Documents show how conservative doctors influenced abortion, trans rights

A small group of conservative doctors has sought to shape the nation’s most contentious policies on abortion and transgender rights by promoting views rejected by the medical establishment as scientific fact, according to documents reviewed by The Washington Post that describe the group’s internal strategies.

The records show that after long struggling to attract members, the American College of Pediatricians gained outsize political influence in recent years, primarily by using conservative media as a megaphone in its quest to position the group as a reputable source of information.

The organization has successfully lobbied since 2021 for laws in more than a half-dozen states that ban gender-affirming care for transgender youths, with its representatives testifying before state legislatures against the guidelines recommended by mainstream medical groups, according to its records. It gained further national prominence this year as one of the plaintiffs in the federal lawsuit to limit access to mifepristone, a key abortion drug.

Despite efforts to invoke the credibility of the medical profession, the American College of Pediatricians is viewed with skepticism by the medical establishment. For years, the group has presented statistics and talking points to state legislators, public school officials and the American public as settled science while internal documents emphasize how religion and morality influence its positions. Meeting minutes from 2021 describe how the organization worked with religious groups to “affect the idea makers through the high courts, professional literature, and legislatures.”

It promotes conversion therapy, a discredited practice intended to change the sexual orientation or gender identity of LGBTQ people that most medical societies warn can result in harm. Pediatric experts deemed a June 2022 report crafted by the group that undergirds a new Florida policy banning transgender care for Medicaid recipients as “unscientific.” Francis Collins, former longtime director of the National Institutes of Health, accused the group in 2010 of distorting his research to “make a point against homosexuality.”

Jill Simons, executive director of the American College of Pediatricians, disputed criticism that her organization promotes policies that do not follow science. “Our recommendations are based on the medical research and what is best for children,” she said.

Her organization exists to represent “all the good pediatricians out there who agree with us who maybe are afraid to step forward,” Simons, a Minneapolis pediatrician, said in an interview with The Post. “Very smart people in the field of medicine have disagreed with a lot of these so-called consensus that is out there.”

Sam Wineburg, a Stanford University psychologist who studies online disinformation, highlights the American College of Pediatricians in his research as an example of a group that uses its name and scientific jargon to convey authority.

“It looks like an official medical organization, and you’re easily duped into thinking that this is the umbrella organization for pediatricians in the United States,” Wineburg said, noting the group has “all of the superficial bells and whistles of credibility.”

The records of the American College of Pediatricians - a cache of more than 10,000 confidential files including strategic plans, meeting minutes, membership rosters, financial statements and email exchanges spanning at least 15 years - were exposed after the organization left the contents of its Google Drive publicly accessible, according to two people who individually accessed the material following the inadvertent breach and shared copies with The Post. The Post examined the documents’ metadata, including the dates of each file’s creation and modification, to determine that they have not been recently manipulated. The document breach was first reported by Wired.

Simons characterized the exposure as a “malicious cyberattack and hate crime” that was “intended to intimidate and incapacitate.” She would not comment on the contents of the documents.

“Those who are against us know that they can’t beat us in debate about the facts of science or the research,” Simons said. “This deliberate attack on us shows that the American College of Pediatricians is having a huge impact, and that they’re afraid of us.”

The organization’s quest to ban the use of puberty blockers and hormone therapy for transgender minors has culminated in a string of recent legislative wins following lobbying in at least eight states, internal documents show.

Arkansas first enacted such a law in 2021, after Michelle Cretella, then executive director of the American College of Pediatricians, described such care as “experimental and dangerous” to legislators. A federal appeals court temporarily blocked it.

Versions of the law have since passed at least 20 other state legislatures, including Florida, Idaho, Indiana, West Virginia, Oklahoma, Missouri, Montana, Texas, North Dakota and Louisiana this spring alone; some face court challenges and one was vetoed by a governor. Similar bills are making their way through legislatures in North Carolina and Ohio.

At the federal level, Sen. Roger Marshall (R-Kan.), an OB/GYN, recently reintroduced legislation endorsed by the American College of Pediatricians that would prevent doctors from performing “gender transition procedures” on minors and bar federal funds from being used for such procedures. Marshall’s spokesperson said he is not a member of the group.

The American College of Pediatricians formed in 2002 after dozens of conservative doctors split from the nation’s leading interest group of pediatricians, the 67,000-member American Academy of Pediatrics, over the academy’s support for same-sex parenting. The academy had determined from its review of scientific literature that children with same-sex parents fare as well as those with heterosexual parents in emotional, cognitive, social and sexual functioning.

Joseph Zanga, founder of the American College of Pediatricians who had led the American Academy of Pediatrics in the late 1990s, described the splinter organization as “a Judeo-Christian, traditional-values organization” in a 2003 interview with the National Association for Research & Therapy of Homosexuality, which promoted conversion therapy. His organization’s core beliefs are “that life begins at conception, and that the traditional family unit, headed by an opposite-sex couple, poses far fewer risk factors in the adoption and raising of children,” he said at the time. Zanga declined a Post request for an interview.

Internal records from 2010 show how the group tied homosexuality to health risks - even death - in a letter campaign to educators, citing a 1991 study to demonstrate that for each year adolescents delay “self-labeling as ‘gay’,” the risk of suicide decreases by 20 percent.

According to more recent research, suicide risk rises with therapy directed at changing sexual orientation. Lesbian, gay and bisexual people who experienced conversion therapy were almost twice as likely to think about suicide and to attempt suicide compared with peers who had not experienced conversion therapy, according to the Williams Institute at the UCLA School of Law.

The documents reviewed by The Post include a 2010 letter from the American College of Pediatricians to 14,800 public school superintendents, urging school officials not to affirm any student expressing homosexuality. It directed them to a website operated by the group that pushed “sexual reorientation therapy” for those with “unwanted homosexual attractions.”

Collins, the former NIH director who led the international Human Genome Project, said in a written statement at the time that the American College of Pediatricians pulled language out of context from his 2006 book to “support an ideology that can cause unnecessary anguish and encourage prejudice.” The group’s characterization of homosexuality in its letter to superintendents is “misleading and incorrect, and it is particularly troubling that they are distributing it in a way that will confuse school children and their parents,” Collins said.

In recent years, the group has trained its focus on transgender care.

Records show the American College of Pediatricians launched a campaign against a St. Louis-based Catholic health system’s transgender care policy in 2017 after SSM Health outlined guidance that included hormone therapy and potential referrals for “gender assignment surgery.”

Cretella, then president of the American College of Pediatricians, urged the archbishop of St. Louis at the time, Robert Carlson, to issue a statement “that will denounce SSM Health’s embrace of transgender ideology over science and sound medical ethics, and demand that they rescind this policy,” according to a Feb. 8, 2017, letter.

Carlson, in his March 31, 2017, response, informed Cretella that he had contacted other bishops who had SSM hospitals in their diocese or archdiocese. Carlson also included a copy of a letter to SSM Health requesting the system cease the implementation of the transgender treatment policy within the next 30 days and revise it in accordance with Catholic moral theology.

SSM Health, which operates hospitals in Missouri, Illinois, Oklahoma and Wisconsin, told The Post it changed its transgender care policy in 2018 to comply with Catholic directives, but it would not say how the policy changed.

Kellan Baker, executive director of the Whitman-Walker Institute, a D.C.-based research, policy and advocacy center focused on LGBTQ health, accused the American College of Pediatricians of “intentionally and aggressively laundering pseudoscience through this veneer of respectability.”

“At first blush without knowing what’s actually behind it, you would think it is a pediatric medical professional organization,” Baker said. “It’s not. It’s a tiny group of fringe conservatives who didn’t like the fact that the field was leaving them behind.”

The group serves as a “vital counterweight” to the “ideological capture” facing medical societies, said Roger Severino, vice president of domestic policy at the Heritage Foundation, a prominent conservative think tank that he said relies on the American College of Pediatricians for scientific expertise.

“They have had the courage to take stands in court and to speak as medical professionals in relating their experience when it comes to questions of human dignity in unborn life, freedom of conscience, and the protection of children,” Severino said.

But Mark Del Monte, chief executive of the American Academy of Pediatrics, noted the vast differences in membership size and policies between his more established, widely respected organization and the similarly named American College of Pediatricians.

“To the extent that people would be confused about who was presenting evidence-based science, that is a concern for us,” Del Monte said. “Every policy statement of the American Academy of Pediatrics represents a rigorous review of the available scientific evidence and an extensive writing process that includes extensive peer review - and a unanimous vote by the board.”

The academy, which said more than 95 percent of its members are physicians, has pointed to “strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate.”

Records from early 2022 show membership of the American College of Pediatricians at about 700 people - just over 60 percent of whom self-identified as possessing medical degrees, including some holding prominent positions as hospital chiefs and a state health commissioner. The group, citing privacy, would not comment on the size or makeup of its membership.

Documents show the American College of Pediatricians worrying about its finances and trying to expand its reach in recent years. The group, supported by membership fees and donors, reported $123,131 in available funds as of January 2022, according to its financial spreadsheets.

The organization sent 15,000 mailers to “conservative” physicians between 2018 and 2019, according to postal receipts and spreadsheets of names and addresses. One 2018 planning document instructed the group to “TARGET CHRISTIAN MDs” in red letters as well as recruit pediatricians in “red states.” It also suggested contacting academics who have doctorates in sociology, epidemiology and bioethics.

Among the most prominent names listed on its internal membership records: John Hellerstedt, the Texas health commissioner from 2016 until 2022. Hellerstedt, in two phone conversations, declined to be interviewed.

Other members run departments at major hospitals in Ohio, Tennessee and Texas as well as a school health service in California, according to a Post analysis of the group’s membership list.

While agendas show the group opened and closed its meetings with prayer, Simons said, “We’re not a religious organization. Many of our members are people of faith.”

The group found an eager audience through conservative media, including the Tucker Carlson and Laura Ingraham shows on Fox News, the documents detail. Since 2016, the American College of Pediatricians has been mentioned in more than 200 articles published by conservative news sites such as Breitbart, Daily Wire, the Epoch Times, the Washington Examiner, the Blaze and the Gateway Pundit, according to a Post analysis. Its profile has continued to rise. The volume of articles mentioning the group during the first four months of 2023 was five times that of the same period in 2020, according to GDELT’s online news database.

“They’re part of a coordinated, politically motivated anti-science ecosystem,” said Peter Hotez, dean of Baylor College of Medicine’s National School of Tropical Medicine and an expert in misinformation.

Cretella, whose Rhode Island medical license expired in 2020 according to state medical board records, equated transgender care to child abuse during an appearance on Carlson’s show in July 2017. Neither Cretella nor the American College of Pediatricians responded to questions about the circumstances leading to the expiration of her medical license.

A senior booker on Carlson’s show contacted Cretella and other doctors affiliated with the group in August 2017 to respond to a Denver Post story about a transgender professional cyclist, according to emails in the documents. “How would a male who is now a female not be at an advantage?” the booker wrote.

“Scientifically speaking, all we can say is that a man dressed in chemical drag is still a man who should not be allowed to compete in women sports,” replied Cretella, who was unable to appear on the show that night.

She suggested the booker contact another member, Paul Hruz, a pediatrics professor at Washington University School of Medicine in St. Louis who voiced concern about children seeking hormone therapy during his appearance on the show. In a 2022 opinion on a North Carolina lawsuit over state coverage of gender-affirming care, a U.S. district judge excluded some of Hruz’s testimony on transgender care after deeming it “unreliable” and lacking scientific basis. After initially agreeing to an interview, Hruz did not respond to subsequent outreach from The Post.

Despite its prominence in conservative circles, the group was concerned it had an image problem, documents show. The Southern Poverty Law Center had designated the American College of Pediatricians as a “hate group” in 2012 for its anti-LGBTQ positions - a label that Amazon said prevented the American College of Pediatricians from receiving donations through the company’s now-defunct charity program, AmazonSmile. The group complained to Amazon, calling its policy unfair, according to emails to the company between 2014 and 2017. The company denied the group’s appeals, writing “that decision is final” in its September 2017 response. (Amazon founder Jeff Bezos owns The Post.)

Slides for a 2018 American College of Pediatricians board meeting focused on recruiting featured an image of Ku Klux Klan members titled “Perception” as well as an image of Justice League superheroes titled “What Our Friends Think of Us,” illustrating how drastically opinion about the group varied, with some viewing them as villains and others as heroes.

Since 2006, the group has partnered with other conservative organizations to file amicus briefs across at least 30 high-profile cases pertaining to same-sex marriage, gay parental rights, abortion and, in later years, transgender issues, according to a 2021 “funding request prospectus.” The group had also submitted an amicus brief in the Supreme Court case that overturned Roe v. Wade last year, emphasizing the group’s belief in the “sanctity of human life.”

The recent release of internal documents has only amplified its cause, said Simons, the group’s executive director. The group is now fundraising for “cyberattack recovery efforts.”

“There’s a silent majority out there that stands with us,” she said. “This act has awoken a sleeping giant.”

The Heritage Foundation sent out a fundraising appeal on behalf of the American College of Pediatricians following the exposure of its internal documents: “It’s more important than ever for us to stand together - and support our pro-life, pro-American ally, American College of Pediatricians.”

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The Washington Post’s Kevin Crowe contributed to this report.