The prestigious Cleveland Clinic has begun using the terminology “assigned female at birth (AFAB)” and “assigned male at birth (AMAB)” to describe cancer screenings recommended for men and women.
The April 5 article on the clinic’s “Health Essentials” online blog titled “The Galleri Test: A New Blood Test for Cancer Screening” was attributed to Eric Klein, M.D., emeritus chair of the Glickman Urological Kidney Institute
Cleveland Clinic spokesperson Erica Foreman told Health Care News the editor of the blog will be using “inclusive language” going forward, in response to a question about whether this is how the renowned hospital organization will be referring to biological sex in the future. At least one other article on the blog uses the terms she described as inclusive.
Sex and Politics
“To me, it is fringe ‘newspeak’ language where they have fallen into the trap of deciding women aren’t women and men aren’t men,” said Marilyn Singleton, M.D., J.D., on the Heartland Daily Podcast on June 21.
The terms AFAB and AMAB are part of the diversity, equity, and inclusion movement and reflect the practices of people who don’t refer to themselves by their genetic sex. The terms have made their way into workplaces, government, and schools. In health care, however, males and females are defined by their chromosomes, says Singleton.
“The people who are doing these things [using non-genetic terms] are social workers or someone other than a medical doctor, and they’re being paid $250,000 a year to pull together all this diversity and equity stuff,” said Singleton. “They’re not even doctors.”
Diagnosis: Confusion
Allowing the individual to decide whether to identify as male or female could lead to incorrect diagnoses, says Singleton.
“Patients don’t tell the whole story all the time, for simple stuff like admitting they smoke even though they smell of cigarettes,” said Singleton. “If a person is delusional about their sex identity and not comfortable about a decision they made and don’t fess up and tell the doctor the truth, they could miss a serious diagnosis.”
A 2019 article in the New England Journal of Medicine described a 32-year-old obese patient named Sam who was brought to the emergency room by a boyfriend, complaining of severe abdominal pain. The emergency medical record described the patient as male. The patient was taking testosterone, but an ultrasound revealed an advanced pregnancy, and the patient later delivered a stillborn baby.
Another concern is laboratory work. Tests are calibrated differently for males and females, and an incorrect identification can lead to inaccurate results.
‘Equity’ vs. Fairness, Care
To presume physicians are exhibiting bias by using the words “male” and “female” is to miss the important common premise behind all care, says Singleton.
“From the get-go, we are taught to treat all patients the same,” said Singleton. “This whole health equity thing has gone beyond just teaching students and reminding doctors that you should treat everybody with the greatest care that you know how to give.”
One state, Michigan, requires physicians to undergo DEI training in which the use of the terms AFAB and AMAB is encouraged. Medical schools across the country are mandating DEI training for staff and implementing it in their curriculums.
AnneMarie Schieber (amschieber@heartland.org is the managing editor of Health Care News.
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