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165th House of Delegates Online Resolution Comment is closed.

All comments will be included in the online Delegate Handbook. 

Comments below will be read-only until Thursday, March 30.


DIRECTIONS

  1. Online resolution comments will be accepted by members from February 24 through March 23. 
  2. Click on link of each resolution to review/view/download PDF of resolution(s).
  3. Click on the google form to comment - one form per resolution.
  4. Comments are posted under the specific resolution as received, with most current comment at bottom of comment box.
  5. Comments are posted after review from MSMA Headquarters.
  6. MSMA reserves the right to edit comments for length, grammar, and clarity.
  7. MSMA reserves the right to not post comments that are unprofessional, derogatory, or of a personal nature.
  8. No images or graphics are allowed.  You may include links in your comments. 
  9. Anonymous comments will not be posted.


Comments

Marc Taormina, MD - Gastroenterology - Lee's Summit - Representing Self - No Disclosures

The MSMA should reject this resolution. Missouri should not become a transgender sanctuary state as this resolution would encourage. Despite the many stated facts promoting gender reaffirming care in this resolution, there is significant controversy and dissent about the benefits of transgender care. Utilizing taxpayer funds for elective transgender therapy is against good public policy. MSMA members who practice and have lived in Missouri caring for our citizens know this is a misdirected resolution promoting transgender activism.


William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

I think this is a TERRIBLE idea and it will be divisive to our association. This is not good medicine. I STRONGLY OPPOSE.


William Robert Reynolds, MD - Plastic and Reconstruction Surgery - Representing Self - No Disclosures

I strongly oppose this resolution as it will require MSMA to support access to gender affirming care and oppose any state/other efforts that limit requirements to provide it in adults. The resolution is a divisive political issue which, as a society, should stay clear. There is junk science associated with surgeries and hormone therapy and the junk science has led many countries to oppose procedures and hormones for minors.

There is one certainty if the MSMA approves such a Resolution-membership will decline as it never has before. Many long-time members will simply quit the MSMA. The goodwill MSMA has with the state legislature will be harmed. The respect the MSMA has in the state legislature will be lost. This resolution should be strongly opposed.


John C. Hagan, III, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core issues for physicians and their patients. This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. This resolution should not be submitted to a reference committee nor considered by MSMA delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate MSMA from the political norms of the state legislature.


Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Personally, I object to those who oppose such resolution based on a fear that they would be divisive and lead to the loss of members without citing any science /evidence as to whether it would be a benefit to patients. I contend that not addressing such matters that concern the health and wellbeing of Missourians, especially when it involves treatments backed by the most prominent medical associations worldwide, is what is divisive and which would be more likely to lead to members leaving our ranks than a well-intentioned, well supported (by science) measure to protect those most vulnerable in our state. Those politicians and legislators who oppose access to such care don't give a rip about the health of children; this is politically motivated threat to health and is in the lane of any state medical association that proports to be a champion of patient health. We have a duty to debate such an important issue. To those who stoke fear that even debating such a resolution would lead to the loss of members, I hereby promise to quit MSMA if it is not debated. I don't expect that MSMA will do everything I think it should do, but if MSMA cowers from debating such issues in public every time a politically controversial medical issue arises, then my time and energy can be more effective in health organizations that put patients first. 


Charles Adams - Medical Student - Kansas City - Representing Self - No Disclosures

As its title states, this resolution pertains solely to gender-affirming care for adults. Something that is so widely supported by the peer-reviewed, multi-sourced statistics is the definition of solid scientific evidence. A primary goal of any medical society should be to improve patient health and quality of life. As the stats have shown for many years, gender-affirming care does exactly that. If peer-reviewed research stating the opposite exists, I would happily read it. A full understanding of an issue requires investigating all arguments and, more than anything, focusing on the scientific literature.

Any issue regarding healthcare is relevant in a medical society. This issue directly impacts Missouri healthcare and the autonomy of Missouri physicians. Certain parties have a considerable amount to gain by pushing incendiary narratives that anger and pit people against one another. It is on us to see through this and do what is best for patients. Transgender Americans are 9x as likely as the general population to attempt suicide. Gender affirming care has been consistently shown to decrease psychological distress and suicidal ideation.

Perhaps taking a stand on this timely issue may dissuade some from the MSMA. Failure to do so will also dissuade people from the MSMA. It will cause Missouri to lose graduating medical students and young physicians who choose to go elsewhere to practice medicine.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

I recall that when I matriculated to medical school, I was told something to the effect that "50% of what we teach you will become known to be wrong within 5 or 10 years. We just don't know which 50% that is." So it is with this issue. The science of this matter differs from the time when many of us were in medical school.

Here is the key point. The science of the matter verifies that "sex" and "gender" are different concepts. Sex is the genetic sex with which one is born, so those who assert that those born a boy will always have a "Y" chromosome are correct, as regards SEX. However, Gender is a different construct. Most of us align as to our sex and our gender, but there exists a substantial minority of our population who do not live in this comfortable place. I can only imagine how disquieting that would be, if I were so-impacted.

But, let's return to "science". When many of us were in medical school, sex and gender were considered to be interchangeable. We now know that this is not true. Just as when I graduated medical school in 1986, quinolone antibiotics were research drugs and today's immune modulators were not even a dream, so also has the science of gender vs. sex moved forward. Many doctors correctly have embraced many new science-derived tools, the results of rigorous peer-reviewed research, such as quinolone antibiotics and immune modulator drugs.

So, my question is this: How can it be that the same doctors of the MSMA who clearly and correctly have embraced numerous research-derived tools like new antibiotics and immune modulators would be the same doctors who roundly reject the peer-reviewed science of the differences between "sex" and "gender"? I know that I am coming off as a "contrarian" here, but I believe that this resolution, which challenges many members' understandably-derived beliefs, deserves our science-informed support. Again, to support this wil require the putting aside of beliefs that are difficult to ignore for many of our good members. Further, this and another resolution regarding this matter were proposed by some of our youngest members. The young members of MSMA are our future, and we owe to them to give their ideas a fair airing. We don't owe younger members the passage of this controversial proposal, but we do owe them a fair consideration of the controversial ideas it contains. So, in the interest of the future of the MSMA, in the interest of collegiality, and in the interest of accepting new scientific findings that are wildly at variance from concepts that many of us either believe or were taught as medical students (or both), I ask that MSMA members become informed of the fact that it is a broadly-held scientific perspective that gender is different from sex, and that there are some in our population whose sex and gender do not align. We are men and women of science, and in living this role, sometimes our beliefs come under challenge. This is one of those occasions. I support this resolution.


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is politically divisive and does not represent the beliefs of many MSMA members. It would divide the MSMA membership and potentially cause members who disagree with this resolution to quit MSMA. MSMA cannot afford this loss or a division of our membership. MSMA can adopt positions for lobbying on this and other issues in response to actual legislative challenges. I have faith in the membership and process at MSMA to represent all of the membership and our patients in these matters. The organization should not have it's hands tied in advance by a resolution such as this, and this resolution should not be adopted.


Brent Davidson, MD - Ophthalmology - Fenton - Representing Self - No Disclosures

Should not be adopted.


Alex Shimony - Medical Student - St. Louis - Representing the MSMA Medical Student Section - No Disclosures

This resolution is narrowly focused on providing health care to a specific group of marginalized Missourians and fighting back against government overreach into limits on the health care that physicians are able to provide their patients. As a physician and patient advocacy organization, we should strive to provide the best medical care possible for our patients and oppose government limits on that care, especially when the peer-reviewed literature overwhelming supports the benefits of providing gender affirming care for transgender individuals. Claims stating this body of literature is "junk science" have not been substantiated and are only based on fear.

I am not naïve to think that this resolution will not be controversial, but that controversy is not based on the science or on the medicine, it is based on a highly charged political environment that has been fed by misunderstandings. While some MSMA members may personally disagree with this resolution, we should not be thinking about our personal beliefs but what is best for the patients that we take care of.

We have heard year after year that there is a physician shortage in Missouri, that medical students who train here don't stay. I have heard that as a state we are the largest exporter of medical students in the country. Medical students and young physicians care about these issues and don't want to practice medicine in an environment that puts them in a straight jacket as to how they can practice medicine. Taking stances on these topics shows that MSMA is serious about fighting for physicians AND patients.


Nicole Neville - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. We cannot call ourselves competent or capable physicians if we let politics decide who receives care. It is undeniable that trans people live longer and happier lives when allowed access to gender-affirming care. It a gross violation of our oath to do no harm if we allow people to suffer simply because of personal prejudice. It is our duty as physicians to rely on evidence based medicine not misguided personal opinions. Trans people are 1-2% of the population, this makes them underrepresented and vulnerable. There are currently over 15 bills trying to harm this small group and we must protect them.

We as prominent and dedicated learners of science already know that sex is not binary. We have hydroxylase deficiencies, androgen insensitivity syndromes, Turner's, etc., to hold onto old beliefs of what gender in order to hurt people we don't agree with is shameful and we need to do better.

It was also once a "political and divisive" issue to allow black people to read. No one who has denied the basic human rights of another group has ever been on the correct side of history. We need to pass this resolution and tell every single person in Missouri that they deserve quality and equitable healthcare.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Michael Hilzendeger - Medical Student - Washington University - Representing Self - No Disclosures

Gender affirming care is simply not a novel practice in medicine. If a male presents to the clinic with a receding hairline, his clinician can prescribe finasteride to address hair loss. If a breast cancer survivor who underwent mastectomy begins to feel dysphoric about their chest, they can receive breast augmentation to feel affirmed by their physical appearance. If a menopausal woman finds herself debilitated by hot flashes and poor sleep, she can be prescribed hormone replacement therapy to address her symptoms. If a patient with prostate cancer needs to be treated with a GnRH agonist, they can be treated with bicalutamide to block a testosterone surge safely and effectively. The list goes on and on. Why is it that these treatments are perfectly acceptable by most physicians and far less divisive than gender affirming care for transgender individuals? One could glean from the opposition to this resolution that its opponents do not object to the practice of gender affirming care but rather object to the mere existence of transgender people. People have existed beyond the gender binary throughout history and it is long past due that this patient population be supported by their physicians. The MSMA should align itself with every major national medical association and support this life-saving healthcare.


Madeline Sauer - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

Very well-written resolution and speaks to a very important issue currently facing health care.

Any argument that this resolution should be abandoned solely on the basis that it is "politically divisive" and may not represent the values or personally held beliefs of some Missourians is diverting attention from the goal of this resolution. This resolution speaks to the medical data (not a belief but a scientifically backed theory) that supporting gender-affirming healthcare leads to better outcomes (including decreased psychological distress and suicidal) for our patients.

The goal of MSMA and this resolution is to protect and foster a safe and supportive environment for our patients to thrive regardless of the individual practitioner's own belief, political stance, or religious background.

This resolution speaks to an important way to improve access and care to Missouri patients and, therefore should be adopted by MSMA.


Nikita Sood - Medical Student - Washington University - Representing Self - No Disclosures

Regarding concerns about membership: The hostility with which our Missouri legislature treats our most vulnerable communities--including transgender patients--is directly related to why me and so many of my peers are leaving this state for the next step of our training. As a medical association, conversations about membership are incredibly important. If MSMA continues to stay silent when our most vulnerable populations are attacked by the state legislature, I worry that we will continue to lose members who feel that we prioritize staying out of political divisive conversations over our duty to our patients.


Ashley Glass - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. Opposition to this resolution has been based on politics, but this resolution is supported by science. This resolution helps reduce harm towards a vulnerable population. It makes health care safer and more accessible to ALL patients. No matter your political opinion, every patient is a human being that deserves quality health care that meets their medical needs. This resolution ensures just that. 


Lauren Van Winkle - Medical Student - Kansas City - Representing Self - No Disclosures

The MSMA states that "We are hundreds of dedicated physicians and staff who are working to maintain medical standards and ethics, and ensure Missourians´ access to quality health care." I am in support of this resolution, due to the overwhelming evidence emerging supporting gender-affirming care for transgender patients. MSMA should strongly consider this resolution and join its colleagues in supporting transgender patients. Access to gender-affirming care is synonymous with access to quality health care, which is at the core of MSMA's aims. 


Nicholas George, MD, MPH - Internal Medicine and Pediatrics - Kansas City - Representing Self - No Disclosures

As a provider of LGBTQ care in the Kansas City area, I can certainly attest to the need for gender affirming care. Many patients who experience gender dysphoria or discordance with their sex assigned at birth have had significant trauma throughout their lifespan. Having an appropriate environment to receive care is crucial. Patients may or may not qualify for treatment options depending on insurance coverage, and providers who are familiar with barriers to access care are vitally important. Furthermore, training programs for providers are needed to ensure appropriate use of services. I am in agreement with this proposal as it will improve health care outcomes and reduce health expenditure on a whole; although, it is only the first steps.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution.


Satya Sivasankar - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

I support this resolution.



Comments

Marc Taormina, MD - Gastroenterology - Lee's Summit - Representing Self - No Disclosures

MSMA should reject this misguided resolution. This resolution wants to codify the use of puberty blockers and the use of public funds for gender affirming care in Missouri youth below the age of 18. Transgender life altering care should not be allowed in minors below the age of 18 and Missouri should not become a transgender sanctuary state. These decisions should be reserved for consenting adults as puberty blockers have significant medical risks including increased cardiovascular, hormonal, and emotional issues that may be irreversible. Allowing activist physicians and counselors to decide what is best for a minor is antithetical to Missouri's core values. We should protect Missouri's youth from transgender activism.


William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This is a HORRENDOUS idea. It is not good medicine. It will divide our society. We should stick with health care and not dabble in nonsense such as this.


William Robert Reynolds, MD - Plastic and Reconstruction Surgery - Representing Self - No Disclosures

This requires MSMA to support access to gender affirming care and oppose any state/other efforts that limit puberty blockers and gender-affirming care in children. This should be strongly opposed by MSMA and I encourage everyone to read carefully the whistleblower Jamie Reed's article in the Free Press (February 9, 2023). It is an amazing expose of her time at the Washington University Transgender Center at the St Louis Children's Hospital.  See: https://www.thefp.com/p/i-thought-i-was-saving-trans-kids

The Resolution should be strongly opposed. Like Resolution #1, Resolution #2 is politically divisive and will decrease our membership, weaken our good reputation in the state legislature. This is a political issue pure and simple.


John C. Hagan, III, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core issues for physicians and their patients. This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. This resolution should not be submitted to a reference committee nor considered by MSMA delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate MSMA from the political norms of the state legislature. 


Charles Adams - Medical Student - Kansas City - Representing Self - No Disclosures

Puberty blockers have been used for decades in cisgender youth to treat precocious puberty. There has been no objection to this use of these drugs on children for whom they are indicated until now. Decisions are best made based on years of reproducible, repudiated research, not a single report whose existence likely provides social or financial influence to individuals or political agendas. Healthcare providers should stick with the science.

There is substantial evidence showing the overall effect of these drugs are positive. “Puberty suppression decreases behavioral and emotional problems, and significantly increases general functioning and social well-being”. Adolescents taking puberty blockers are overwhelmingly satisfied with their treatment and “perceive it as essential and life-saving”. Powerfully, 82% of transgender individuals have considered taking their own life and 40% have attempted suicide, with suicidality highest among transgender youth. Further providing irrefutable evidence, the efficacy of hormone blockers have been explicitly stated by the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and American Psychological Association.

The point of a medical society is to discuss issues relating to the sacred patient-physician relationship. We have a responsibility to use our education and our best scientific judgement to examine the available research and make timely recommendations to society. Especially considering most Americans lack understanding of this issue. The MSMA’s decision on this issue has the potential to either hugely help or harm transgender youth. It is our duty to do everything we can to safeguard access to healthcare for this vulnerable population.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

As I stated re: Resolution #1, I recall that when I matriculated to medical school, I was told something to the effect that "50% of what we teach you will become known to be wrong within 5 or 10 years. We just don't know which 50% that is." So it is with this issue. The science of this matter differs from the time when many of us were in medical school.

Here is the key point. The science of the matter verifies that "sex" and "gender" are different concepts. Use of medications offer clear benefits to some who live in the gap where there sex and gender do not align. Those who assert that those born a boy will always have a "Y" chromosome are correct, as regards SEX. However, gender is a different construct. Most of us align as to our sex and our gender, but there exists a substantial minority of our population who do not live in this comfortable place. I can only imagine how disquieting that would be, if I were so-impacted.

Without repeating all of the comments I offered for Resolution #1, I ask that MSMA members become informed of the fact that it is a broadly-held scientific perspective that gender is different from sex, and that there are some in our population whose sex and gender do not align. We are men and women of science, and in living this role, sometimes our beliefs come under challenge. This is one of those occasions. I also support this resolution, because it offers support for a tool that is highly useful for those whose sex and gender are not aligned.


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is politically divisive and does not represent the beliefs of many MSMA members. It would divide the MSMA membership and potentially cause members who disagree with this resolution to quit MSMA. MSMA cannot afford this loss or a division of our membership.
MSMA should not take a position on this resolution at this time, as the actual impact of the gender transition clinics on the individuals they treat is being hotly debated right now. Independent journalist Bari Weiss' interview with the counselor pushed out of the clinic at Children's Hospital in St. Louis should be studied https://www.thefp.com/p/i-thought-i-was-saving-trans-kids Additionally, the use of hormones, puberty blockers and so forth is being restricted in most of Europe, where I believe these issues are more evidence-based and less political https://www.city-journal.org/yes-europe-is-restricting-gender-affirming-care.  MSMA can adopt positions for lobbying on this and other issues in response to actual legislative challenges. I have faith in the membership and process at MSMA to represent all of the membership and our patients in these matters. The organization should not have it's hands tied in advance by a resolution such as this, and this resolution should not be adopted.


Alex Shimony - Medical Student - St. Louis - Representing the MSMA Medical Student Section - No Disclosures

This resolution is narrowly focused on providing health care to a specific group of marginalized Missourians and fighting back against government overreach into limits on the health care that physicians are able to provide their patients. As a physician and patient advocacy organization, we should strive to provide the best medical care possible for our patients and oppose government limits on that care, especially when the peer-reviewed literature overwhelming supports the benefits of providing gender affirming care for transgender individuals.

Puberty suppressing hormones are not irreversible, in fact as soon as an individual stops taking the medication, their natural hormone function returns. It is this reason why they are used in children, because they can delay a child from going through a puberty making their physical body more discordant with their gender. If they change their mind later on, which is incredibly rare, the medication can be stopped and they can go through puberty as normal. These treatments are safe, effective, and widely supported as standards of care by a multitude of medical organizations such as the American Academy of Pediatrics, the Endocrine Society, and the American Academy of Child and Adolescent Psychiatry. As physicians, we routinely look to provide the best care for our patients and we should not let our own personal beliefs effect the care of those patients.


Nicole Neville - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. Once again, we cannot let personal prejudice deny people access to healthcare. This is a decision that needs to be made by children, their parents, and their physicians. It is a gross overstep to interfere with parents getting life-saving care for their kids for no other reason than ignorance. Children are smart and capable beings who have a better understanding of their bodies and their lives than strangers on the internet do. Medicine and politics are intertwined and we need to take a strong stance in order to protect our patients and let them know that we support them.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Bina Ranjit - Medical Student - Kansas City - Representing Self - No Disclosures

Hormone blockers are given to children and adults for a variety of reasons. Spironolactone is a popular choice given to people for sx like acne and hirsutism. Gender affirming care consists of simple steps like helping a patient manage their unwanted facial hair and this simple step can make a world of difference to one's confidence and mental well-being.

Everything is political said my political professor in college. It is important as a medical association to discuss and support issues faced by our physicians. If a legislative body bans all gender affirmative care, physicians are going to be left helpless to treat any and all patients. Truth is kids are dying because society doesn't accept what they've known their entire lives. They should be able to trust their physician to provide them with adequate care. And we should be able to keep them healthy and alive. 


Ashley Glass - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution for reasons I previously stated under resolution #1.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution.


Nikita Sood, MD -  Washington University - St. Louis - Representing Self - No Disclosures

I am speaking on behalf of myself in SUPPORT of this resolution. "Puberty suppressing hormone blockers are recognized as both safe and lifesaving by the World Professional Association for Transgender Health, American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Psychological Association, and the Endocrine
Society." The medical experts are at a clear consensus on the importance of providing gender affirming care to transgender youth and as a medical association, I believe MSMA should align with these experts.

I will not reiterate verbatim my comments regarding membership on Resolution #1, though much of the sentiment is the same. If MSMA remains silent during this unprecedented attack against our most vulnerable patients (and a well-respected medical institution), MSMA will also risk losing dues-paying members.


Satya Sivasankar - Medical Student - University of Missouri - Columbia -  Representing Self - No Disclosures

I support this resolution.



Comments

Marc Taormina, MD - Gastroenterology - Lee's Summit - Representing Self - No Disclosures

The MSMA should reject this resolution. The assigned sex at birth is a fact. It is a biological certainty that you are or either male or female when you are born. Trying to erase the biological distinction by allowing a legal change to birth certificates and legal documents is an attempt to dismantle the basic structural DNA evidence of the differences between a man and a woman - changing a document does not change the basic composition of the human body. This incendiary resolution is an attempt to remove the final barrier to gender homogeneity and to alter Missouri's mainstream values, structures and our way of life. Finally, gender identification is paramount in emergency situations when physicians may be called upon to render care in an unresponsive patient - another reason to reject this resolution.


William Robert Reynolds, MD - Plastic and Reconstruction Surgery - Representing Self - No Disclosures

This is a TERRIBLE idea. Stick with the genetic makeup of the newborn. This will divide our association. Leave the politics to the politicians. Please stay with THE SCIENCE. You either have a Y chromosome, or you don’t.


John C. Hagan, III, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core issues for physicians and their patients. This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. This resolution should not be submitted to a reference committee nor considered by MSMA delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate MSMA from the political norms of the state legislature. 


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

As I stated re Resolutions #1 and #2, I recall that when I matriculated to medical school, I was told something to the effect that "50% of what we teach you will become known to be wrong within 5 or 10 years. We just don't know which 50% that is." So it is with this issue. The science of this matter differs from the time when many of us were in medical school. Here is the key point. The science of the matter verifies that "sex" and "gender" are different concepts. Those who assert that those born with their SEX as a boy will always have a "Y" chromosome are correct, as regards SEX. However, Gender is a different construct. Most of us align as to our sex and our gender, but there exists a substantial minority of our population who do not live in this comfortable place. I can only imagine how disquieting that would be, if I were so-impacted. Without repeating all of the comments I offered for Resolution #1, I ask that MSMA members become informed of the fact that it is a broadly-held scientific perspective that gender is different from sex, and that there are some in our population whose sex and gender do not align. I am thankful not to be one of those people, but we are men and women of science. In living this role, sometimes our beliefs come under challenge. This is one of those occasions. I also support this resolution, because it offers support for a process that is highly useful for those whose sex and gender are not aligned.

That said, I am troubled by the idea that those who were born with a "Y" chromosome yet whose gender is female should be allowed to compete against other girls or women in sports events. No matter how low a trans-gender Y-chromosome possessing person's testosterone level becomes, that person is born with various biomechanical advantages that accure to their having a "Y" chromosome. A man's "Q-angle" at the knee, the angulation of the femur at the hip, offer advantages in running sports that cannot be reversed by hormonal therapy. And, the "carrying angle" or an XY man of female gender, as opposed to an XX woman of male gender, has an advantage for swimming. If one looks up world records for men vs. women in swimming and running sports, the difference between XX and XY is larger than can be accounted by testosterone levels.

SO, even though I support permitting an XY person born a boy to change their birth certificate to reflect their female gender, I staunchly oppose them leveraging this to enable crossing over to compete in girls' or women's sports.


Julia Dmowska, MD - Resident - Representing Self - No Disclosures

As you learn in medical school, there are very many conditions including Androgen insensitivity syndrome (XY), Klinefelter's syndrome (XXY), Turner syndrome (XO), XYY syndrome, and intersex individuals. Gender dysphoria is a clinical diagnosis as stated in DSM-5-TR. Birth certificates ask for gender, they do not ask for sex. If allowing an intersex individual or a patient with Androgen insensitivity syndrome to identify a certain gender on a birth certificate why are we not allowing a person with another clinical diagnosis to do the same?


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. Such resolutions should not be adopted by the house of delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and should not be approved.


Charlie Adams - Medical Student - Kansas City - Representing Self - Primary Author of Resolution

Commenting as primary author of the resolution, as of 2023, differences in sexual differentiation are considered important enough to healthcare that they are an emphasized aspect of COMLEX 1/Step 1. In the first year of medical school alone, we learned about several intersex conditions. It is important that we acknowledge and learn about possible variations in sex so that we are best able to serve all patients. It makes sense to change rules in society that are restrictive and exclusionary to entire populations.

Birth certificates are not a requirement to be treated at medical facilities. The ability to change one’s gender marker on driver’s licenses and insurance cards is easily accessible already. For that reason, healthcare providers often don’t know when they are treating transgender people in the first place. This has very often been my experience as if I do not tell providers I am transgender; they assume I was born male at birth.

Protecting the ability to alter one’s birth certificate is required to change some legal documents or to obtain employment. Statistics show that presenting an ID contrary to one’s physical gender expression poses physical danger to this population.  Thirty-two percent of transgender people who presented an ID that did not match their gender expression were harassed, asked to leave an establishment, or physically assaulted. Additionally, safeguarding the ability to change gender markers and names on IDs results in increased well-being in the trans community. Those who are able to do so experience significantly lower rates of depression, anxiety, suicidal ideation, or psychiatric distress.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Ashley Glass - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. This resolution is not intended to be about politics. This resolution is about public health. Transgender people are harassed, harmed, and largely unsupported by health care. If there is a way that we, as a medical society, can help change that, then shouldn't we? I understand we have to assess the implications of passing any resolution. However, claims that passing this would dissolve the MSMA and ruin relationships with legislatures, the same could be said if it is not passed. 


Lauren Van Winkle - Medical Student - Kansas City - Representing Self - No Disclosures

"The Mission of the Missouri State Medical Association is to serve its members through promotion of the science and art of medicine, protection of the health of the public." As aforementioned in my comments for Resolution #1, an overwhelming amount of studies are showing that gender affirming care for transgender patients is beneficial for their health outcomes. Part of gender affirming care includes identity. Transgender patients should have the ability to receive official documentation that matches their identity; this is an essential step in their transition. This may seem peripheral to the mission of MSMA, however as physicians and medical students we can take this opportunity to shed a light on these issues. I support this resolution, because the protection of the mental and physical health of the public is our goal.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution.


Nikita Sood, MD -  Washington University - St. Louis - Representing Self - No Disclosures

I am in SUPPORT of this resolution. Arguments claiming that gender should solely be defined by chromosomes ignore the many medical conditions that contradict that claim. An individual with androgen insensitivity syndrome will have XY chromosomes but will phenotypically present as female and may identify as female. Should they then have male or female on their birth certificate? Ultimately, restrictions that require a surgical transition to allow for a gender marker change just place arbitrary barriers that hurt transgender patients and help no one. 


Satya Sivasankar - Medical Student - University of Missouri - Columbia -  Representing Self - No Disclosures

I support this resolution.

Comments

Marc Taormina, MD - Gastroenterology - Lee's Summit - Representing Self - No Disclosures

The MSMA should reject this resolution. The assigned sex at birth is a fact. It is a biological certainty that you are or either male or female when you are born. Trying to erase the biological distinction by allowing a legal change to birth certificates and legal documents is an attempt to dismantle the basic structural DNA evidence of the differences between a man and a woman - changing a document does not change the basic composition of the human body. This incendiary resolution is an attempt to remove the final barrier to gender homogeneity and to alter Missouri's mainstream values, structures and our way of life. Finally, gender identification is paramount in emergency situations when physicians may be called upon to render care in an unresponsive patient - another reason to reject this resolution.


William Robert Reynolds, MD - Plastic and Reconstruction Surgery - Representing Self - No Disclosures

This is a TERRIBLE idea. Stick with the genetic makeup of the newborn. This will divide our association. Leave the politics to the politicians. Please stay with THE SCIENCE. You either have a Y chromosome, or you don’t.


John C. Hagan, III, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core issues for physicians and their patients. This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. This resolution should not be submitted to a reference committee nor considered by MSMA delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate MSMA from the political norms of the state legislature. 


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

As I stated re Resolutions #1 and #2, I recall that when I matriculated to medical school, I was told something to the effect that "50% of what we teach you will become known to be wrong within 5 or 10 years. We just don't know which 50% that is." So it is with this issue. The science of this matter differs from the time when many of us were in medical school. Here is the key point. The science of the matter verifies that "sex" and "gender" are different concepts. Those who assert that those born with their SEX as a boy will always have a "Y" chromosome are correct, as regards SEX. However, Gender is a different construct. Most of us align as to our sex and our gender, but there exists a substantial minority of our population who do not live in this comfortable place. I can only imagine how disquieting that would be, if I were so-impacted. Without repeating all of the comments I offered for Resolution #1, I ask that MSMA members become informed of the fact that it is a broadly-held scientific perspective that gender is different from sex, and that there are some in our population whose sex and gender do not align. I am thankful not to be one of those people, but we are men and women of science. In living this role, sometimes our beliefs come under challenge. This is one of those occasions. I also support this resolution, because it offers support for a process that is highly useful for those whose sex and gender are not aligned.

That said, I am troubled by the idea that those who were born with a "Y" chromosome yet whose gender is female should be allowed to compete against other girls or women in sports events. No matter how low a trans-gender Y-chromosome possessing person's testosterone level becomes, that person is born with various biomechanical advantages that accure to their having a "Y" chromosome. A man's "Q-angle" at the knee, the angulation of the femur at the hip, offer advantages in running sports that cannot be reversed by hormonal therapy. And, the "carrying angle" or an XY man of female gender, as opposed to an XX woman of male gender, has an advantage for swimming. If one looks up world records for men vs. women in swimming and running sports, the difference between XX and XY is larger than can be accounted by testosterone levels.

SO, even though I support permitting an XY person born a boy to change their birth certificate to reflect their female gender, I staunchly oppose them leveraging this to enable crossing over to compete in girls' or women's sports.


Julia Dmowska, MD - Resident - Representing Self - No Disclosures

As you learn in medical school, there are very many conditions including Androgen insensitivity syndrome (XY), Klinefelter's syndrome (XXY), Turner syndrome (XO), XYY syndrome, and intersex individuals. Gender dysphoria is a clinical diagnosis as stated in DSM-5-TR. Birth certificates ask for gender, they do not ask for sex. If allowing an intersex individual or a patient with Androgen insensitivity syndrome to identify a certain gender on a birth certificate why are we not allowing a person with another clinical diagnosis to do the same?


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. Such resolutions should not be adopted by the house of delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and should not be approved.


Charlie Adams - Medical Student - Kansas City - Representing Self - Primary Author of Resolution

Commenting as primary author of the resolution, as of 2023, differences in sexual differentiation are considered important enough to healthcare that they are an emphasized aspect of COMLEX 1/Step 1. In the first year of medical school alone, we learned about several intersex conditions. It is important that we acknowledge and learn about possible variations in sex so that we are best able to serve all patients. It makes sense to change rules in society that are restrictive and exclusionary to entire populations.

Birth certificates are not a requirement to be treated at medical facilities. The ability to change one’s gender marker on driver’s licenses and insurance cards is easily accessible already. For that reason, healthcare providers often don’t know when they are treating transgender people in the first place. This has very often been my experience as if I do not tell providers I am transgender; they assume I was born male at birth.

Protecting the ability to alter one’s birth certificate is required to change some legal documents or to obtain employment. Statistics show that presenting an ID contrary to one’s physical gender expression poses physical danger to this population.  Thirty-two percent of transgender people who presented an ID that did not match their gender expression were harassed, asked to leave an establishment, or physically assaulted. Additionally, safeguarding the ability to change gender markers and names on IDs results in increased well-being in the trans community. Those who are able to do so experience significantly lower rates of depression, anxiety, suicidal ideation, or psychiatric distress.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Ashley Glass - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. This resolution is not intended to be about politics. This resolution is about public health. Transgender people are harassed, harmed, and largely unsupported by health care. If there is a way that we, as a medical society, can help change that, then shouldn't we? I understand we have to assess the implications of passing any resolution. However, claims that passing this would dissolve the MSMA and ruin relationships with legislatures, the same could be said if it is not passed. 


Lauren Van Winkle - Medical Student - Kansas City - Representing Self - No Disclosures

"The Mission of the Missouri State Medical Association is to serve its members through promotion of the science and art of medicine, protection of the health of the public." As aforementioned in my comments for Resolution #1, an overwhelming amount of studies are showing that gender affirming care for transgender patients is beneficial for their health outcomes. Part of gender affirming care includes identity. Transgender patients should have the ability to receive official documentation that matches their identity; this is an essential step in their transition. This may seem peripheral to the mission of MSMA, however as physicians and medical students we can take this opportunity to shed a light on these issues. I support this resolution, because the protection of the mental and physical health of the public is our goal.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution.


Nikita Sood, MD -  Washington University - St. Louis - Representing Self - No Disclosures

I am in SUPPORT of this resolution. Arguments claiming that gender should solely be defined by chromosomes ignore the many medical conditions that contradict that claim. An individual with androgen insensitivity syndrome will have XY chromosomes but will phenotypically present as female and may identify as female. Should they then have male or female on their birth certificate? Ultimately, restrictions that require a surgical transition to allow for a gender marker change just place arbitrary barriers that hurt transgender patients and help no one. 


Satya Sivasankar - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures


Comments

Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Excellent. See: https://www.nejm.org/doi/full/10.1056/NEJMp2210192


Comments


Comments

Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Great resolution except the RESOLVES are a bit weak. I would suggest adding something along these lines to request some means to transfer this criminal liability to the state of Missouri given the (intentional) ambiguity of the law.

RESOLVED, that MSMA will not deny MSMA membership to any physician charged with or convicted of a crime with respect to the provision of healthcare involving abortion when such alleged crime would not have been illegal prior to the Dobb’s decision.

RESOLVED, that MSMA will formally request that the governor of the State of Missouri immediately set up an abortion decision-making commission, available on a moment’s notice, which will assume FULL responsibility for the decision as to whether or not it is legal to perform the abortion in any and every situation where said abortion is declared by any physician to be indicated to protect the life and health of the mother. If the commission deems it is legal, that physician may proceed without the threat of any criminal liability. If the abortion request is denied, than the State will immediately assume the medical liability for that women’s care for the remainder of that pregnancy with respect to the provision of abortion services providing that the requesting physician(s)/hospital provide timely updates, based on the commission's guidance, back to the commission until the time of birth and/or death of the mother.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - Disclosure: Author of Resolution

Dr Cornella, with surely the best of intent, proposes a state-convened committee to adjudicate whether an emergency exists, at a time when we ALL KNOW that such an emergency already exists. I appreciate that we are living in a topsy-turvy world right now, and that he wants to build in a protection for doctors.

However, once we determine there is an emergency, the EMTALA statute should suffice, and state laws shouldn't matter, unless we have quit following the Constitution of the United States and its "Supremacy Clause".

ALSO: The holding of a hearing by the type of commission envisioned would only add needles delay and give commission members the chance for "grandstanding".

Further, if the commission won't grant us "permission" to do that which we know we need to do anyhow, and they "accept blame" for what happens afterward, that accepting of blame does no good for the patient! We know what we need to do when an obstetrical emergency threatens the patient and dooms the fetus. I would not be content to look my patient in the eye and tell her that I know what needs to occur, but I can't do it because I fear what a malevolent committee might do to me.

PLUS: Who gets appointed to serve on these committees? In Ohio in a prior session of their legislature, a legislator proposed a law to require the attempted re-implantation of an ectopic pregnancy into the uterus, rather than permitting doctors to do the right thing.

In closing, we must not let ourselves be painted into a corner on this matter. Let's not do ANYTHING that even gives anyone the mistaken impression that we want or are even willing for ANY state actions to ensue, once we have determined that an emergency condition exists.

I am thankful for Dr. Cornella's thoughtful efforts, but I suggest we not adopt his well-intentioned suggestion here. 


Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

I concur with Dr. Gaddis' response to my first comment, but would say that EMTALA will not shield the physician on those cases that meet the criterial from emergency from being sued. As I understand it, the physician has to prove innocence and from what I see, there is a desire to strike fear in physicians who do any abortion such that a suit is likely to be brought by someone (laws written such that a person does not have to have legal standing, but more of a bounty hunter) even for cases that are legal. Agree that no ethical physician would let any law stand in the way of patients' interest, but there should be some mechanism that takes those cases that are legal and protects them from frivolous legal action, right? I think the resolutions regarding abortion being considered should point out in the Whereas clauses that the current abortion law's vagueness is not unintentional as it seeks to create a climate of confusion and fear that blocks all abortion, regardless of the legal exemptions and so action by MSMA is needed to protect patients and physicians. 


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - Disclosure: Author of Resolution

Dr. Cornella and I agree more than we disagree, I believe. However, we need to keep the distinctions between "civil" law and "criminal" law clearly in mind. To be sued for alleged malpractice is a matter for civil litigation. The matter at hand and addressed by this proposed resolution is the very real risk of being indicted for an alleged felony, a matter of criminal law, over the action of taking steps to cause the termination of a pregnancy that is causing an emergency medical condition.

Unfortunately, due to the flawed Missouri abortion statute, a potential "fallout" for doctors who act correctly and in compliance with any reasonable medical standard of care is the potential for a CRIMINAL indictment of a doctor, and that is not a "civil" matter such as alleged malpractice, which IS a matter of CIVIL law.

Because of the supremacy clause of the US Constitution, Article VI Para 2, EMTALA (a federal statute) must be held to supervene over current state laws to the contrary. EMTALA provides a legal shield those who provide EMTALA-mandated care to a patient with an obstetrical emergency, even if a fetal heartbeat remains. However, it is that presence of a fetal heartbeat which could potentially be used by agents of the state of MO to allege the doctors giving medically-indicated care have committed a felony offense. (Also, recall that current MO statute specifies a need for a "positive defense", but that is another topic for another day).

This resolution does not delve into how current MO law is highly flawed. The resolution simply asks that the MSMA stand behind the idea that if a doctor is charged with a felony offense for doing the right thing and complying with EMTALA to successfully and correctly treat a patient with an obstetric emergency, that an exception MUST be made as regards medical staff privileges. It is my understanding that to be charged with a felony leads invariably to loss of hospital privileges.

I seek that the MSMA advocate that for a doctor to be charged with a felony incurred due to providing medically indicated care should constitute a special exception, for which staff privileges will not be removed. (I thank Ravi Johar, MD,  for noting this horrible downstream consequence of being charged with a crime by an overzealous prosecutor looking to make some "cheap" political points).

To my view, the actions of former AG Eric Schmitt as regards school mask mandates in the time of the winter 2021-2022 COVID flare shows that the medical community cannot trust the state or its agents to apply common sense or to adhere to principles of good health when there is a political point to be made. Since we do not seek and cannot change who are the politicians in office (and indeed, this would not be a matter germane to the MSMA), we must address that we realize that we CAN work with hospitals to protect our members, in the case that such a felony indictment becomes issued.

We KNOW that there will be cases of ectopic pregnancies and other obstetric emergencies in which the patient does not yet have "unstable" vital signs, yet for whom EMTALA clearly dictates that we act quickly, even BEFORE the patient has signs of physiologic instability. We can logically fear that somewhere in Missouri, a doctor or some doctors who did the right thing, will be charged with a felony. We need to protect those doctors from loss of hospital staff privileges while they contest the ridiculous charge that they acted illegally when acting to preserve the life of the mother and her reproductive system's future health, as dictated by the EMTALA statute.


Comments

Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Excellent. However, found the last RESOLVED to be confusing (to me) with the wording. Maybe substitute: RESOLVED, that our MSMA oppose efforts to INCLUDE provisions IN spending bills which limit state funds from being used for abortion care.


William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

I think this is a terrible idea. This is not the common sentiment among our society. We should stick with pure science and leave this alone.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

I can provide a copy of an article from the Phi Beta Kappa quarterly, "American Scholar", which documents that abortion access was quite the norm in colonial times when the Constitution of the United States was adopted, and that state-level prohibitions of elective abortions of pregnancies did not begin to become enacted until the middle of the 19th Century. While I doubt that such an article would be persuasive to those opposed to enabling access to abortions, it does cast as a lie the assertion that in America, we have "always" had laws against abortion, even from the first years of the Republic. That article to which I refer, "Safer than Childbirth", by Tamara Dean, appeared in the Spring 2022 edition of "American Scholar". As the article details, abortion in the 19th Century was widely accepted as a means of avoiding the substantial risks of pregnancy in that era. In fact, at that time, even the leaders of the Catholic Church believed that it was only at the time of "quickening" that it was believed a human life had begun to exist. So, the assertion that the Catholic Church has always viewed abortion as an evil or as a sin is demonstrably false. 


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. Support for or opposition to abortion is a electrified rail that MSMA should not touch. Such resolutions should not be adopted by the House of Delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and this resolution should not be approved.


Brent Davidson, MD - Ophthalmology - Fenton - Representing Self - No Disclosures

Should not be adopted.


Charlie Adams - Medical Student - Kansas City - Representing Self - Primary Author of Resolution

I am commenting as the primary author of the resolution. The majority of both physicians and Americans support access to abortion care. Yet we as a country have allowed a small group of powerful politicians implement restrictions to this vital care. The states with the most restrictive abortion laws also have the worst maternal and child health outcomes. We owe it to our most vulnerable patients to advocate for policy that protects them. Those forced to give birth after being denied an abortion are four times more likely to be in poverty for four years after than those who received abortions. It is time we get the politicians out of our exam rooms and out of people’s uteruses. We do not allow politicians who know nothing about medicine to make decisions on other issues. We should not allow them to do so on this issue.


Alex Shimony - Medical Student - St. Louis - Representing the MSMA Medical Student Section - No Disclosures

This resolution at its core is about protecting the physician patient relationship and stopping non-physicians in Jefferson City from dictating how Missouri physicians should practice. We don't tolerate that invasion on other aspects of medical care so why do we allow it in this space. As maternal mortality rates in the United States continue to rise (https://www.cnn.com/2023/03/16/health/maternal-deaths-increasing-nchs/index.html), people should be empowered to make the best health care decisions for themselves with the advice of their doctors.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Madeline Sauer - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

This resolution speaks to the importance of evidence-based standard of care for our patients in Missouri, including access to safe medical abortions. As mentioned, preventing access to care can increase the maternal mortality rate by 29%.

Regardless of the political or religious stances of an individual physician, it is our duty as physicians to safeguard our patient's access to safe care in Missouri, which this resolution helps with. I support this resolution and the MSMA should adopt it


Ashley Glass - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. Abortion services is health care and this resolution is backed by research. 


Lauren Van Winkle - Medical Student - Kansas City - Representing Self - No Disclosures

The MSMA's goal is to "ensure Missourians´ access to quality health care." This includes evidence-based reproductive healthcare. I support this resolution and its further consideration. 


Priya Thakur - Medical Student - Kansas City - Representing Self - No Disclosures

I am in support of this resolution.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution.


Nikita Sood, MD -  Washington University - St. Louis -  Representing Self - No Disclosures

I am in SUPPORT of this resolution. As a student pursuing a career in OB/GYN, I and many of my peers had to focus our residency applications outside of Missouri so that we could better ensure we would get appropriate training and avoid unnecessary politicization of the care we provide. It is important to me that MSMA support access to abortion care (and, by extent, abortion training) in our state.


Satya Sivasankar - Medical Student - University of Missouri - Columbia -   Representing Self - No Disclosures

I support this resolution. Evidence-based medicine forms the cornerstone of medical practice. Being unable to provide medical care that is supported by evidence is a disservice to our patients. It is important to recognize that medicine is unique because it is ever changing. Ideas and practices that were acceptable years ago are later found to be nonoptimal. Medicine should never stay stagnant as that would only result in poor care for patients. I believe that is the core of this resolution and why we should support. 


Ramona Behshad, MD - Dermatology - St. Louis - Representing elf - No Disclosures 

Highly personal.  Deeply divisive. Membership not united on this front. Do not adopt.


Comments

Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Excellent. Long overdue. I would just add that MSMA should also support smart gun technology legislation: https://www.americanprogress.org/article/smart-guns-technology-that-can-save-lives/


William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This is a BAD IDEA. Leave politics to the voters. This will divide our association.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

The last "Resolved" is a bit imprecise, yet clearly well-intended. What is a "high capacity" magazine? What is an "assault rifle"? Would it not be more precise to propose to ban private ownership of weapons that have a capacity in excess of a precisely-stated number of rounds per unit time (e.g. anything greater than x rounds per y min)?

ALSO, might the "Whereas" clauses benefit from a statement that modern firearms have advantages in ease of firing, in accuracy of targeting and in number of rounds fired per second that did not exist in Colonial times, when the Second Amendment was written (and therefore, the Second Amendment must be viewed as a source that does not and cannot be logically argued to support the bearing and use of weapons that have been designed and manufactured to modern specifications not possible at the time of the adoption of the Constitution)? 

After all, if the "originalist" view of the Constitution of the United States holds that no support for the right to abortion can be held to exist, because the Constitution was silent on the matter, and if "Originialists" wish to be consistent (e.g. you can't be an "originalist" for one part of the Constitution and not another), then by extension, the Constitution is also silent on the issues of modern firearms, and thus a logical Originalist would limit the available firearms to those available in the latter Colonial times.


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. Support for or opposition to gun control/bans is a electrified rail that MSMA should not touch. Such resolutions should not be adopted by the house of delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and this resolution should not be approved.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution taken directly out of the far-left anti-gun handbook. It uses intentionally vague terminology such as "assault-type firearms" and "high-capacity ammunition magazines" to confuse the reader. I assume the sponsor is referring to what would be more accurately classified as "modern sporting rifles" and "standard capacity magazines" which are in common use with tens of millions of Americans. The statistics cited are intentionally misleading to provoke an emotional response. The facts show that semiautomatic rifles are rarely used in criminal homicide (the entire category of "rifles" is only 3%), and are almost never used in suicide. Banning them will not significantly address either problem. Furthermore, most so-called red-flag laws present serious due-process legal issues as written, and we currently have a mandatory background check requirement.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Madeline Sauer - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

Any argument that this resolution (or any other resolution for that matter) should not be adopted based solely on the potential political or religious stances of individual members of MSMA is inherently missing the point of MSMA and these resolutions.

This resolution is in keeping with AMA policy to focus on Firearms Violence Prevention and increase the safety of all Americans. Firearm safety is an important medical issue, and it is MSMA's duty to diligently craft and approve firearm safety resolutions since it keeps our patients and fellow Missourians safe.

Additionally, there is support for firearm safety by our national medical societies, and Missouri would be remiss not to also provide resolutions and support in keeping with the national medical community. 


Nikita Sood, MD -  Washington University - St. Louis -  Representing Self - No Disclosures

I am speaking in SUPPORT of this resolution. Firearm violence is the #1 cause of death in children. Our patients in Missouri are affected by firearm violence every day. This resolution proposes support for reasonable measures to reduce firearm violence.

As the resolution itself says: "the intention of this resolution is not to take guns from sportsmen and restrict second amendment rights, firearm safety measures are needed to protect the health and well-being of our citizens, especially our children; while there is no simple solution to reducing gun violence in Missouri, there are several common-sense steps from which to begin."



Comments

William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This is a bad idea and totally unnecessary. You either have a Y chromosome or you don’t. This is a divisive idea and will harm our association.


John C. Hagan, III, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core issues for physicians and their patients. This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. This resolution should not be submitted to a reference committee nor considered by MSMA delegates. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate MSMA from the political norms of the state legislature. 


William Robert Reynolds, MD - Plastic and Reconstruction Surgery - Representing Self - No Disclosures

Another bad idea which is politically fraught with consequences that MSMA does not need. 


Jay Devineni, MPH - Medical Student - Columbia - Representing Self - Author of Resolution

Thank you to all who have provided feedback on this resolution. I am the primary author, and I would like to address the concerns that have been raised and clarify exactly what the resolution is and is not asking.

First and foremost, this resolution is asking MSMA to oppose anti-DEI bills that directly threaten the accreditation of our medical schools. If passed, these bills would prohibit our medical schools from requiring education in diversity, equity, and inclusion (DEI), despite the fact that the LCME (accreditation body for allopathic schools) and COCA (accreditation body for osteopathic schools) both require instruction of these concepts in their accreditation standards. Protecting the accreditation of Missouri's medical schools is well within the scope of MSMA's mission, as a loss of accreditation would impede our state's ability to maintain an adequate supply of medical graduates and address physician shortages.

Secondly, I want to clarify exactly what "DEI Education" means in the context of medical education. It largely refers to teaching medical students about the social determinants of health that underlie various health disparities, which is essential for students to learn if they want to provide high-quality, patient-centered care. Although the presence of DEI education tends to attract a more diverse pool of medical school applicants, it is NOT the same thing as affirmative action and does not involve any alteration of admission standards. It also does not punish anyone for their opinions - in fact, it encourages diverse perspectives.

As such, this resolution is not asking MSMA or its members to subscribe to any belief or position on affirmative action, gender affirming care, or any other issue that MSMA typically finds controversial. All it is asking is for MSMA to oppose a specific type of bill that: 1) directly jeopardizes the accreditation of our medical schools; and 2) fundamentally undermines the teaching of important health concepts. Thank you. 


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

I support this student-submitted resolution. Just as we rightly decry instances in which the state interposes itself inappropriately into the patient examination room, as has occurred with the abortion issue, so we should stake out an objection to permitting the state to make curricular mandates. Legislators can be very bad for enabling the implementing of what science tells us is possible. It is very easy to cite proposed legislation that would be scientifically impossible to implement. Consider, for example, the recent proposal from an Ohio legislator in 2021 to require fetuses removed as an ectopic pregnancy to be re-implanted into the uterus. Consider MO Rep Caleb Rowden's 2022 proposed law to make the removal of an ectopic pregnancy a felony offense. We as men and women of science are in a much better position than any legislator to determine what is appropriate for our patients, AND for a medical school or residency curriculum. It is a well-recognized fact that patients at risk for health care disparities can benefit from DEI initiatives in medical schools, so as to better educate the students and residents who are the learner community, toward enabling better patient outcomes. We should stand behind the idea that the state needs to keep its unwelcome and invasive nose out of this matter of social science.

Keep the unwanted legislators' "camel's nose" out of our medical education enterprise "tent."


Yak Nak - Medical Student - University of Missouri-Columbia - Representing Medical Students - No Disclosures

Recent legislative efforts to ban diversity, equity, and inclusion (DEI) requirements in medical schools are deeply concerning. Efforts to limit DEI education in medical schools is a disservice to both medical students and the patients they will one day serve. Medical education must reflect the diversity of the communities being served, and that includes education in DEI topics. Without a strong foundation in DEI, medical students will be ill-equipped to provide culturally competent care to patients from diverse backgrounds. It is imperative that we oppose any attempts to limit DEI education in medical schools and continue to prioritize education that reflects the needs of our diverse patient populations.


Amanda Faust - Medical Students - University of Missouri-Columbia - Representing Self - No Disclosures

As a fellow medical student at the University of Missouri I am in support of continuing DEI in our curriculum. It is an essential part of our medical education and should be treated as such. The principles and ideologies taught in DEI educate shape physician-patient interactions and ultimately the delivery of care. This piece of our education should be protected. 


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and highly political and will be evaluated negatively by many dues paying MSMA members. Support for or opposition to DEI education is a controversial matter that MSMA should not touch. Such resolutions should not be adopted by the house of delegates.
To the extent that diversity or DEI education is required for accreditation by allopathic and osteopathic schools, MSMA will defend the need of the schools and can certainly lobby in favor of our schools' compliance with their accreditation standards. MSMA does not have to be bound to supporting these principles beyond that. If adopted as a MSMA position, this resolution will cause a loss of many dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and this resolution should not be approved.


Brent Davidson, MD - Ophthalmology - Fenton - Representing Self - No Disclosures

Should not be adopted.


Charlie Adams - Medical Student - Kansas City - Representing Self - No Disclosures

I personally would not like to see my school or any medical school in Missouri lose its accreditation for such an unnecessary reason. DEI education makes us more competent and empathetic physicians. It improves care for patients. If we want to lessen the healthcare gaps of underserved communities, we must start by informing the next generation of doctors about these issues. I am in full support of this resolution.


Nicole Neville - Medical Student - Kansas City - Representing Self - No Disclosures

I support this resolution. Banning diversity, equity, and inclusion in healthcare is based on ignorance and hatred. There are clear and present racial divides in medicine that need to be discussed if we have any hope of making them any better. It is absolutely ridiculous to think that we can become better physicians by learning less. Our vulnerable populations depend on us being educated about their healthcare needs in order to receive quality healthcare.

Attempts at banning diversity, equity, and inclusion, are a sad attempt to deny healthcare to those who need it most. Removing DEI would harm black women, the LGBTQ+ community, homeless populations, survivors of abuse, immigrants, etc. Our job as physicians is not to pass judgement on who deserves healthcare it is to provide it to everyone. 


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


James Donnelly, MD - Dermatology - Chesterfield - Representing Self - No Disclosures

I oppose this resolution as it is controversial, inappropriately politically polarizing, contrary to MSMA’s policy of avoiding resolutions that will alienate many dues paying MSMA members and our friends in the Missouri State Legislature. MSMA should not take a position on this resolution, and not accept it for discussion by the delegates due to its threat to MSMA viability. 


Madeline Sauer - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

As the resolution states, diversity, equity, and inclusion (DEI) education helps to reduce health disparities, improved patient care, and better financial performance.

Diversifying our workforce, training, and allowing physicians to connect more with their patients is imperative to patient outcomes. Regardless of the political or religious stances of an individual physician, it is our duty as physicians to safeguard our patient's access to healthcare and equitable treatment within the healthcare system. I support this resolution and think the resolution should be adopted by MSMA. 


Nikita Sood - Medical Student - Washington University - Representing Self - No Disclosures

I am speaking on behalf of myself in support of this resolution. The crux of this resolution is that Missouri legislators' initiatives to prohibit DEI education in medical schools directly threaten the accreditation of our Missouri medical schools. MSMA should oppose bills that threaten the accreditation of Missouri medical schools. I do not think that MSMA protecting Missouri medical school accreditation is politically divisive or should lead to us losing members.


Bina Ranjit - Medical Student - Kansas City - Representing Self - No Disclosures

DEI education provides the much needed human context to our basic sciences curriculum. It also prepares you to be a resident and physician in whatever part of the country your training takes you. Social determinants of health education has been excellent so far in informing students on issues pertinent to a diverse America today. Removing this from curriculum would be a disservice to Missouri students. 


Emily Schaff - Medical Student - Representing Self - No Disclosures

As a medical student myself, I would like to voice strong support for this resolution. DEI initiatives are a requirement for LCME accreditation of medical schools. Current Missouri HB 489 poses a threat to our medical schools' ability to retain accreditation, and this resolution would give explicit foundation in MSMA policy to oppose this proposed bill. We are very aware that Missouri is facing a physician crisis and that physicians are likely to practice close to where they train. Without accredited medical schools, students will be forced to train elsewhere, and this crisis will be further exacerbated. Even if you do not agree with DEI ideologies, it should not be disputable whether LCME accreditation is imperative for our schools to achieve. Please support this resolution as it will allow MSMA to oppose HB 489 and keep Missouri medical schools accredited. 


David Kuhlmann, MD - Sleep Medicine - Sedalia -  Representing Self - No Disclosures

I support Resolution #9. Medical schools should be allowed to shape their own curriculum. I actually wish that I would have had DEI education when I was in medical school. So many of our patients are from different backgrounds. It would have been nice to have a little training on that in the 90's. Anyone opposed to heavy handed government should support this resolution that attempts to ban what medical schools currently teach.


Maren Loe, MD - Washington University - St. Louis - Representing Self - No Disclosures

I support this resolution. Medical schools need to be able to change their curricula to comply with LCME requirements. State level legislation will complicate this.

Charlie Adams - Medical Student - Kansas City - Representing Self - No Disclosures

I think it is necessary to specify all protected groups. Otherwise, it leaves room for certain individuals to take issues with a group and claim they do not need to respect them. This is often religiously-based with people claiming they don’t need to recognize another group’s humanity if it does not align with their religious views. This has been especially prevalent in much of society as we’ve all seen in the news. Leaving it general may have the same intent but it lacks the amount of protection spelling it out grants. I will say that I, as a transgender medical student, looked into the discrimination and diversity statements of every single school I applied to. If they did not specify protection of gender identity or LGBTQ populations, I did not apply there. It would be awful to go to a medical school and have to wait until I got there to find out if it is actually a good place for someone like me. KCU spelled all of that out in a way that I knew I was protected and the school has been wonderful as far as how supported I feel as a trans student. To make other students and physicians from marginalized groups feel they have a place in the MSMA, we should explicitly write out that we see, acknowledge, and protect people from these varying perspectives and life experiences.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. It amounts to virtue signaling, as these groups are already protected by current anti-discrimination policies. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.


Madeline Sauer - Medical Student - University of Missouri - Columbia - Representing Self - No Disclosures

This is a no-brainer resolution that should be adopted. We are providing inclusive language that is in keeping with AMA language. 


Bina Ranjit - Medical Student - Kansas City - Representing Self - No Disclosures

Clarity in a non-discrimination policy is key in empowering members to feel safe, accepted, and free to report incidence of discriminatory practices/behavior. Studies have shown positive outcomes where state-level policies were protective, such as reduced suicidal ideation/attempts and better health outcomes.

A visiting physician speaker once said to my class that most people may not even notice a non-discrimination statement at your clinic but the people who’ve been hurt before will and that’s why you have one—that’s why you should make it visible to everyone.

Physicians in Missouri deserve to practice freely and not worry about perceptions of their attributes like age or color as long as their competency is intact.

Should we need to amend this statement in the future to add protected classes, I think that would be an easy fix. Almost every organization has a detailed non-discrimination policy to protect their members and Missouri physicians deserve the same.


Nikita Sood, MD -   Washington University - St. Louis -  Representing Self - No Disclosures

I am speaking in SUPPORT of this resolution. Firearm violence is the #1 cause of death in children. Our patients in Missouri are affected by firearm violence every day. This resolution proposes support for reasonable measures to reduce firearm violence.

As the resolution itself says: "the intention of this resolution is not to take guns from sportsmen and restrict second amendment rights, firearm safety measures are needed to protect the health and well-being of our citizens, especially our children; while there is no simple solution to reducing gun violence in Missouri, there are several common-sense steps from which to begin."



Comments

Frank Cornella, MD - Oral Maxillofacial Surgery - Springfield - Representing Self - No Disclosures

Perfect. A great improvement over the existing statement.


William White, MD - Ophthalmology - Kansas City - Representing Self - No Disclosures

This is a terrible idea. We should stick with the science. This is an area for fools to trod. If we pass this, it will divide our association.


Gary Gaddis, MD, PhD - Emergency Medicine - Chillicothe - Representing Self - No Disclosures

I stand in opposition to this proposal. I oppose overly prescriptive attempts to add clarity to an issue. The current broadly-worded resolution appears to me to already be in alignment with AMA policy. I find nothing unclear about, "All human beings..." As a 65-year-8-month old, I could cite numerous examples where, in attempting to add clarity, one "paints one's self into a corner." This appears to me to be one of those types of situations. Please vote against this well-intended resolution.


John Holds, MD - Ophthalmology - St. Louis - Representing Self - No Disclosures

This resolution is divisive and unnecessarily political and will be evaluated negatively by many dues paying MSMA members. The existing human rights/discrimination policy is thorough and adopted last year. This resolution should not be adopted by the house of delegates. If adopted as a MSMA position, this resolution will cause a loss of dues paying members and likely alienate legislators whose support we need on many matters. This resolution is peripheral to the purpose and goals of MSMA which stress unifying active members around core shared issues for physicians and their patients and this resolution should not be approved.


Brent Davidson, MD - Ophthalmology - Fenton - Representing Self - No Disclosures

Should not be adopted.


Charlie Adams - Medical Student - Kansas City - Representing Self - No Disclosures

I think it is necessary to specify all protected groups. Otherwise, it leaves room for certain individuals to take issues with a group and claim they do not need to respect them. This is often religiously-based with people claiming they don’t need to recognize another group’s humanity if it does not align with their religious views. This has been especially prevalent in much of society as we’ve all seen in the news. Leaving it general may have the same intent but it lacks the amount of protection spelling it out grants. I will say that I, as a transgender medical student, looked into the discrimination and diversity statements of every single school I applied to. If they did not specify protection of gender identity or LGBTQ populations, I did not apply there. It would be awful to go to a medical school and have to wait until I got there to find out if it is actually a good place for someone like me. KCU spelled all of that out in a way that I knew I was protected and the school has been wonderful as far as how supported I feel as a trans student. To make other students and physicians from marginalized groups feel they have a place in the MSMA, we should explicitly write out that we see, acknowledge, and protect people from these varying perspectives and life experiences.


Adam Buchanan - Ophthalmology - St. Louis - Representing Self - No Disclosures

Strongly oppose - should not be adopted. It amounts to virtue signaling, as these groups are already protected by current anti-discrimination policies. This is a politically divisive resolution sponsored by non-physician, non-dues-paying members. It will severely damage MSMA membership and our standing with the Missouri state government and the citizens of Missouri.