america that cannot be cured by what is right with america. >> president george w. bush in 2001. >> and this is my solemn pledge. i will work to build a single nation of justice and opportunity. >> and president barack obama in 2009. >> the challenges we face are real. they are serious and they are many. they will not be met easily or in a short span of time, but know this, america. they will be met. >> watch the story inaugural speeches saturday at 7 p.m. eastern on american history tv on c-span2. >> democracy is always an unfinished gratian. >> democracy is worth dying for. >> democracy belongs to us all. >> we're here in the sanctuary of democracy. >> great responsibilities fall

once again to the great democracies. >> american democracy is bigger than any one person. >> freedom and democracy must be constantly guarded and protected. >> we are still at encore of democracy. >> this is also a massive victory for democracy and for freedom. >> and now former law enforcement law enforcement and healthcare researchers discussing the role of parents in making health care decisions for their children including vaccine mandates, religious exemptions, gender-affirming care and investigations into medical child abuse. business sosa by the american enterprise institute. it runs just over an hour. >> all right everyone. now that we have settled all the legal issues around parents' rights, we are ready to move on to the medical sphere. the eagle eyed among you will recognize that we dod not have a

single in the on this panel, that was not by design. we had a doctor who's going to come, and expert from usc. fortunately the wildfires have made her home the home of many of herom friends and so our thoughts are her but we are going to move on. but as a result i'm going to offer just a few sort of contextual remarks about kind of the medicalic sphere. i'm not a doctor. i do not play one on tv, but i just thought it would be helpful to have a bit more context. ical professionals are responsible for about 13% 13% of child maltreatment reports in this country. 40% of the reports were substantiated versus 26% overall. often doctors and nurses are responsible for reporting the most serious cases of physical abuse as these children are the one show up in emergency rooms. they are also responsible for

reporting substance exposure newborns and other parental behavior that might affect the long-term health of babies. doctors are often seeing red flags when it comes to kids that we are less and less likely to believe them. a recent study found the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71% in 2020, the 40% in 2024. among those with lower levels of trust in the medical profession were women, african-americans, people from rural areas, people with low incomes and lower levels of education. these lower levels of trust in the medical profession can impact the likelihood parents will trust doctors to make determinations about kids health. can we trust doctors diagnosed child abuse, to tell us when to vaccinate our children, to diagnose or treat -- what does it mean the medical establishment seems increasingly

odd with parents? is the medical kinard ignoring parents for the sake of protecting children or had overstepped the bounds? other dangers to children of the do defer parents more often? to answer some of these questions we have four great panelists today. i'm going to get very brief introductions. emma camp is an associate editor at "reason" magazine were submitted a number of articles about this topic. mike webber has spent four years in law enforcement with 15 years as a crimes against children investigator. maxine eichner is the graham kenan dissing professor of law at unc-chapel hill and leor sapir is senior fellow at the manhattan institute where s written extensively about issues related to transfer you also have gout can access more extensive bios on my body wanted to start by asking each of the panelists to talk about their work in where they see the rubber meeting the road on the issue of parents right. we're going to start with emma.

>> thank you so much for having here today. really exciting and , wondere here with so many incredible thinkers on this topic. so to start, at reason i've done a little bit of reporting on child protective services, child protective services abuse and how child abuse pediatricians often get involved in many of these cases. and the sword prevailing feeling i get from a lot of parents who can accuse of child abuse by child abuse pediatricians who find themselves in the system, is it overarching feeling of a lack of due process? there is this feeling once an accusation of abuse has been lodged its nearly impossible to get removed even if they are plausible alternate explanations for for a child's injuries. for example, earlier this year i did and a basket of peace with. they took their infant daughter to the doctor after the notice chefs and swelling in her leg.

that led to the doctor recommended they go to the hospital for several fractures were found in the parents were accused of abuse. specifically the mother was accused of abusing the child. almost immediately it became obvious that was another explanation. the intent was obviously medically fragile. at one point she was hospitalized for six days -- the infant -- she continued experiencing bruising at every single foster placement shoes at but according to the state when should bruising with the bears lose abuse but when she had bruising with foster parents it was just this conversation. she was found a very low vitamin d and another doctor suggested in which actually had was neonatal rickets. she had a very large soft spot in her head that according to some people who would handle certain scene a little too big for baby as old as she was and so additional doctor said this is probably about issues related

to neonatal rickets but the child abuse pediatricians who saw her stater over and over and over that it must have been accused, that there's no, no explanation but abuse and that no other possible evidence could have convinced them is child wasn't being abused. this is all parents are no past interactions with the criminal justice system. the parents had a toddler aged daughter with the found injuries on her, and if i remember correctly at this point in the case they've dropped the case official criminal charges pending. that's one story among many. you can find with other great investigative reporters of written about these cases parents will often say things like i feel like you can only get my kid back if i admit to abuse i didn't do. where there the ceiling is a presumption of guilt. if a parent is guilty, if the deathly abuse the kids in odyssey works to be guilty and

to insist you innocent and guilty and said you know what, i'm sorry. but problem is it doesn't create a situation which parents can be innocent. there are other civil liberties issues that compound on this. one of them being the prevalence of warrantless searches. it isn't quite the same as a criminal search warrant but most of the time yet to get a warrant to search some so in the cps case. these cases are, not necessarily what topic abuse pediatricians involved but a study estimate the lifetime risk of a child being subjected cps investigation is as high as one in three. propublica did investigation in new york city cps agency a while ago and they found in less than .2% of the searches the agency had obtained a warrant and parents often agree to the searches out of fear, feaf coercion, i do sometimes being told completely lied to by the

social worker that pounding down the door there plenty good reasons want a parent would want to consent to be searches the ss considered it often doesn't just include looking at a home but often the children's body. children often are twofold underpants and the that the shirts. very understandable why a parent would not want to consent to that. there's an issue of drug testing. a lot of times how cbs is involved with women who are drug testing for after childbirth but the pump is a lot of times these are key and a drug cup that are sensitive as lost positives from over-the-counter medications, prescription drugs that are prescribed correctly, even poppyseed to cells like an urban legend but you can test positive for drugs. i've done it, for reasons. most interrelating there's an article in the martial project finding that women were being fescue by cps and since having their children removed when he tested positive for drugs are given during labor.

a study done in 2022 2022 % of women given fentanyl in the epidural tested positive for it later. all of this leads to this environment where there's a feeling of a general lack of due process and avoid child abuse pediatricians in particular are infallible. you end up with cases where parents feel their rights are violated. >> thank you. mike? >> respond a little bit the emma. child abuse pediatricians are not the best can we don't investigate crimes. it's not the job. that's something i should understand. that is the police job come investigate crimes. it's cps job to determine if the abuse has happen where the should be placed and cps doesn't make that determination. family court judge makes that determination. i'm going to tell you that family court judges at least in my state of texas they are

heavily on the side of caution for the parents. sometimes too heavily. sometimes a virtual back back into abusive homes. that's a very, very special i also have a lot of talk about concepts and about this big picture. every single case is dependent on evidence involved in that case, right? you can't just lump everything together and say this is a false allegation so all of these are false allegations. it's not the way this works. it's not for any criminal investigation of the works. i can tell you in my state now interestingly enough i think texas and new york are the states that have cps are forced to read parents the rights when they go talk to them. i cannot tell you how insane that is the police perspective. i'd had read anyone the rights if and not in custody. that is, supreme court has ruled over and over and over.

no one is ever in cps custody, ever. so, and their rights sheet and my state is a full page. so what that is done for my criminal investigations, what i have to do now is i have to rush by suspect to a jury because they only have so much fun for the can contact the suspect. the things that legislators are doing are far-reaching. when you get into, i know i'm sure going to get into which is medical child abuse, you have a huge lack of understanding in the legal community. probably the two dumbest committees on that are police and attorneys. judges are attorneys. they just do not understand the concept of how a mother could intentionally exaggerated false prior abuse symptoms.

it's about what we call soufflé. they are hard cases. they involve a lot of work and a lot of times human nature takes over people decide to do their jobs. and i have a quote here come visit from a defense expert on a case. i want to read this. this is after the jury found this mother guilty of abusing her child at sentencing her to 20 years. regards of the verdict in this trial and really regardless of whether the child's mother is guilty or not, there's a larger issue here. that is dogmatic. that is extremely frightening for individual cases. that is you can be on a crusade in criminal cases. he had to look at the evidence in each and every case to make a determination on the evidence whether there is guilt or not. >> thank you. maxine?

>> thank you. i've brought you a slideshow. i want to work with you. what i think is wrong with the so-called medical child abuse diagnosis, and covered glue that about why it is i cannot a diagnosis but happy to think that more in questions. so the genesis of medical child abuse came in 1977 when a british pediatrician roy meadow published two case studies of mothers who it turns out had deliberately misled doctors to get the children medical care that they knew that their children didn't need. it appeared for some twisted purpose like getting attention. in one of those cases the mother

did what we call fabricated illness, meaning she lied about her child being ill. she made her daughter look like she had symptoms with the urinary tract infection by putting her own menstrual blood in the child's urine specimen. yes, heinous behavior. in the other case, the mother actually induced illness by feeding her child salt and her child later died from that. roy meadows said this behavior could be likened to ascend and psychological center in which patients feigned illness to get attention in medical care from doctor in the name by proxy stuck. soon doctors both sides got both sides of the left started to diagnose this behavior. but three issues came up.

first, roy meadow had called this syndrome by proxy. he hadn't meant to suggest this was a real psychological syndrome which some particular psychopathology that made the people do this though, mentally ill for lots of people took it that way. it later turned out from investigation, has no particular psychopathology associate with this behavior. some people have depression hurts and people of the mental illness. others register completely mentally healthy. that's when issue. second and related issue is who is going to diagnose this behavior? was a mental health practitioners or pediatricians who came in contact with the child but not the parent usually? and the third issue an issue that the munchausen syndrome by proxy diagnosis eventually

founded with how to separate these really twisted parents from parents children who were legitimately ill, often with rare illnesses that people didn't recognize. although rare illnesses mean they are rare, there are more than 7000 rare illnesses, a one in 20 children actually have a rare illness. ultimately, pediatricians addenda pretty poor job at separating children with legitimate medical illnesses from a the twisted parents. and as you can see here, roy meadow turned out to be the lead candidate in this. he was stricken from the british medical roles, , not allowed to testify at trials anymore after a mother who had been

responsible for convicting to it to make children die, she was convicted for murder, which is also, let us recognize, and absolutely heinous consequence, for a pair to an already had to make children die. it turns out a geneticist was able to track that it was a genetic illness. she was released from prison, died of alcohol poisoning a few years later. her life in ruins. the question became what do we do with a misguided going forward. the suggestion that ultimate taken up was let's talk about this instead as medical child abuse. that suggestion came from carol jenny and her husband thomas general guillot as a child abuse pediatrician, and which he said is let's not talk about this as

munchausen. let's call a child abuse. let pediatricians diagnosing because they are experts in diagnosing child abuse. and she came up with this definition. medical child abuse is when a child receives unnecessary and harmful or potentially harmful medical care at the instigation of a caregiver. if you take a look at that definition, it does not talk about parents intentionally inducing illness in healthy children or fabricated illness in healthy children. it is a much broader and vague r definition. and, in fact, the way jenny said has it should be interpreted was even more vague. anything that could potentially harm a child even if it didn't harm a child, an extra medical examination, a blood draw constituted something that was

potentially harmful. so what that means is that whether a pediatrician could diagnose medical child abuse depended on, first, whether they decided that medical care was unnecessary, that this child refused. recognize can any medical care a child receives has been authorized by some doctor and also whether the caregiver instigated medical care. now, if you think about it, too, parents instigate most medical care for their child, if what you mean is they take the child to the doctor. kids party cannot get medical care and less the parents take the kids to the doctor. so this is a far broader definition, if you believe that parents have a constitutional right to direct their children's medical care, which the supreme court certainly believes, this

should be a chilling definition for you. nevertheless, the american academy of pediatrics a few years later accepted this as the way to, quote, diagnose this behavior going forward. as i said, you look at this definition, this is not a legitimate medical diagnosis. this is a determination by the pediatrician at the parent is to blame. nevertheless, pediatricians present this to judges as within their scientific authority as simply a medical diagnosis. so what does it mean about how many parents can be targeted by pediatricians? well, carole jenny told us this when she sold this new concept. she went through 115 case files in which she been asked to look

for munchausen syndrome, and said that 33% of those files she decided there was munchausen. this is a pretty startling high figure given that the supposed at rates of medical child abuse in the medical community are one in 50,000 kids. and the rate of children with a diagnosis we know is one in 20 children. so for 33% of those cases to come up as positive is startling. and serious pediatricians looking to figure out that induction or fabrication behavior should be trying to pare this down. what jenny told us is, in fact, 76% of the cases she was asked

to review turned out to register as positive for medical child abuse under her new standard. recognizing it is more than twice as many parents that are new supposedly diagnosis targeted. if you believe that kids should remain with parents, and it is harmful to pull them out and accused the parents of abuse, this should cause great alarm. it did not cause great alarm for carole jenny. in fact, she touted this new much broader diagnosis and its ability to get to more than twice as many parents is a a virtue of this new diagnosis. and they were off to the races in the united states. so where are the extra cases coming from? carole jenny tells us that, too.

under the munchausen syndrome by proxy diagnosis, when a child was diagnosed with this legitimate medical illness, that was taken to be a diagnosis of exclusion. it excluded the medical child abuse, munchausen syndrome by prognosis. but under medical child abuse, carole jenny said the fact that a child has no legitimate medical diagnosis does not exclude medical child abuse and, in fact, she said, 74% of the cases that she designated as medical child abuse had legitimate medical illnesses in the children diagnosed. so the point now is medical child abuse is picking up a very different group of parents than those original parents who had been committing this heinous

fabrication or induction behavior. it is targeting parents of kids with legitimate medical illnesses. sorry about that. wrong click. can we go. so one know is there is absolutely no reason to associate now the three-quarters of parents were getting picked up with kids with legitimate medical illnesses with that kind of heinous behavior. i have spent the last four years parsing the medical literature. there is no reason to suspect that parents sick children would be responding in some twisted way, and a lot of evidence that suggests these parents are just doing the best they can in a difficult set of circumstances, getting the kids that medical

care they believe their children need. this last slide. pediatricians who are serious about getting it right, locating these twisted parents and leaving alone the parents who are doing the best they can would try to do better than they did under this original munchausen syndrome by proxy diagnosis, in terms of figure out how to target the right parents. child abuse pediatricians have done nothing of the sort. they rely on a process that carole jenny suggested which is essentially going through a child's medical charts to see if the statement of the parents recorded about the child's

history matches the medical testing, et cetera, the observations of parents. how reliable is this determination? we have no idea. pediatricians have never tried to test its reliability. we can make some guesses as though. we know from a number of medical studies outside of the medical child abuse field, medical records are rife with errors. ..

we also know from studies of what they tell investigators outside what they make all kinds of mistakes. there's a study from others, 20% tell doctors and correctly whether the kid has been monitored with the fetal monitor whether the kid experienced jaundice. ose happen all the tim.

medical child abuse those two judge and has the child removed. the pediatrician and expert in rare disease. and they look for medical policies and they are the same indicators present in kids with kitted medical conditions. i'll leave it there and happy to take questions.

>> thank you for inviting me. i work with modification seizures gender government care gender transition and it's both the medical and educational and they become the main show so the argument made by the other side it's should have access to these they perform and persuasive.

there is a growing consensus a lack evidence safety and effectiveness and european countries have sharp restrictions in the case of sweden, denmark or altogether delegating them to research trials.

the world health organization a year ago came out for the safety and benefits so there is a growing treatment and things are very different and the mainstream medical organization and both of them have come out in favor of these. they agreed with and those who appeal, they are good because

say so. and most experts with that. and the leading advocates. forget about consensus and all about the economist writes in the art already shifting changes happen because of systematic evidence.

>> evidence income with this. and interviewed at the new york times american doctors and specifically those off the rail. we have an parent should be the ones undergo these procedures.

in paris don't have the right to tell -- turns have a right to from evidence-based clinicians and a key so i sent a text to my friend that give me a quick example the want you to prescribe my kid anti- virus and frank friends i'm not going to do that person because you have had antibiotics and we are going to destroy system and it is for

this treatment. that is constrained by prior ethical and political so that is the firstborn. in their consent forms and working closely with the whistleblower the gender clinic and journalists and they are incomplete at best.

parents are told sometimes in front of their kids your kid will commit suicide if you don't. that is extortion. there's no credible evidence to suggest they are the thing for suicide. you responsible. they need to stop saying this is not.

in a should be left to parental discussion. what they really mean this kind to want to sign up with the gender affirming care. it's always among for adaptive this note. i cannot tell you. i spoke to my wife and i disagreed with the gendered with its out information would only communicate with the wife because they often times get divorced. and they testified.

the marriages keep them dark a lot of stuff third reason in the fourth which i have been trying to make the case and i wish people would take this more seriously it is gender responsibility for what they are doing and they are the ones who bear responsibility. the model model imported in so what they are claiming is the last alone, don't come us and has legal implications of mental

malpractice that is the medical side of things. in the social consensus like that, they agreed to send pronouns and whatever bathroom they want and parents are unsafe for their kids and only then will they notify and they are unsafe for kids and they will

become depressed. i'm sorry, they can be at once. it is troubling in itself and so far there's so far there's only been one systematic review of evidence on the mental health consequences of social transition in children and adolescents that is part ofn a review and unsurprisingly came back with findings there's no credible evidence that social transition is linked to any mental health. we don't know. there's no quality evidence. what we do know based on decades of research and this was a computer issue a mapi to tease it out but what we do know is that social transition appears to be, and locks in in a staf gender distress or confusion that in the vast majority of kids would disappear over time

usually to the process of puberty which is clarifying for many kids. most of these kids come out okay. so schools transition kidsne behind their parents back, set them up for medical treatment that is irreversible and harmful consequences were otherwise they kid if it not been social transition would have come to terms with his bodily facts and that's what i've called this school to clinic -- in this particular case sometimes the only tool parents have to stop this process school to clinic high point in its tracks is been notified. manynd parents facing relentless campaign by school counselors, teachers, administrators, some rights advocates organizations like the aclu that bully schools and adopting policies. the only recourse parents have is to get the kids at school and that's what they do. thank you. >> thank you. i'm going to try, these are obviously different presentations, i'm going to draw

some threads which are important. maxine, you talked about how parents are getting children the medical care they believe their children need. i think this is a thread that may be i would like all of you to address because it gets at a lot of the different beliefs parents will have but the question of to what extent we should be accommodating those beliefs is very important. we could diagnose this as a mental illness we could say this is a religious belief. parents can have all sorts of reasons for believing their children deserve a particular or meet a particular kind of medical care but i want to draw each of you out on where that line should be drawn. mike didn't speak the first time around. i want to give a chance to talk about some of the cases he's

looked at and how he thinks, how you think this line should be drawn in those cases. >> the line for me is very clear. clear. it's a criminal offense. i investigate them to the point where i can either prove it is approved it isn't. it's important people realize police investigations is not to convict the guilty but but o could be innocent in many cases. i have cleared people who have been innocent. >> visa cases like the ones maxine was mentioning? >> correct. it's important, the creator of that term was a pediatrician. he was not a psychologist. this was initially meant to be applied to the abuse of the child. as a society because we have decided we don't want to accept the fact that a mother could do this to a child, with switch that around and applied it psychologically to the mother. which is an excuse for the

behavior. this is abuse. they present no different in any other setting. they will confess. confess is a bad word. they will give admissions. i've got an admissions from four or five of them. they will never tell you the whole truth. specific cases we can talk about. george honeycutt, his son, his wife was medicating his son and then take him to the doctor, a sedative, taking into the the doctor to present symptoms of normal pressure hydrocephalus. she did that and got a brain monitor laced inside his head. unneeded surgery.de the doctor saw actual symptoms because she was drugging the child. this is the behavior we get into what we get into the cases that i investigate. the more serious ones are going

to come to me. some of the ones i couldn't investigate, we had a mother she will probably end up abusing her child and we have to wait 2g something before we can do anything. she is presenting her child as having cystic fibrosis when multiple genetic test done, the child doesn't have the disease but she keeps going to the doctors and keeps presenting that diagnosis to try to get what she wants. maxine didn't talk anything about a police investigation. we can do so much if we choose to. the importance of medical records in these cases and reviewing those medical records, talked about discrepancies. what we see when we go through these because i've done this you see intentional lying only to negative of the health of the child. you will see mom present the child have thanksgiving was diagnosed at this other place. it was never diagnosed anywhere. all to attempt to get medical care for the child.

i then can get personal items from that mom. and the george honeycutt case she claimed the children cerebral palsy, three other medical conditions that the child never had. maybe these kids have some underlying medical, sure, but when you put the status of this is underlying medical you need to look at what in particular that underlying medical is. for instance, if they have asthma that needs an inhaler as needed, and that's it, that's underlying medical condition. right? that doesn't mean you need a feeding tube. a lot of the cases we see our gastric tubes, i neatly placed, a central line placed and she started poisoning her child with pathogens from her lab that she took home through a breathing treatment. she admitted, she will talk to anyone and she will tell you she

does these things. to deny this in total is really, really scary for children. since 2019 i have filed 12 criminal cases on offenders in one texas county on medical child abuse. it's there. please silvio not investigating it. cbs in texas has no policy on medical child abuse. they provide no mandated training for the investigators. when a report is called and they have no way to class fights oftentimes they were classified as medical neglect and so when you're your 25 euros fresh out of college investigate pickles at one of these calls, use their mom -- the mom taking a cue to the dock all the time. they don't know. they're going to close that complaint. pediatricians in my state have an hour required for human trafficking, education,,

pediatricians. they have nothing required for medical child abuse. i would argue they're probably more likely to see a case of this than the are human trafficking. or as likely. police have no training on this. family court, the last article in juvenile and family court journal on this was in 1990. attorneys and judges don't know what this is. i've read writings, the family court will automatically accept medical child abuse diagnoses. that is completely untrue. i can tell you from very personal experience, i serve in a confessional society -- the other experts on the committee but testified in family court can tell you the same thing. doctor feldman will tell you the testified numerous times that this is what it is and the courts have ignored him and give the kid back to mom. these offenders especially the more advanced ones that i'm going to see, they have

compulsion to do this abuse. they do not stop in other cases where the abuse was reported in one case in particular brittany phillips reported for time to cps, nothing done. another case where it was reported on her own child and then she did to her granddaughter. when cps gave her custody of her granddaughter, even though she reasonably medical child abuse on her own child. so there are numerous issues, and i hope you'll join me in calling for education for law enforcement, for doctors, for cbs. will you join in calling to educate them on how to approach of these investigate these? >> not only that, i would actually join you in trying to get accurate standards to

distinguish between the many parents with children, with legitimate medical illnesses, who are just trying to do the best they can for their children and those heinous parents. do you understand the ratio -- >> i would never see this cases because my doctors would never report them. by child abuse cases never report the type of case. the cases i get reporter our criminal law violations. have actually done something to their child. >> and have you read the "houston chronicle" series by mike hixson? >> i i am very familiar with it. >> medical diagnoses -- >> theresa may with mike and mike is not on these articles. >> we are running out of time before we take questions in the audience so think of your questions. >> i would happily answer your general question. ..

>> and i know you wrote about the take care of maya case which came famous because of the netflix movie. in that case the parents actually left the country to have their daughter, i understand, have their daughter have procedures that are not necessarily approved in the u.s. for her diagnosis and so, i was wondering if you could answer this question of, you know, how we are drawing the line about parents getting children the care that they think they need, how far outside of the kind of--

these approved choices should we be going and how should we think about parents who, you know, of course they have the best intention, but just to bring up something that came up on the previous panel like make they're engaged in faith healing, going to another country because that's where they could get female circumcision for-- there are all -- once you expand the options that a parent believes they need for their child, we could be entering difficult territory. >> that's a difficult line right now when you think about the gender affirming care, child transition cases and you know, for example, in texas in 2022, there was an order pronounced i believe by the attorney general basically saying we're going to investigate parents who are getting their child transition treatment if that's child abuse. the treatments were fully legal

in texas at the time and they've now been banned so you were having, you know, cps workers knocking on the door investigating parents who were getting medical treatment presented by doctors as being effective and safe and what they should be doing for their kids and we're seeking out the treatments in good faith. and while i think in terms of what i think about the evidence based treatments i'm inclined to agree more with-- i think that child protective services, government and coming and investigating or possibly removing children, that's not the appropriate use of that agency, to sort of solve these medical controversies over what the correct treatment course for an illness is, when especially in america, there's such, you know, if you're a parent who knows nothing about this and you have a child who is suffering, you know, i think it would be really difficult to know what to do. obviously, there is a line, i think a good example is, you know, if the child has cancer

and parents are saying, no, we're not going to give our kids, we're going to do faith healing and the child is going to die if they don't have medical intervention, but actually drawing that line is something i'm not giving a satisfying answer, i'm saying, i don't know, this is difficult. where this is debated mostly is gender issues, parents seeking out medical care or not seeking out medical intervention in good faith should not be treated as medical child abusers. >> and then we are going to -- oh, okay. you each get two sentences, and then a different question. >> and i agree completely. the texas approach in 2022, it was imprudent, it was unethical something after parents and i think it also, it kind of

underscores this idea that the responsibility should be laid at the feet of parents. the problem is clinicians who are ideologically driven telling parents this is what they need to do and going after parents feeds into that narrative. it should be about what parents decide to do. i agree, yes. >> yes, we have long kong constitutional dictates by courts that distinguishes when the state can intervene, when parents are making choices that may seem unwise for their kids. the general rule is, parents have constitutional rights to direct their kids' medical care, that's because we think that parents generally know their kids best and are most motivated to find out what's in their children's best interest. now, there are limits on that because sometimes parents make really poor decisions and the way courts have crafted those

guidelines say that the state and doctors can intervene when the parents are choosing a medical course that no legitimate doctors in the communities support and that could result in extreme a harm to children. those guidelines have been around for 80 or so years. they have worked very well. my own deal is there is no reason to intervene with those guidelines. >> all right, questions from the audience? we have microphones right here? >> thank you all for coming. my question is for you, mr. -- is that correct? my question is about some of the laws that enable states to take custody of people who identify as transgender from other states. there's a case in minnesota where they say, the cliche,

trans fef refugee, if you don't treat a child with care, it's like a broken leg and kids suffer through the pain, in any event they've taken custody from parents through through and courts have done it. can you elaborate on this? >> this is a great question, part of the spiral that we're seeing playing out in the political realm where republicans with measures and democrats outdo them on their side and so on, so forth and those so-called sanctuary state laws are a response to the red state ban. essentially what these laws do, is they instruct their in-state authorities to not respect things like court orders from other states, right? so if, you know, if you have a

court order from texas siding with a nonaffirming parent and the mom takes the kid to california, being a sanctuary state under the sanctuary state law, the health authorities in california can disregard this order. you can see why this is almost certainly going before the supreme court with the full faith and credit laws. there's a serious problem. look, all of these controversy, political, regulatory controversies are of course, downstream from the underlying medical and ethical issues. that's in my work at least, i try to keep the focus on the medical issues themselves because my view is, we cannot resolve the medical issues by debating the political and legal fallout for those issues. we have to keep the focus on the medical issues themselves. but, yes, it is a serious problem. i don't know how common it is. i've actually asked folks who

are kind of in red state governments how common is this? nobody knows. no idea. >> we have a question online and it's actually something i'm a little-- i think it's really an interesting tension between what maxine is saying and what mike is saying. are these cases overreported or underreported? and i think from mike's experience it sounds like he thinks it's underreported if there are this many cases in this one county that are being investigated, i think maybe because you've been trained in this and most of the people in other counties are not, and maxine, you're presenting evidence that suggests that there is overreporting going on, but the question is, it gets at this, the 76% statistics. i think the question here is about the denominator. so this person, this researcher was asked to review 115 cases. were they-- the 115 cases cases that were

reported offered to her because there were suspensions of child abuse and so what does that-- does that just-- i think the question is, if there are suspensions of child abuse, maybe 76% is the accurate number. i mean, it is bigger than the number from before, but maybe we're just dealing with a lot of underreporting and trying to match these numbers that that's the problem? >> so, it's an excellent question. it would be really good if somebody had actually taken time to investigate whether mike is right and all of the cases in which child abuse pediatricians are reporting medical child abuse, indeed, have that heinous behavior, but child abuse pediatricians have never investigated that. there's been no empirical

investigation. the reason that my stronger than a hunch, my contention is that these cases are closely overreported is, first of all, you've seen that 76% figure that i gave to you in the expansion that i showed you between the munchausen syndrome by proxy versus child abuse diagnosis, the fact that most of the parents that are targeted today three quarters have children with legitimate medical illnesses. over and by that, by child abuse pediatrician's own studies what they have found is that the rate of munchausen syndrome by proxy is two in 100,000 children or one in

50,000 children. the rate of children with complicated medical issues or rare illnesses, as i've told you, is one in 20. that means that there is one child who has been abused in by over medicalization for every 5,000 children with a rare or complicated medical illness. the diagnostic criteria that people look at for suspected medical child abuse picks up many of these kids, so the idea that three quarters or two-thirds of the children who somebody reports as suspected for medical child abuse should

be diagnosed with medical child abuse, strikes me as way-- what's the number who are being reported for medical child abuse? >> the number-- we don't actually. we don't have figures on the number of people every year. states don't break it up that way, who are being charged with medical child abuse. the best-- i'm sorry, who are reported. the best statistics we have are the statistics i gave you from carol jennings saying of all the kids who were respected who were referred to her, two-thirds of them, she has diagnosed with medical-- >> we may be dealing with a tiny number of people who are actually reported for these. >> and she was-- that's why my question was about the denominator, i don't want to get hung up on this too much. >> i wrote a new york times column in 2015 that competed

that -- back then there were not a lot of large of amount, but recognize, if two-thirds of those not large amount of people are then being found to have committed medical child abuse, that's way too high. >> i don't know if the number is 40, maybe it's not too high. i mean, i think there's an issue-- we're having a statistical problem here. and i want to let mike respond and time for one more question. >> we have data on it, 2022 study, in seattle, looked at 145 cases, suspected the cases over a five-year period. they had a board set up. everyone had to agree that it was medical child abuse and they only did this through medical records review. they didn't have any police involvement. why? because police don't investigate these cases and out of these 145, they diagnosed 65

cases of medical child abuse positively, 37 they didn't know one way or the other. >> mike, it was a medical records review. >> exactly. this is an evidence-based diagnosis. you don't go look at a child and see if they're being medically child abused. that isn't the way this works. you look at the behavior of the offender and again-- >> tell me why you think relying-- tell me what evidence you have that support your contention that relying on medical records gives an accurate so-called diagnosis? >> i'm telling you that's the best research we have i don't rely on medical records. >> i go out and get additional evidence and that's what they should be doing and they don't investigate how this is a crime. when it rises to the level of a criminal violation, it's

absolutely criminal behavior. they know what they're doing, they know what they're doing is wrong and when they're doing it, the legal definition of sanity and any expert on abuse will tell you this. >> i think we have one more question. zack, no? >> just to comment, we're suggesting that underreporting and overreporting are opposites rather than both occurring at the same time, which is a much more likely scenario and talks to the quality of our decision making, the quality of our data and the quality of our standards, so we should not ignore both sides of the equation. >> i consulted with a detective in texas that's in montgomery county on his first case, giving the playbook how to do it. and no one was investigating. >> will they make criminal cases? we'll see. again, i want to go back to

this, it depends on the individual evidence in that individual case always. >> one more, here we go. >> first of all, i wanted to say, mike is part of a highly respected organization which does evidence-based research that i deeply respect, but is it sappier-- they call the wrong name all the time, i'm with you, i'm with you. you said something in passing and i want to make sure i understand what you're saying. you're saying that the systemic evidence, that the social transition, respecting social transitions lost in gender distress, that would resolve itself by itself and then most of these kids turn out to be gay. is that true statistically?

most of these kids turn out to be gay? >> complicated. we'd have to go down the rabbit hole of research to answer this question properly. the historic research dating back 40 years, a figure 85% or more does so that's the majority of these kids are gay. so if you look at the clinic where they started experimenting with puberty blockers, the cohort after transition, out of 55 kids-- even before the surgery out of 70 kids in the cohort all, but one was same sex attracted. they're all gay in that study, so, yeah. >> so doesn't at that indicate that the distress may also come from being gay in schools and culture that's not accepting? >> that's the-- explanation.

even the dutch clinician, one of the founders of the field, published a paper in 2013 called factors associated with persistence of gender identity -- and he said, you know, yes, cross-sex identification and related to stress is far mow repredictive of a future homosexuality and the resolution of gender identity issues than of adult trans sexualism. as befitting the dutch they see the problem and they say don't worry about it, puberty blockers are totally reversible and kids can come off them whenever they want, we know that's not true on research. >> and europe has done what it's done and evidence based and i'm not going to make -- but if you're going to say that schools should not have gender affirming attitudes, right, what then do you fill that up with? you've got children in very

difficult situations and it's not just caused by the fact that they think they should be another gender or society. it's also caused because they're probably gay. what do schools do to help those children? >> again, that's a great question. complicated, of course. i think that the thing at that we should all be able to agree on is that parents should be in the know and directing these decisions and not kept in the dark. if you're asking what should schools do? look, i think it's part of normal and healthy child rearing to communicate to children scientifically accurate information about facts and gender, that's a minimum. i don't want schools teaching pseudo science, any kind of pseudo science, sex is not assigned at birth and any school at that teaches that, i look at curriculum of schools where i live. they start, it's indoctrination. >> we're going to disagree on

assignment at birth, that's fine, but my point is that if you know that these distressed and these are very distressed children. if you know these distressed children are in these schools and are going to be coming out, coming out gay, don't you think the schools need to have much better support for gay children? >> depends what you mean by support, doesn't it? >> i mean, they can't be bullied. >> of course. >> but that's not of course. that's not of course. >> i agree with you they shouldn't be bullied. >> it's not of course that they're safe at home, right, the gays who will line up to describe the horrors of what was done to them usually in the name of religion because they were gay is enormous. you can imagine why teachers want to protect them. and now what teachers probably should be doing is reporting those parents to the

authorities. >> and then what happens with cps when they do, that's the problem. >> let's not talk about the adults, let's talk about the children. >> cps investigates-- >> the children are suffering at school and at home so i think the easy idea that you automatically tell parents that you know are harming a child in my book are not the answer. >> agree to disagree. >> okay, we're going to let-- you guys have made it to lunch, congratulations. we are going to take a 15 minute break before our final panel, but please join me in thanking our panelists today. [applause]. [inaudible conversations] stay tuned to the c-span network for comprehensive coverage for nominees.

marco rubio, and john ratcliffe, nomination for cia director, before the intelligence community and former florida attorney pam bondi beginning her confirmation hearing and she'll testify across two days, today and thursday and also on thursday, scott besbesslin. watch on c-span, our free app or c-span.org. >> i franklin delano roosevelt. >> i harry s truman. >> do solemnly swear. >> that i will faithfully execute the office of president of the united states. >> the office president of the united states. >> and will to the best of my ability. >> and will to the best of my ability. >>