An Obama Judge’s Absurd Reasoning for Restoring Funding to the American Academy of Pediatrics

I n 2025, the Department of Health and Human Services terminated seven grants awarded to the American Academy of Pediatrics (AAP). A department spokesperson declared at the time that those grants (among others) were terminated “because they no longer align with the Department’s mission or priorities.” The AAP sued in response, arguing that ceasing funding amounted to retaliation against the organization’s constitutionally protected expression. This month, U.S. District Judge Beryl Howell similarly suspected a “retaliatory motive” behind the grant terminations; she granted a preliminary injunction, thereby restoring millions in funding.

In her (long) decision, Judge Howell — an Obama appointee — wrote the following:

This is not a case about whether AAP or HHS is right or even has the better position on vaccinations and gender-affirming care for children, or any other public health policy. This is a case about whether the federal government has exercised power in a manner designed to chill public health policy debate by retaliating against a leading and generally trusted pediatrician-member professional organization focused on improving the health of children. . . .

HHS was never free to retaliate with terminations of grant awards to recipients engaging in protected First Amendment speech disfavored by current HHS leadership, and the public suffers no harm when HHS is restrained from doing so.

I am not a sophisticated lawyer or judge, but I think Howell’s assessment is absurd. She is correct that the lawsuit itself is not a case to determine the “better” medical-related policies. However, awarding funding for research should involve meritocratic evaluations by considering whether the organization has a strong record of producing high-quality data; any position to the contrary suggests we have to be entirely nondiscriminatory and therefore hand out cash to every existing research project.

While the AAP is obviously allowed to endorse policies different from those of the administration, the First Amendment does not (or at least, should not) guarantee federal funding to an organization for the purposes of conducting subpar research that is later cited to justify its policies. By Howell’s reasoning, we could not terminate funding to a medical association that endorses self-harm in the form of cutting among teenage girls when a new administration is firmly against self-cutting, because that amounts to chilling speech, rather than being an instance of simply refusing a research grant to people who do bad research. This sounds ridiculous because it is ridiculous. (We should remember, though, that “gender-affirming care” interventions — particularly surgeries like mastectomies or vaginoplasties, which have been performed on dysphoric teenagers — are just celebrated types of cutting.)

Contrary to Howell’s statements, the AAP is no longer a “generally trusted” authority because the association fails to satisfy basic academic standards. For example, the AAP formally endorsed “gender-affirming care” in a 2018 policy statement titled “Transgender and Gender-Diverse Children and Adolescents.” The report was produced by Jason Rafferty, who “conceptualized the statement, drafted the initial manuscript, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work.” (You might be familiar with Rafferty if you attended his presentation with slides featuring the very scientific diagrams known as the “genderbread person” and the “gender unicorn.”)

The 2018 policy statement is rather long, but not much digging is necessary to discover that pro-LGBTQ ideology prevented accurate representation of data. The report states that “puberty blockers” are “reversible,” despite also stating that “research on long-term risks, particularly in terms of bone metabolism and fertility is currently limited and provides varied results.” And so the 2018 policy suggests there isn’t enough research to arrive at a conclusion while simultaneously asserting a conclusion. However, at the time, we had plenty of data showing that such drugs had devastating, long-lasting consequences. By 2017, more than 10,000 adverse-event reports about Lupron — a puberty-blocking drug that is also given to pedophiles for curbing desire — had been filed with the Food and Drug Administration by women who received it as children; their conditions included osteoporosis, degenerative disc disease, broken teeth, blood disorders, seizures, and much worse. In public comments on a petition that urged Congress to investigate Lupron, women lament that the drug ruined their lives. Even Lupron itself warns that it should not be taken for more than a year “due to concerns of bone thinning” that “may not be completely reversible after stopping treatment.” (Maybe Rafferty overlooked this information when he was busy; he sometimes is preoccupied directing his energy toward cultivating a “safe and inclusive space” by “honoring patients’ identity and pronouns.”)

More damningly, the AAP’s 2018 report underwent a particular — and unusual — kind of peer review. It was sent to two activists prior to publication: the self-described “trans person” Isaac Albanese, who has stated that it is “important to be a visible transgender activist” and “there is no ‘right’ way to transition,” as well as Jayeson Watts, who claims to “advance rights for the Transgender and Queer communities” so that “future generations of transgender individuals in Rhode Island and beyond have fewer barriers to living authentically as themselves.” Submitting a manuscript for something akin to a sensitivity reading demonstrates that representation of the data and evidence was influenced by political considerations, thereby delegitimizing the article and all its claims.

However, let us put aside research quality and instead examine what Howell perceives as the crux of the issue: the First Amendment and a culture of free expression. “When force and coercion replace reason in the marketplace of ideas, the public suffers by denial of access to high-quality information,” Howell wrote. She added, “In the realm of public health policy, where evidence-based research can make the difference between lives well-lived and chronic illness or even death, assuring such public access to information and debate is acutely important.”

While we already know any organization committed to medical “gender affirmation” is not particularly concerned with “evidence-based research,” it is worth acknowledging that the AAP removes itself from the “marketplace of ideas” by rejecting substantive debate. When five pediatricians submitted a resolution to the AAP in 2022 to systematically review the 2018 policy on gender-related medicine, the AAP suddenly adopted a new procedural rule that effectively insulated the resolution from consideration. And, when the HHS published its umbrella review in 2025 that concluded there is not strong evidence that “gender-affirming care” for minors is an effective treatment, the AAP issued a statement — within hours — condemning the report as “inaccurate” and “misleading.” (I reported on the HHS umbrella review; I can assure you that the document cannot be digested within mere hours.) Oddly enough, when presented with the opportunity to peer-review the HHS report that it had firmly condemned, the AAP declined to do so.

Other arms of the AAP seem to similarly curb free expression for political aims. For example, its academic journal Pediatrics urges authors to present data through an ideological framework: “Results related to race and/or ethnicity should be interpreted in the context of racism (eg, interpersonal, institutional, or internalized) and histories of exclusion, mistreatment, and exploitation, rather than as behaviors or presumed deficits” (emphasis mine). Likewise, the AAP’s guidelines for “inclusive, anti-biased language” tell researchers to “consider using terms that describe underlying systemic causes to create a narrative that compels solutions to address larger societal problems.” In other words, research must be interpreted a certain way to tell a specific type of story that encourages activism.

Moreover, some of the journal’s recommendations are just plain silly. Pediatrics encourages employing the word “pathway,” as opposed to “pipeline,” because “as a result of oil companies transporting crude oil through sacred American Indian/Alaska Native lands, this terminology may be considered offensive and evoke historical trauma.” Not only do potential contributors have to avoid potentially “offensive” words, they seemingly must abandon basic facts. The journal’s submission instructions, for instance, state that “race and ethnicity should be acknowledged as social constructs rather than as genetic or biological categories.”

If further information is required to demonstrate that AAP and its organizational tentacles have a commitment to social justice, look no further than the entire portion of Pediatrics dedicated to “Diversity, Equity, Inclusion, and Justice.” Articles submitted should, the guidelines say, “question assumptions of traditionally held beliefs of race and other social constructs and encourage the promotion of health equity.”

It is simultaneously entertaining and infuriating to see the AAP claim that it has suffered from speech discrimination when it has a record of adopting progressive stances under the guise of “science,” then proceeding to stifle any dissenting opinions that are actually grounded in compelling evidence. The AAP’s lawsuit insists that the HHS retaliated for its espousing views different from the government’s, arguing that “the award terminations are only explicable as retaliation for AAP’s advocacy.” But there is an alternative justification. To me, it is entirely reasonable to cease funding AAP research projects — regardless of what the studies are exploring — on the grounds that the organization distorts data to advance particular views, which is distinct from terminating grants simply for advancing particular views.