Second opinions

Last year in June, one of the largest medical societies in the United States, the American Academy of Pediatrics (AAP), published a policy statement describing how doctors should treat “lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth.” Pediatricians, the organization warned, should guard themselves against “homophobia and heterosexism,” which it claimed could contribute to “higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections.” It added that doctors should never refer such patients for “conversion” or “reparative therapy.”

Quentin Van Meter, a pediatric endocrinologist from Atlanta and a 37-year member of AAP, was outraged: There was no evidence the health risks linked with LGBTQ lifestyles were primarily driven by social stigmatization. After nearly four decades of heavy involvement in the AAP—including serving as chairman of the Uniformed Services West chapter—Van Meter decided not to pay his $650 annual dues.

When a member services employee called, Van Meter told her the AAP no longer represented his views. She answered, “Yeah, we’ve heard a lot of that,” the doctor recalls.

For Van Meter, the LGBTQ policy was one overdose too many. Back in 1976—the year he became a member—the organization had been more ideologically balanced. But by the late ’80s and ’90s, he says, AAP leaders were appearing in photo ops with Democratic politicians and promoting gun control across the United States.

“Whatever the Democrats wanted, the AAP said, ‘How high should we jump, and what should we say?’” says Van Meter. “I’m saddened that something that could have turned out to be very beneficial for kids has actually turned out to be a political slimeball.”

AAP is one of several mainstream medical associations founded decades ago that appear to have trended leftward in recent years. They were created to represent and further the interests of the medical field and local doctors, but increasingly, conservatives who belong to them believe their views are no longer represented among leadership.

The stakes are high: Groups like the AAP, the American Medical Association, and the American Congress of Obstetricians and Gynecologists spend hundreds of millions of dollars lobbying lawmakers in Washington, D.C., pressing for changes to healthcare insurance, abortion laws, sex education funding, and more. They publish regular policy statements intended to reflect best practices in their fields. Doctors, lawmakers, and even judges use the statements to guide their own decisions.

Conservatives see the leftward lurch and want to push back, but as Van Meter says of the AAP, “If you don’t believe in the political views of the leadership … you are shunned.” Instead, some are joining smaller, distinctly conservative medical associations that are acting as an antidote to their liberal counterparts.

ONE OF THEM is the American College of Pediatricians (ACP), where Van Meter serves as a board member: “We are all about science. We are all about proofs.” The organization is not religiously affiliated, but Van Meter describes members as “moral people who are like-minded, and want truth, and want what’s best for children.”

Den Trumbull, the president of the organization, became fed up with AAP in 2002, when the organization issued a controversial policy statement in favor of allowing same-sex couples to adopt children.

“They said it was based on science,” says Trumbull. But he and many of his colleagues found it to be shaky science: In the technical report accompanying the statement, the AAP argued children of same-sex couples were emotionally and socially well-adjusted. Yet, they admitted of their research, “the small and nonrepresentative samples studied and the relatively young age of most of the children suggest some reserve.”

That year, Trumbull and three other doctors—including former AAP president Joseph Zanga—founded the ACP as an alternative pediatric association. “All of us were members of the AAP,” says Trumbull, a pediatrician from Montgomery, Ala. “We felt like the AAP was increasingly placing its social issue policy on political correctness and not on science.”

The ACP promotes abstinence before marriage, respects the sanctity of life from conception to natural death, and recognizes the “father-mother family unit, within the context of marriage, to be the optimal setting for childhood development.” Citing scientific studies, it opposes same-sex parenting as potentially harmful to children, and calls it “unethical” for doctors to withhold psychotherapy as an option for adolescents questioning their sexuality. (Some research suggests as many as 75 percent of youth who experience same-sex attraction ultimately declare themselves heterosexual.)

Since 2012, by contrast, AAP has issued policy statements in support of gay marriage, in favor of providing teens with emergency contraceptives and condoms, and in opposition to parents keeping guns in their homes.

AAP policy doesn’t necessarily reflect the views of the members it claims to represent. The organization’s policy statements are written by committees (appointed by elected board members), and its 62,000 member pediatricians do not vote on them. In a statement, AAP told me, “Each policy statement is reviewed extensively by internal AAP expert bodies and approved by the board of directors.” It added it has “no political affiliation.”

Trumbull said ACP submits all its policy statements to a member vote: Policy does not become official unless three-quarters of the membership approve. (ACP does not publish its membership size but has members in 46 states. Its current-year budget is about $70,000, it said.)

Even without a lobbying arm, ACP has waded into big controversies, filing amicus briefs in cases like Welch v. Brown, in which it defended the right of California doctors to offer sexual orientation change therapy to adolescents.

“When we take a look at the amicus briefs that are filed … we find ourselves as the only secular group speaking on behalf of the child,” said Trumbull. “Our focus has to be on the well-being of the child, not the wants of adults.”

GOVERNMENT-CONTROLLED healthcare has been a noticeably polarizing force among doctors. In a surprise move in 2009, the American Medical Association (AMA), representing about 1 in 5 U.S. doctors, endorsed Obamacare. The move sparked an exodus of about 12,000 from the organization, or 5 percent of its membership. (Its ranks have recovered since then.)

Some of those frustrated doctors presumably joined other, smaller medical associations, such as Docs4PatientCare, formed in 2009 specifically to oppose nationalized healthcare.

Around that time, the Association of American Physicians and Surgeons saw an uptick in membership. It was the first medical society to sue to overturn the Affordable Care Act. “We believe that physicians should work for patients and not for third parties, including government,” says Jane Orient, a doctor from Tucson, Ariz., and a spokeswoman for the group, which was founded in 1943. It has about 5,000 members, and its budget is a fraction of the AMA’s: Officers and directors attending the group’s meetings pay for their own plane tickets.

By comparison, AMA is a giant: Along with state affiliates, it has spent nearly $300 million on lobbying efforts since 1990, and last year it was the nation’s eighth most active Washington interest group. It has traditionally supported Republican efforts toward malpractice reform and opposed government control of healthcare, even opposing Medicare in the 1960s. “Since that time the AMA has drifted farther and farther to the left, and actually seems to be one of the primary advocates of government medicine,” says Orient.

THIRTEEN DOCTORS founded the American College of Obstetricians and Gynecologists (ACOG) in 1951. Now based in Washington, D.C., the association calls itself “the nation’s leading group of professionals providing healthcare for women,” with over 58,000 members. (The group’s companion 501(c)(6), the American Congress of Obstetricians and Gynecologists, formed in 2009 to take over lobbying activities and also uses the ACOG acronym.)

In 2012, ACOG encouraged doctors to recommend intrauterine devices and contraceptive implants to adolescents, endorsed over-the-counter access to emergency contraceptives for young girls, and said doctors should “support media campaigns clarifying that emergency contraception will not terminate an established pregnancy.” (Doctors who believe life begins at fertilization would dispute that claim.)

In September last year, after the U.S. Supreme Court struck down the Defense of Marriage Act in United States v. Windsor, ACOG issued a statement endorsing homosexual marriage.

ACOG’s “progressive” tendencies began early on. In 1971 ACOG issued a statement saying doctors should be legally free to provide contraceptives even to an unmarried adolescent “who refuses to involve her parents.” In 1972, ACOG said minors should have access to legal abortion with or without parental consent. Just a few months later, in January 1973, the U.S. Supreme Court decided Roe v. Wade.

A week after the Supreme Court decision, a Florida obstetrician and gynecologist named Matthew Bulfin got on the phone and began asking colleagues about starting a pro-life special interest group within ACOG. By April, the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG) was born.

Today, AAPLOG is a nonprofit entity with 2,500 associates and members, many of whom remain members of ACOG because of the professional benefits provided. “We exist to give a second opinion,” says Donna Harrison, AAPLOG’s executive director. On its website, the organization has posted documents addressing subjects ranging from surgical abortion to emergency contraception to breast cancer.

The second opinion is needed: Fact sheets on ACOG’s website describe abortion as a “low-risk procedure,” claim there is “no evidence that having an abortion increases the risk of getting breast cancer,” and claim “most experts agree that one abortion does not affect future pregnancies.”

But Harrison points out studies have linked abortion to breast cancer, depression, suicide, and alcohol abuse. And women who have abortions are more likely to have a subsequent premature birth, she says: “This association is well known and well documented, and yet ACOG, in their publications, refuses to acknowledge it.”

For Harrison, the final overdose came in November 2007, when ACOG published “Committee Opinion Number 385.” It said doctors who morally object to “reproductive services” like abortion or emergency contraception “have a duty” to refer patients to doctors willing to provide them—or in an emergency, are obligated to provide them themselves, “regardless of the provider’s personal moral objections.”

“I told ACOG that I would no longer be a member when they put out ethics statement 385,” says the Michigan doctor, who has not paid her dues since then.

ACOG spent $1.5 million on lobbying efforts in 2013 alone, according the Center for Responsive Politics, which tracks publicly reported political spending and contributions from individuals, businesses, and organizations. According to lobbying records ACOG was legally required to file, the organization has weighed in on issues related both to women’s health and to abortion. Between 2006 and 2009, ACOG lobbyists pressed their case on abortion access, emergency contraception, international family planning, stem cell research, and the pro-abortion Freedom of Choice Act. Records from 2010 to 2013 indicate pro-life bills, such as the No Taxpayer Funding for Abortion Act, were also on their political agenda. (The records don’t always say whether they lobbied for or against a bill.)

A 2008 filing noted an ACOG lobbyist worked to “urge House and Senate to shift federal funding from abstinence-only sexuality education to fund comprehensive sexuality education.” Toward the end of the year, ACOG weighed in on the “Mexico City Policy” (pro-abortion groups called it the “Global Gag Rule”), a ban on using federal funds to provide or promote abortion overseas. President Bush had upheld the ban throughout his two terms. But near the close of 2008, an ACOG lobbyist “communicated with the Office of the President-Elect on the Global Gag Rule.” Newly inaugurated President Barack Obama repealed the ban as one of his first orders in January 2009.

ACOG did not return my request for comment on its lobbying records and fact sheets.

AAPLOG has sometimes succeeded in halting actions that could threaten the rights of pro-life doctors: In 2008 the American Board of Obstetrics and Gynecology (ABOG), an organization that certifies ob-gyns to work in hospitals, updated its certification standards to require doctors to “adhere to ethical standards outlined by ACOG and sanctioned by ABOG.” The move could have forced pro-life doctors to provide abortion referrals or lose their certification, and consequently, hospital jobs.

“They changed their wording very subtly,” says Harrison. “So we screamed.” The Bush administration listened and months later issued rules to strengthen doctors’ conscience rights. ABOG soon after deleted the problematic language.

Looking to the future, Harrison is concerned the new healthcare law’s cost-cutting measures could make it harder for doctors who refuse abortions to get hired at cash-strapped hospitals. The fight, she says, will be tough: “It feels kind of hostile for those of us who practice Hippocratic medicine.”

Paid in cash

For a glimpse into the political culture at the American Academy of Pediatrics, just follow the money. According to the Sunlight Foundation, employees of AAP and its affiliates have given about 4 out of 5 dollars in reportable campaign contributions to Democratic candidates or causes.

The giving habits of AAP’s lobbying chiefs are also telling: Elizabeth “Jackie” Noyes, who served as director of AAP’s Department of Federal Affairs in Washington, D.C., from 1977 until retirement in 2009, donated at least $39,525 to Democrats (including Al Gore, John Kerry, and Hillary Clinton) and liberal causes between 1994 and 2008. At least $18,575 of that went to EMILY’s List, an organization that works to elect pro-abortion, Democratic women to office.

AAP’s new lobbying director, Mark Del Monte, gave at least $2,525 to Democratic politics between 2008 and 2013. Of that, $275 went to support an initiative opposing California’s ban on homosexual marriage, Proposition 8. According to AAP’s IRS documents, Del Monte received $219,211 in compensation and benefits from the organization in 2012.—D.J.D.