effects of gay and lesbian parents and of legalized same-sex marriage on children. Then they published a well-referenced paper, not “whereas-ing” and “be-it-resolve-ing” about what the government should do, but concluding what the evidence shows:

More than 25 years of research have documented that there is no relationship between parents’ sexual orientation and any measure of a child’s emotional, psychosocial, and behavioral adjustment. These data have demonstrated no risk to children as a result of growing up in a family with 1 or more gay parents. Conscientious and nurturing adults, whether they are men or women, heterosexual or homosexual, can be excellent parents. The rights, benefits, and protections of civil marriage can further strengthen these families.

The differences may seem subtle, but I think they’re critical. Where the APA statement on torture was free of citations and references to studies, the AAP paper on gay parents was full of them. Where the APA statement said what the government must and must not do, the AAP paper instead identified what would help and hurt children of gay parents.

Even better might be a model that lays out the evidence in a peer-reviewed paper and that is distributed accompanied by a letter from the parent professional society – a letter not to elected representatives, but to the society’s own members, encouraging those members to weigh in directly, individually, if they feel strongly about the issue. That, it seems to me, would be better for science and medicine, and safer for professional societies, too.

Published on: November 7, 2008
Published in: Bioethics

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