written by Tara Haelle

A small group of pediatricians called the American College of Pediatricians periodically releases policy statements about various child and teen health issues. It’s obviously always important to understand who or what the source of information is, even when (perhaps especially when, George Orwell would say) the name itself sounds reliable.

So, who are these ACP* folks? First, they’re not in any way associated with the American Academy of Pediatrics, the national organization representing more than 60,000 pediatricians across the U.S. who make recommendations based on the most current research. The AAP are recognized as a credible, evidence-based professional organization whose positions carry great influence in child and maternal health. Certainly several medical specialties have more than one professional organization, but that doesn’t mean they are all equivalent in terms of their reliability.

While the AAP relies on the evidence base to issue their policy statements, American College of Pediatricians relies on a politically-motivated social conservative agenda in drafting their policy statements. I don’t discuss politics or political ideology on this blog, and that’s not going to change today. Social conservatism and social liberalism or progressivism both have a place in our political landscape. But when political ideology replaces evidence in promoting a particular policy about children’s health, an organization oversteps its bounds in prioritzing children’s best interests. Belief systems should not dictate health or medical recommendations when they contradict facts from research.

The AAP has issued a tremendous number of evidence-based policy statements over the years. From foster and adopted children to children and disasters to mental health to adolescent health to sports and fitness to vaccines to community health to… there’s just about no topic related to children’s lives that the AAP hasn’t considered in light of the most current scientific research. By contrast, the American College of Pediatricians has issued exactly 34 position statements, and even a brief perusal of their titles will make it clear that they are ideologically focused not because they cover topics that the AAP does not but because the list is proportionally dominated with controversial topics about which social conservatives have strong political agendas.

Although politics shouldn’t interfere with the scientific process or the pursuit of scientific knowledge, we all know that’s not actually how it plays out. Unfortunately, the vast majority of these policy statements rely on ideology rather than facts and evidence to promote a position. While some of their statement most certainly are supported by the evidence — such as their position statement on bullying and their statement on the harms of marijuana use for children and teens — others diverge significantly from the evidence. For example, their section on corporal punishment contains information that not only contradicts that of the AAP’s policy statement, but also that of the American Academy of Child & Adolescent Psychiatry and the evidence base in general. (The American College of Pediatricians explicitly states “The spank must be painful, yet not harmful,” which sort of defies logic on its own.)

The American College of Pediatricians has published a position statement on parenting by gay, lesbian and trans parents that attempts to discredit the evidence showing that these parents can provide just as supportive, loving and beneficial environment as any other parent(s). But the evidence on LGBTQ parenting is very clear, as the AAP’s statement explains: children need a loving and supportive home environment, and a parent’s gender or sexual orientation has no negative influence on a child’s development.

The American College of Pediatricians position on abortion — they’re certainly entitled to an ideological position — contains scientifically inaccurate information, such as the debunked misconception that abortion increases the risk of breast cancer and preterm birth. (I am not discussing or inviting a discussion of pro-life versus pro-choice abortion positions here; my concern is only in the promotion of information that is scientifically inaccurate, regardless of one’s position on this issue.)

Again, these are hot button issues — but that’s my point. They are relying on ideological beliefs to replace evidence rather than simply providing an ethical or moral argument in addition to what the evidence shows. The latter is fine. The former is not. Therefore, their position statement on HPV vaccination should be viewed in this context. They write in their statement, “The debate as to whether vaccinating adolescents against a sexually transmitted infection such as HPV may contribute to an increase in premarital sex is not settled.” That’s inaccurate. A couple dozen studies have investigated this question in depth and determined that vaccination against HPV does not increase the likelihood of a child or teen engaging in sexual activity any more than getting a tetanus vaccine encourages kids to step on rusty nails.

Similarly, their most recent press release updating their HPV vaccine statement needlessly creates fear about an alleged risk of the HPV vaccine that is not supported by the evidence. They attempt to link HPV vaccination with six cases of premature ovarian failure among the millions of doses of the vaccine administered. While it is important to investigate all adverse events that occur after vaccination, it is also important not to confuse correlation with causation. There is no reliable evidence that the HPV vaccine causes ovarian failure.

Premature ovarian failure is a tragic, rare occurrence caused by chromosomal defects, toxins such as those from chemotherapy or radiation treatment for cancer, an autoimmune disease or unknown factors, but there is no evidence or described biological mechanism which would suggest HPV vaccination is one of those factors. But statistically, premature ovarian failure is practically guaranteed to occur at least sometimes after administration of the HPV vaccine — not because the vaccine causes it but because that’s how random distribution over time works.

It’s important that safety surveillance for all vaccines continues. Researchers use the Vaccine Adverse Event Reporting System to look for patterns and then investigate them using the Vaccine Safety Datalink. But it’s also important that information about the risks and benefits of vaccines does not become muddled as a result of ideological beliefs that interfere with the evidence.

Edited to add: Please be sure to check out the excellent blog post all about the HPV vaccine written by Dr. Chad Hayes.

Edited to add Feb. 3, 2016: The American College of Pediatricians has issued a statement of clarification to note that they are a “pro-vaccine organization… [that] continue[s] to recommend that the HPV vaccine be offered to adolescent patients as a form of proven protection.” They state that their update “is NOT a call to abandon HPV vaccination.”

*Per a comment below, I changed all references of “ACP” to “American College of Pediatricians” since the ACP acronym most accurately represents the American College of Physicians, another legitimate, evidence-based doctor organization.