Bioethicists are accusing a noted American paediatric endocrinologist and researcher of what they claim is the first attempt to prevent homosexuality and bisexuality in the womb in a dispute that has drawn in leading major medical organisations.
The accusations revolve around the experimental prenatal treatment of female foetuses for a condition called congenital adrenal hyperplasia (CAH), which can result in girls being born with ambiguous genitalia.
The paediatrician, Dr Maria New of the Mount Sinai School of Medicine and Florida International University, US, is a longtime champion of the prenatal use of a powerful steroidal medication called dexamethasone to prevent the development of CAH in the womb.
CAH and sexual orientation
But some medical ethicists accuse New of having a hidden agenda. New has also taken part in research that has linked CAH to sexual orientation, noting that girls with CAH were more likely to be bisexual or homosexual and more likely to be interested in traditionally "masculine" careers and hobbies.
The bioethicists believe New's desire to treat female foetuses with dexamethasone stems from a desire to "prevent" lesbianism or bisexuality and steer girls toward classically defined femininity.
"Her main goal has been to prevent ambiguous genitalia and all the things that come with it, including what she calls 'behavioural masculinisation,'" charged Alice Dreger, professor of clinical medical humanities and bioethics at Northwestern University's Feinberg School of Medicine. "She includes in that what she calls 'masculinised orientation.'"
Try to prevent homosexuality
Dreger described New's work as the first instance in the history of medicine that "clinicians are actively trying to prevent homosexuality."
Congenital adrenal hyperplasia remains a relatively rare condition, with about 1 in every 10,000 to 18,000 children born with the disorder, according to the US National Institutes of Health. Girls and boys with CAH lack an enzyme needed by the adrenal gland to produce a pair of hormones, cortisol and aldosterone. The lack of these hormones prompts the body to produce more of the male sex hormone, androgen. This can cause girls to have genitals that look more male than female, even though their internal sex organs develop normally.
New denies charges
New declined to be interviewed for this article, but released a statement denying the charges.
"In my six years at Mount Sinai I have not administered the drug to any woman for the purpose of treating an unborn child," New's statement read. "Allegations that my goal is to prevent lesbianism are completely untrue." She added that she has received approval to conduct long-term evaluation of children who earlier received treatment with prenatal dexamethasone for CAH.
But Dreger said New's statement dodges the primary accusation that she and other ethicists have laid against the doctor: that New has recommended dexamethasone for use in treating CAH without notifying parents that the drug is not approved for that use.
"We're concerned that the women don't know the drug is experimental, or that they are part of an experiment," Dreger said. "All the major medical societies have said this is very experimental and should be done in clinical trials only, if at all."
Dreger noted that the website of the Maria New Children's Hormone Foundation attests that she "has treated over 600 pregnant women at risk for the birth of a CAH-affected child. Treatment begins as soon as pregnancy is confirmed." The website does not explain what treatment New used, only that she has been developing a treatment since 1984.
Guidelines on CAH use
A number of major medical societies are drafting physician guidelines on the use of dexamethasone for CAH in a consensus paper prepared by the Endocrine Society and scheduled for publication in the Journal of Clinical Endocrinology and Metabolism.
The guidelines will recommend that prenatal treatment of CAH continue to be regarded as an experimental procedure, noting that dexamethasone therapy can cause low birth weight and birth defects, such as cleft palate. The guidelines will be endorsed by the American Academy of Paediatrics, the Lawson Wilkins Paediatric Endocrine Society, the European Society for Paediatric Endocrinology, the European Society of Endocrinology, the Society for Paediatric Urology, the Androgen Excess and PCOS Society, and the CARES Foundation.
The guidelines are not concerned with aspects of sexuality, according to Dr Phyllis Speiser, who helped draft the document.
Safety of the foetus
"Our main concern is long-term safety to the foetus. There are some trials that have been conducted in animal models that have some potential for long-term consequences," said Speiser, who is chief of paediatric endocrinology at Steven and Alexandra Cohen Children's Medical Centre of New York and professor of paediatrics at New York University School of Medicine.
Besides an increased risk of cleft palate, those health concerns include a slight reduction in birth weight, she said.
"Our objective really is to be able to gather more information so we make sure that we can properly inform the families. Right now it's difficult to say what all the long-term safety concerns might be," Speiser said, adding that the controversy regarding homosexuality was not a factor in the drafting of the new guidelines.
"That's really not in the list of concerns that we have. That's not an objective of this therapy - it never has been. I don't think that's really on the table here for consideration," Speiser said. "Unfortunately, doctors' intentions may have been misinterpreted."
Sexual orientation and biology
But Dreger and her colleagues remain concerned that medical attempts to prevent homosexuality in utero will arise if researchers determine that sexual orientation is an innate quality of human biology.
Dreger worries that that knowledge could lead to prenatal interventions to direct humans toward heterosexual development.
"Evidence that homosexual orientation is inborn could, instead, very well lead to new means of [its] pathologisation and prevention, as it seems to be in the case we've been tracking," she and co-writers Ellen K. Feder and Anne Tamar-Mattis wrote in a recent paper on New's research. - (August 2010)
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