The Press Council considered a complaint from Dr Michelle Telfer, the Head of Department of Adolescent Medicine at the Royal Children’s Hospital and Director of the Royal Children’s Hospital Gender Service (RCHGS), concerning 45 articles published in The Australian which appeared online and some which appeared in print. The first article complained about was published on 9 August 2019 and the last on 29 June 2020. A list of the articles is available here.
The articles – which included editorials and opinion pieces – concerned the role of gender affirming healthcare and its application by the RCHGS; transgender children and adolescents; the safety and ethics of giving hormone treatment to young people experiencing gender dysphoria; what the articles referred to as social contagion amongst young girls identifying as transgender; rates of de-transitioning in transgender young people; and a call for an inquiry into a gender affirming model of healthcare for transgender young people.
The complainant said a number of the articles contained specific inaccuracies and did not distinguish fact from opinion; that overall they lacked fairness and balance in reporting the facts and they caused significant distress to her and her colleagues; and offence, distress and prejudice to gender diverse people and their families.
The complainant said the articles included comments from people asserting that gender affirming treatment is ‘experimental’, or an ‘uncontrolled experiment’ or ‘novel’. The complainant said gender affirming healthcare is not experimental and is accepted internationally by medical experts in the area as the best treatment. The Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents (ASOCTG) is accepted as the current best standard of care for Australia and is used as such across the country. She said that gender affirming healthcare has been used for 20 years internationally and 16 years in Australia and has been authorised by the Family Court and has support in the medical profession as acceptable medical treatment.
The complainant said the medical profession recognises as experts only those who practise extensively in the area. However, the articles repeatedly included comments against gender affirming treatment from people put forward as experts on treatment of gender diverse children and adolescents who do not practise in the area. She said their views are based on social ideology rather than medical evidence and they have affiliations or associations with organisations or groups of a religious or political nature which are not disclosed. She said that it was misleading to omit reference to the fact that none of these people put forward as experts actually work clinically in the area of transgender health.
The complainant also said the articles refer to discredited theories such as social contagion, include rates of de-transition among transgender adolescents which are inaccurate, inaccurately asserted that the Royal Australian and New Zealand College of Psychiatrists (RANZCP) had abandoned reliance on the ASOCTG and misleadingly reported in three separate articles that there was a “national inquiry” to be conducted into transgender care. She said that for all these reasons the articles were not fair and balanced and, combined with the publication repeatedly approaching her for comment, had a significant adverse effect on her health, particularly given the sheer number of articles and the repeated references to her in the articles. The complainant said the articles, and the repeated references to her, unfairly personalise her role by describing the RCHGS as “the Telfer Clinic” in some of the articles and further implying that the RCHGS and the practice of the many skilled and experienced medical practitioners there, including her, are harming children. She said given the distress she had experienced and given her workload as a treating doctor it was not possible for her to respond to all the publication’s enquiries and given the nature of the series of articles, the opinion piece offered by the publication would not in any practical sense correct the errors, alleviate the distress or provide sufficient balance and she did not trust the publication to deal fairly with material she might provide.
The complainant also said that for the same reasons the articles, and particularly a number of the headlines, were likely to and did cause substantial distress, fear and anxiety and prejudice to people who are transgender and their families. The complainant said the accumulation of the inaccurate and unfair reporting over time had exacerbated the stigma, discrimination, marginalisation, social rejection and abuse that the transgender community receives on a day-to-day basis. She said that as the articles challenged the experience of life of people who are transgender and their families, the publication should have included a statement providing details of sources of help in view of the vulnerable community the articles focused on.
The publication said the medical care of children and adolescents who are transgender and gender diverse is not only a matter of significant public interest, but also a matter of considerable debate worldwide among medical practitioners and patients, parents and children, advocates and people who de-transition, lawyers and academics, politicians and the judiciary. The fact of this debate, which has resulted in landmark legal rulings here and overseas, questions over treatment guidelines, and calls for political intervention is cause enough for it to fulfil its purpose and report on the various points of view being raised questioning aspects of the care provided. The publication said it has endeavoured to shed light on all aspects of the debate over the treatment of transgender and gender diverse children as a matter of public responsibility as a media organisation, in the public interest as a matter of public policy and expenditure of public funds, as a legal and ethical issue and as a health and welfare issue for some of our most vulnerable children.
The publication said that on multiple occasions it had offered the complainant opportunities to comment on articles and input from RCHGS has been sought on numerous occasions. The complainant had also been offered space on the newspaper’s commentary page. The publication said it has sought information and data, responses and background on the RCHGS’s practices. The publication had sought assistance in contacting patients from RCHGS to give their view of their treatment. It said it has been rejected in its multiple attempts to engage with the complainant and staff at Royal Children’s Hospital. Accordingly, it had endeavoured to provide balance by including public statements, links and videos to represent the views of the RCHGS.
The publication noted that while the complainant disparaged some of those people who have been quoted in the articles, the complainant had offered no balancing quotes or expertise. In regard to the articles concerning ‘calls for an inquiry’ into gender affirming healthcare, the publication said that following its news reports of concerns about gender clinic treatments, the government saw the need for those concerns to be examined. The Federal Health Minister’s request for advice has been followed by three other reviews or inquiries, all triggered by news reports in the publication. The publication said that in each article the quotes were always sourced and the relevant qualifications of those quoted are published and factual material is offered with sources and any available data or studies.
The publication said in relation to the claim by the complainant that its coverage lacked balance, the complainant declined requests to contribute to the debate, or even provide commentary on her position. Instead, the publication went to great lengths to provide the views of the complainant and the RCHGS and other interest groups that refused to engage with it.
The publication said that the debate over the medical treatment and care of transgender and gender diverse children is of such public interest that discussion of this issue is of great importance not only as a matter of public policy but also as a matter of the future of individual treatment.
The Council’s Standards of Practice applicable in this matter require that publications take reasonable steps to ensure that factual material in news reports and elsewhere is accurate and not misleading and is distinguishable from other material such as opinion (General Principle 1), is presented with reasonable fairness and balance, and that writers’ expressions of opinion are not based on significantly inaccurate factual material or omission of key facts (General Principle 3) and provide an opportunity for a response to be published by a person adversely referred to (General Principle 4). The Standards also require publications to take reasonable steps to avoid causing or contributing materially to substantial distress or prejudice, or a substantial risk to health or safety, unless sufficiently in the public interest (General Principle 6).
As to the factual inaccuracies raised by the complainant concerning regret rates for hormone therapy, high rates of de-transition and social contagion, the Council notes the apparent conflict in research material relating to these issues and is unable to resolve this conflict. As to the complaint about reporting a national inquiry, the Council notes that national inquiry might have a wide range of meanings. While the Royal Australian College of Physicians (RACP) was not undertaking a statutory inquiry, the Council considers it was undertaking enquiries and is a national body. Accordingly, it finds no breach in this respect. However as to the statements that the RANZCP had abandoned reliance on the ASOCTG, the Council is satisfied it is not correct and was a breach of General Principle 1.
As to fairness and balance in presentation of factual material over time, the Council notes that there is a relatively high threshold before a publication will be considered to have failed to take reasonable steps to present factual material with reasonable fairness and balance. While many articles approached the issue from a particular perspective, the publication did take steps to try to achieve a measure of fairness and balance in an area of social uncertainty. It was also reasonable to refer to the complainant in her role as head of the RCHGS. While the Council accepts that many in the medical community would consider that only transgender treatment specialists are regarded as experts, it considers there is no requirement for the publication to rely only on such experts.
On the other hand, the Council notes that gender affirming healthcare has been used for 20 years internationally and for 16 years in Australia. Aspects of the treatment have been authorised by the Family Court and it is supported by specialist doctors treating gender dysphoria as currently the best medical treatment which was largely not reported in the articles. In quoting opinions of named persons critical of gender affirming treatment, the publication omitted that they were not medical specialists in transgender treatment. Also, in a number of articles the RCHGS was described as “the Telfer Clinic”. The Council considers that by repeatedly quoting the views of professionals from various fields of medicine and psychology that the treatment was experimental and harmful without explaining they are not medical specialists in the area, and linking the criticism so personally to the complainant, the publication failed to take reasonable steps to ensure fairness and balance and breached General Principle 3.
As to General Principle 4, the Council accepts the publication did repeatedly contact the complainant for comment during the series of articles and that the publication’s offer of an opinion piece was not accepted by the complainant and accordingly finds no breach in this respect.
As to General Principle 6, the Council considers the articles were likely to and did cause substantial distress to the complainant. There is undoubted public interest in a journalistic analysis of the debate on the many issues connected with transgender issues and people, and associated healthcare. However, the public interest did not justify the extent of references to the complainant in so many of the articles or implying that the healthcare practised at the RCHGS is out of step with mainstream medical opinion and this was a breach of General Principle 6.
As to offence, distress and prejudice affecting gender diverse persons and their families, the Council recognises that such a series of articles is likely to have such an effect, even a substantial one particularly given the lack of material published from the specialist part of the medical profession which was supportive of affirmative gender treatment. However, the Council notes that even medical treatment accepted as appropriate by a specialist part of the medical profession is open to examination and criticism and the difficult issues connected with treatment of gender dysphoria need to be debated to allow society to move forward. The Council considers, given the range of issues and concerns such as those expressed in the UK concerning the Tavistock clinic and at least some medical opinion, that the material dealing with the issues was sufficiently justified in the public interest and General Principle 6 was not breached in this respect.
The Council notes the publication’s view that a sources of help notice was not appropriate because the risk of self-harm has not been established or the notice itself would increase risk. While the Council considers the absence of a notice was a not breach, it accepts that a number of the articles would be read by a vulnerable section of the community and might be taken to be challenging their experience of life and including sources of assistance might have been a prudent step.
Due to the scope and detail of the material relating to this complaint, it has not been possible to include details of all arguments put forward by the complainant and the publication. However, the Council considers that its conclusions encompass in general terms the arguments put forward.
If this Adjudication has raised any concerns for you please refer to one of the sources of assistance here: https://presscouncil.org.au/uploads/52321/ufiles/APC-Advisory-Guideline-2019-final.pdf.
Relevant Council Standards
This Adjudication applies the following General Principles of the Council.
Publications must take reasonable steps to:
1. Ensure that factual material in news reports and elsewhere is accurate and not misleading,and is distinguishable from other material such as opinion.
3. Ensure that factual material is presented with reasonable fairness and balance, and that writers’ expressions of opinion are not based on significantly inaccurate factual material or omission of key facts.
4. Ensure that where material refers adversely to a person, a fair opportunity is given for subsequent publication of a reply if that is reasonably necessary to address a possible breach of General Principle 3.
6. Avoid causing or contributing materially to substantial offence, distress or prejudice, or a substantial risk to health or safety, unless doing so is sufficiently in the public interest.