A critical review of the American College of Pediatricians' Facts About Youth project
This week the American College of Pediatrics introduced a project called Facts About Youth which purports to be
a resource created by health professionals to provide policymakers, parents and youth with the most current medical and psychological facts about sexual development.
Amid debate in the medical and mental health fields concerning the causes and proper approaches to youth with non-heterosexual attractions, Facts is a non-political, non-religious channel presenting the most current facts on the subject. Facts is committed to advancing a school environment in which all students will experience the opportunity to achieve optimal health and safety, even in the midst of differing worldviews. Facts is intended to be a resource to promote the factual and respectful discussion of these potentially divisive issues. This is a web site for and about youth and their needs.
While there may be some useful information here, I do not agree with much of what is claimed. The essential claims are that the site is "a non-political, non-religious channel presenting the most current facts on the subject." In fact, the presentation is one-sided, with dated research and reparative theory dominating the content.
Following the link "homosexuality," one reads what seems like a fair statement regarding causes of same-sex orientation.
Clinical and scientific research suggests that the causes of homosexuality, or same-sex attraction, are multi-factorial with environment and temperament playing the strongest roles.
If one understands environment broadly as nurture and temperament broadly as nature, then this is a pretty obvious statement about the influence of both experience and biology. However, pretty quickly you find out that on this website, the terms mean whatever reparative drive theory say they mean. More on that in a bit.
The website purports to offer current research in a non-political channel. However, the reference list on the homosexuality page negates that claim. The first two references come from the NARTH (National Association for Research and Therapy of Homosexuality) website and are not studies but summaries of studies and the third is from NARTH board member George Rekers, published in a book by Julie Hamilton, NARTH president. Whatever one thinks of NARTH, one must concede that the organization is most certainly not impartial on the subject.
The list of additional resources is anything but current. There are 13 references listed, all but two of them were published prior to 2001. Those older references have been updated by newer work but you wouldn't know it by reading here. The most current facts are not here, nor are they referenced here.
The references are also quite selective with four pertaining to child abuse, four relating to gender nonconformity/gender identity, one being a very dated (1993) critique of biological theories, one being a reference which actually undermines one aspect of reparative theory, one 1988 review of the link between homosexuality and mental disorders and two non-research books on the politics of homosexuality. This page alone is enough to discredit the claim that the page is current and non-political. The references are old and very selectively presented. There are no references on this page to the recent brain studies (e.g., Savic and Lindstrom, 2008), the brain scan work of Safron, et al, Wilson and Widom's prospective child abuse study, Andrew Francis's 2008 study of family factors and sexuality, findings of greater than expected X chromosome skewing in mothers of some gay males, or attentional differences related to sexual orientation.
Some newer research could have been presented which would have supported at least a broader environmental set of influences but these too were omitted. For instance, one of the newer and larger twin studies found
Overall, the environment shared by twins (including familial and societal attitudes) explained 0-17% of the choice of sexual partner, genetic factors 18-39% and the unique environment 61-66%. The individual's unique environment includes, for example, circumstances during pregnancy and childbirth, physical and psychological trauma (e.g., accidents, violence, and disease), peer groups, and sexual experiences.
In fact, twin researchers are not sure what an individual's unique environment involves. It may be that subtle differences (e.g., chorions) in the pre-natal environment of twins account for some of that variance. In any case, looking around the website reveals another bias which may limit even more what "facts" will be presented.
To wit, the two links which purport to provide a "more in depth analysis" about what causes homosexuality lead to Julie Hamilton's Homosexuality 101 and a Family Research Council article which defends reparative theory (the view that homosexuality derives from a failure of bonding with the same-sex parent). The organizations which the ACP refer readers to are PFOX, NARTH, Freetobeme.com (a religious resource), the Ex-gay educators caucus of the NEA, and JONAH (Jewish - that's religious, right?). All of these groups promote the same reparative narrative of how homosexuality develops.
There are so many problems with the site that I have to be selective. For instance, regarding lifespan of homosexuals, the site states:
The only epidemiological study to date on the life span of gay men concluded that gay and bisexual men lose up to 20 years of life expectancy.
One may think this is a reference to Paul Cameron but when one clicks the link, instead there is a summary of Hogg et al's 1997 Canadian study. However, again this site does not live up to the claim of providing the most current facts on the topic. In a 2001 follow up letter commenting on their study, Hogg et al said:
In contrast, if we were to repeat this analysis today the life expectancy of gay and bisexual men would be greatly improved. Deaths from HIV infection have declined dramatically in this population since 1996. As we have previously reported there has been a threefold decrease in mortality in Vancouver as well as in other parts of British Columbia. (p. 1499).
In other words, the prior results may not be accurate in that location today nor were even these results meant to be generalized to all gay men. Furthermore, there is another epidemiological study which is more current. Morten Frisch and Henrik Brønnum-Hansen, in a 2009 issue of the American Journal of Public Health, evaluated data from Denmark and concluded that mortality for homosexual men marrying after 1996 is virtually the same as for heterosexual men in Denmark. This is the most current information but you won't find it on the factsaboutyouth.com website.
Finally, the site has a section on change therapy. I am not sure why this is needed since the authors say most confused kids will end up straight. Anyway, the section here repeats NARTH's views about change therapy and lo and behold references my 1998 review of the literature on conversion therapy - except now the link isn't live since I recently asked NARTH to remove my articles from the NARTH website. The mistake I made in that review is the same one NARTH makes in their recent paper and that this website makes. In my review, I summarized every study or anecdote I could find on reorientation without regard for the quality of the research methods (e.g., sampling, design, etc.). There are so many problems with the early research, most notably the absence of control groups, reliance on anecdotes and follow ups that I do not view that review as anything more than suggestive of the need for further research. If anything, I have come to see that efforts to change are most frequently efforts to bring one's behavior and desires in line with religious beliefs or social expectations.
On the change therapy page, the statements about modalities would no doubt be confusing to a teen trying to get through this site, with unsubstatiated references to EMDR, reparative and Imago therapy. There are no controlled studies of these methods for purposes of sexual reorientation. Mentioning EMDR, etc., is all the more striking when you consider that a medical group hosts this project. Can you imagine pediatricians choosing drugs or medical treatments based on the kind of evidence provided here?
One more observation: I am confused by the denial of religious influence on this site. If done differently, I might support a conservative group of docs who wanted to encourage youth to consider the role of faith and family in making sense of their same-sex attractions. However, this site avoids that discussion and pretends that the resources listed are not associated with the religious right. I would prefer that the group simply declare their views directly. Physicians should recognize the important role of religious faith and for those people who believe at their core that homosexual behavior is wrong, there should be alternatives. This site however, provides only limited information and limited options and falls far short of the stated objectives.
An additional problem: The ACP website misrepresents Francis Collins. The website makes it seems as though Collins believes in sexual reorientation because he does not believe homosexuality is predetermined by a gene or genes. However, he actually said this to Exgaywatch:
It troubles me greatly to learn that anything I have written would cause anguish for you or others who are seeking answers to the basis of homosexuality. The words quoted by NARTH all come from the Appendix to my book "The Language of God" (pp. 260-263), but have been juxtaposed in a way that suggests a somewhat different conclusion that I intended. I would urge anyone who is concerned about the meaning to refer back to the original text.
The evidence we have at present strongly supports the proposition that there are hereditary factors in male homosexuality - the observation that an identical twin of a male homosexual has approximately a 20% likelihood of also being gay points to this conclusion, since that is 10 times the population incidence. But the fact that the answer is not 100% also suggests that other factors besides DNA must be involved. That certainly doesn't imply, however, that those other undefined factors are inherently alterable.
Your note indicated that your real interest is in the truth. And this is about all that we really know. No one has yet identified an actual gene that contributes to the hereditary component (the reports about a gene on the X chromosome from the 1990s have not held up), but it is likely that such genes will be found in the next few years.
Collins confirmed the accuracy of this statement to me in a separate email. Note that he says his words were juxtaposed to create a different meaning than he intended. Also, note that lack of genetic predetermination does not mean that orientation is generally alterable.