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.
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 -