Iowa Attorney General Brenna Bird joined a group of other Republican state attorneys general this week in sending a letter to the American Academy of Pediatrics (AAP) accusing the organization of possibly violating consumer protection statutes. The Republican group claims the AAP’s guidance on standards of care for transgender and gender diverse (TGD) young people seeking gender-affirming treatments amounts to consumer fraud.
The letter was sent on Tuesday by the leader of the Republican group, Idaho Attorney General Raúll Labrador. Like Bird, Labrador was elected attorney general in 2022 and is in his first term in office. He attracted national attention last year when he announced he would prosecute healthcare providers who referred patients in need of an abortion to doctors in other states. (Idaho bans abortions starting at the fertilization of an ovum.) A federal court issued an injunction stopping Labrador from bringing any such charges.
In a written statement about the AAP letter, Labrador said, “It is shameful the most basic tenet of medicine — do no harm — has been abandoned by professional associations when politically pressured.”
Labrador went on to accuse the AAP and other organizations of medical professionals who support medical gender-affirming treatments for TGD youth of “sacrificing the health and well-being of children with medically unproven treatments that leave a wake of permanent damage.”
According to Labrador, even the selective use of medication to block puberty hormones causes “permanent damage.” The letter cites studies conducted in other countries that are at odds, in part or in whole, with the AAP guidance on care for TGD youth.
“Children with gender dysphoria need and deserve love, support, and medical care rooted in biological reality,” Labrador said. “Parents should be able to trust that a doctor’s medical guidance isn’t just the latest talking point from a dangerous and discredited activist agenda.”
The letter sent by Labrador and the other Republicans warns the AAP that Idaho’s consumer protection law “prohibits ‘[e]ngaging in any act or practice that is otherwise misleading, false, or deceptive to the consumer.’”
“Most other states likewise prohibit making statements to consumers that are false, misleading, or deceptive,” the letter adds on behalf of the other signatories. “Each of us takes our responsibility to protect consumers in our states very seriously.”
In addition to Bird, 18 other Republican state attorneys general joined Labrador in signing the letter. So did the president of the Arizona State Senate and the speaker of the Arizona House, both of whom are rightwing Republicans. (Arizona Attorney General Kris Mayes is a Democrat.)
The letter is presented as a response to the AAP board of directors voting to “reaffirm the 2018 AAP policy statement on gender-affirming care.” That vote happened at the beginning of August 2023. Neither Labrador’s statement nor the letter explain why the group of Republican officials waited more than a year to send their letter, or address why they decided to warn a nationally respected professional organization with possible prosecution just 42 days before a national election.
Donald Trump has made attacks on gender-affirming care for young people a regular part of campaign speeches. He has repeatedly told bizarre lies about kids going to school, having surprise gender-reassignment surgery during the school day, and coming home after school that same day as a different gender.
AAP’s 2018 guidance states gender-affirming care is “best facilitated through the integration of medical, mental health, and social services, including specific resources and supports for parents and families. Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.”
The letter asserts that AAP guidance claims the results of using puberty-blocking hormone treatments are always reversible — and this might constitute consumer fraud, according to the signatories — but the 2018 guidance has a section on “reversibility” that clearly distinguishes between effects that can be “[p]artially reversible (skin texture, muscle mass, and fat deposition)” and those that are “irreversible once developed (testosterone: Adam’s apple protrusion, voice changes, and male pattern baldness; estrogen: breast development).”
At the same time the AAP board of directors voted in August 2023 to reaffirm the 2018 guidance, it also voted to authorize “development of an expanded set of guidance for pediatricians based on a systematic review of the evidence.” In the letter sent this week, Labrador, Bird and the other Republican elected officials want the AAP to turn over documents being used in that review, as well as “all communications” involved in the process.
The AAP has not yet responded to the letter.
Iowa is one 25 states that has passed a ban on gender-affirming health care for transgender people under 18. (The law doesn’t restrict any gender-affirming care for cis-gendered people under 18.) SF 538, passed in March 2023, was opposed by every health care professional who testified before the Iowa Legislature. Every Republican in the Iowa Senate voted in favor of the health care ban, while all the Democrats in the Senate opposed it. In the Iowa House, five Republicans joined all the chamber’s Democrats in voting against it.
Gov. Kim Reynolds signed the bill into law after comparing gender-affirming medical care for transgender minors to health- and safety-threatening behavior such as smoking and drinking alcohol, and saying the ban “is in the best interest of the kids.”
A new peer-reviewed study published in the scientific journal Nature on Thursday examined the impact of banning gender-affirming medical treatments for transgender minors in the 19 states that had enacted such bans by 2022. Researchers found suicide attempts by transgender and gender-nonconforming teens increased by as much as 72 percent in the years following the bans. (Data from Iowa is not included in the study because SF 538 became law in 2023.)
Bird has not yet issued any statement about the letter threatening the AAP or mentioned it on her social media accounts. Normally, Bird seeks to draw attention to work on issues that excite conservatives, such as joining more than a dozen lawsuits against the Biden administration since becoming attorney general 22 months ago, or her multiple attempts to have state laws and regulations in California overturned.
This is not the first time Bird has joined other Republican attorneys general in sending letters warning of possible criminal prosecution to pressure private organizations that act in ways conservatives object to. In December, she and 13 other Republican attorneys general sent a letter to the New York Times, the Associated Press, CNN and Reuters warning them their coverage of Israel’s war in Gaza may result in them being charged with “material support for terrorism.”
Two weeks before Bird sent that letter, she signed onto another one from a group of Republican attorneys general to two major firms that provide analysis and advice for investors, demanding they “quit recommending woke investment strategies” or face possible legal action for breaching their fiduciary responsibilities to their clients.
In July of last year, Bird and a group of Republican state attorneys general sent letters to the CEOs of the companies on the Forbes 100 list, warning them they may face legal action by the states if they don’t eliminate their diversity, equity and inclusion programs. (None of those companies is headquartered in Iowa.)
Bird signed the first of this sort of threatening letter just one month after taking office. In February 2023, she joined Republican colleagues in letters to the CEOs of Walgreens and CVS threatening the pharmacy chains with unspecified legal action if they followed FDA regulations and made a prescription drug commonly used in medical abortion more readily available.
So far, Bird has not taken any legal actions pursuant to any of these letters.
Earlier this week, the Des Moines Register published the results of a new Iowa Poll examining the job approval rating of statewide elected officials. According to the poll, only 36 percent of Iowans approve of the job Bird is doing.
