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The announcement of the Labor Government’s proposed ‘misinformation’ Bill, while alarming, is not surprising. Anyone paying attention in recent years, especially the last three, will have noticed that our ‘freedom of speech’ has already been significantly curtailed through online censorship, government censorship (thank you, Department of Home Affairs), and self-censorship.

Nowhere has this been more palpable or alarming than the censorship of freedom of inquiry in science and medicine. During the Covid years, we discovered just how captured the medical profession is. Like lifting the lid on Pandora’s box, anyone who spoke out soon discovered the evil treasures in store for those who dared to question the narrative.

The result was spectacular and tragic. Doctors who wanted to keep their jobs had to shut up, roll up their sleeves, and work on. Those who spoke up or questioned the forced jab were marginalised, censored, sacked, or suspended. The message was clear: speak out at your peril. Despite the messaging, I was still shocked at how many capitulated. Surely this was the time we were meant to speak up and ask questions? Especially the hard ones. Isn’t this what we trained for?

Paying the Price

Every so often, I meet someone who helps restore my hope in the medical profession. Last week, that person was Dr Jillian Spencer, a senior staff Child and Adolescent Psychiatrist who was recently suspended from clinical practice at the Queensland Children’s Hospital. She now faces serious threats to her position, professional career, and livelihood, including potential regulatory action. Her crime, it seems, is to question out loud the affirmation model of transgender care.

Spencer says she is not alone in her concerns: ‘I would say that the vast majority of Child and Adolescent psychiatrists hold very serious concerns about the affirmation model, but to speak up in the current climate or even to take a more cautious clinical approach puts their employment at risk,’ she shared at a recent forum.

If there is any doubt that questioning ‘the narrative’ is dangerous for medical professionals, Spencer can set the record straight. Her experience of raising concerns within the organisation through the ‘proper channels’ has not gone well.

‘The process is to raise concerns internally (within an organisation) so that you’re doing it professionally and appropriately, rather than having to speak out. But when I pushed that to the maximum internally, it went very badly. So now I’m in the position of speaking out (publicly).

The majority of child psychiatrists (are silent) for good reasons and self-preservation. The good reasons being wanting to be available to help people and to not be perceived as biased. But also, a lot of it is fear. And I don’t think my case has helped either, as I’m at risk for my employment and my (registration). It’s very serious. And so, I can’t blame them.’

But the costs of speaking out extend beyond the doctor involved. Patient care and service delivery stand to suffer too.

‘The danger of speaking out is that you lose the capacity to help more people,’ Spencer shares.

‘For example, a gender-questioning young person might be reluctant to see me now that I’ve spoken out, and that’s not something I want because I want young people to feel comfortable with me. My job is to listen and understand and to do what I can to help them.’

Now, this job is on hold indefinitely. However, Spencer is undeterred. Rather than quietly waiting for the ‘powers that be’ to hand down judgment, she demonstrates a commitment to her convictions by continuing to speak out. Loudly and often. To an outsider, it would appear Spencer has reached a point of reluctant acceptance of her situation and that she might as well go ‘all in’. Arriving at this point has come through painful reflection, ‘dark times’, and the realisation that the organisation Spencer has served faithfully for decades has apparently abandoned her.

‘It’s a really difficult employment situation,’ says Spencer

‘Some people say, “Well, if your organisation is doing something that you disagree with, then the appropriate pathway is to resign.” But if you’ve been with an organisation for 20 years, you feel a part of that organisation. I feel like part of the family and part of changing the culture internally. It’s part of my job.’

‘People say “You need to resign or accept it.” But it’s also a responsibility to try and help your organisation do the right thing and… ‘speak up for safety.’

Best Interest of the Child

Listening to her speeches, presentations, and interviews, it is hard to argue that Spencer is motivated by anything other than safety. Child safety appears at the core of her message time and again.

‘It’s a really hard situation for child and adolescent psychiatrists… and for any mental health clinicians who work with children. Because there’s a lot of organisational and social pressure to affirm children,’ Spencer shares.

‘But when we start to look at the evidence base behind the affirmation model, we find the studies have major flaws, and they don’t show sufficient benefit to outweigh the risks and the harms.

‘Previously, our discipline always took a developmental approach, which means that the years of childhood and adolescence were understood to be a period of incredible growth and change. We didn’t label children with long-term conditions, such as personality disorders, because we knew that a lot of conditions would ease with maturity, and indeed, the eleven studies that were conducted before the affirmation model was in use when they used a watchful waiting approach found that 60 to 90 per cent of children with gender dysphoria became comfortable in their own bodies with maturity.

‘I assure you that this is not part of a culture war. This is a really serious child protection issue. We entered our field to try to assist children to thrive, but the gender clinics have been set up, and psychiatrists are being forced to affirm the social transition of all children and go along with the idea that puberty blockers and cross-sex hormones will lead to benefit.’

Spencer’s words highlight the dangerous waters our children are in. Treatment pathways and models of care are being imposed while the evidence is unclear, pathways that have modalities with irreversible and devastating consequences for children in terms of fertility, sexual and long-term health. Anyone who would step into these waters without a cautious approach does not understand the potential ramifications.

One of the arguments used to justify support for the use of cross-sex hormones and puberty blockers is mental distress and the risk of suicide in those experiencing gender dysphoria, as highlighted in a recent Four Corners report. However, Spencer paints a broader picture.

‘There’s no evidence to show that the social transition or the use of puberty blockers or cross-sex hormones reduces the death rate or improves psychological functioning.

‘What we know from the eleven studies that were conducted before the affirmation model was in use – so that’s when they didn’t use puberty blockers and cross-sex hormones – is that the vast majority of (children with gender dysphoria) grew up to become comfortable with their body if they’re allowed to go through the full course of adolescence.

‘My personal opinion is that that we could disallow the prescription of puberty blockers. But I’d be perfectly happy if Australia aligned itself with all the European countries that have conducted systematic reviews of the evidence behind puberty blockers and cross-sex hormones. From those systematic reviews, they realised that no child should be prescribed puberty blockers outside of a clinical research trial or in exceptional circumstances. And in the UK, they’ve even gone further in recommending caution around social transition.’

Censored

In voicing concerns at a recent rally, Spencer stumbled on another issue facing doctors who dare speak out. Soon after, the hospital told Spencer she allegedly broke the Queensland public services Code of Conduct through her public statements. It’s an allegation Spencer contests, saying she was speaking as a private citizen. In the speech, Spencer neither identifies herself as a doctor nor makes mention of her role or employer. The question is, where does a doctor’s autonomy begin and the employer’s jurisdiction end?

Have we already entered the era where the reach of our employers and regulatory authorities extends fully into our capacity to speak publicly anywhere?

The AHPRA Code of Conduct for medical professionals outlines several expectations of health professionals to question, examine and discuss the potential risks and benefits of treatment in addition to advocating for vulnerable communities, including children. It would seem, therefore, that Dr Spencer is simply doing her job.

‘We are not being allowed any professional discretion,’ she argues.

‘It is incredibly distressing to be forced into harming other people’s children, or otherwise face the potential loss of one’s career, livelihood or to be cast out of the workplace as has happened to me. But this is too important, so I will not be silenced.’

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Originally published in The Spectator Australia. Photo by Los Muertos Crew.