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have a mucoid phenotype.8However, we have previously re-ported that nearly 60% of rheumatic fever–associated isolates col-lected during the resurgence of these infections in the late 1980s were not mucoidal.8 Further, the mucoid phenotype, as he is aware, often is strongly influenced by culture conditions. There-fore, we do not agree that absence of mucoid phenotype is a universally reliable indicator of an attenuated organism.

Dr Burke’s Letter

We respectfully suggest that Dr Burke review the important paper by Catanzaro and colleagues,9(published 50 years ago) which is the basis for the prevailing belief that eradication of the organism is necessary to prevent rheumatic fever. That report states: “The data clearly indicate that when the infecting organism is not eliminated from the patient by therapy, the attack rate of rheumatic fever is not reduced appreciably.” If Dr Burke has data to the contrary, we would like very much to examine it.

We regret that, because of space limitations, our response to these 4 letters is not as complete as we would like. The issues raised in these letters as well as in our article have practical implications for practicing primary care physicians. That is why after having puzzled over these data for more than 4 years, after attempting to enlist the aid of the FDA, and after seeking advice from colleagues, we were still left with unresolved issues; we felt the obligation to raise the issues publicly. Through open dialogue, ideas may be generated that can lead to future studies directed toward providing useful answers, not only in everyday clinical practice, but also in understanding the sequelae of this unique bacterial infection.

Edward L. Kaplan, MD Dwight R. Johnson, MD University of Minnesota Department of Pediatrics Minneapolis, MN 55455

REFERENCES

1. Kaplan EL, Johnson DR. Unexplained reduced microbiological efficacy of intramuscular benzathine penicillin G and oral penicillin V in erad-ication of group A streptococci from children with acute pharyngitis.

Pediatrics.2001;108:1180 –1186

2. Shulman ST, Gerber MA, Tanz RR, Markowitz M. Streptococcal pharyngitis: the case for penicillin therapy.Pediatr Infect Dis J.1994;13: 1–7

3. Zaher S, Kassem A, About-Shlieb H, Kholy AE, Kaplan E. Differences in serum penicillin concentrations following intramuscular injection of benzathine penicillin G from different manufacturers.J Pharm Med.

1992;2:17–23

4. Lee LH, Ayoub E, Pichichero ME. Fewer symptoms occur in same-serotype recurrent streptococcal tonsillopharyngitis.Arch Otolaryngol Head Neck Surg.2000;126:1359 –1362

5. Siegel AC, Johnson EE, Stollerman GH. Controlled studies of strepto-coccal pharyngitis in a pediatric population. I. Factors related to the attack rate of rheumatic fever.N Engl J Med.1961;265:559 –566 6. Markowitz M. Rheumatic fever—a half-century perspective.Pediatrics.

1998;102(suppl):272–274

7. Rothbard S, Watson R. Variation occurring in group A streptococci during human infection. Progressive loss of M substance correlated with increasing susceptibility to bacteriostasis. J Exp Med. 1948;87: 521–533

8. Johnson D, Stevens D, Kaplan E. Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis.J Infect Dis.1992;166: 374 –382

9. Catanzaro F, Rammelkamp J, Chamovitz R. Prevention of rheumatic fever by treatment of streptococcal infections. II. Factors responsible for failures.N Engl J Med.1958;259:51–57

Coparent or Second-Parent Adoption by

Same-Sex Parents

To the Editor.—

I am responding to the AAP press release regarding the Feb-ruary 2002 issue ofPediatricsand the “Technical Report: Coparent or Second-Parent Adoption by Same-Sex Parents.”

As a long-time member of the AAP, I am angry and terribly disappointed but not surprised by the Academy’s issuing a state-ment advising the world that the “AAP supports adoption by same-sex parents.” I take issue with the “Technical Report” by the Committee on Psychological Aspects of Child and Family Health. This is a report heavily biased by the homosexual community, with nearly half of the references coming directly from homosex-ual books or journals and none from the perspective of the tradi-tional family. I very much doubt that the Family Research Counsel or Focus on the Family were asked to provide an alternative view. For the AAP to issue such a statement that legitimizes same-sex marriage and calls for same-sex adoption, as if the body of pedi-atricians making up the AAP agree, is outrageous. But why am I not surprised? The AAP has too often taken the moral low ground on other issues such as school-based sex education and abortion. I feel that I must maintain my membership in the Academy for professional reasons and I wish to remain involved at the state level through the Florida Pediatric Society, but I do not want to be associated with this type of proclamation! As a physician who has worked with and for children for over 30 years, I am embarrassed that the AAP would allow this committee to publish such a report. E. G. Guttery, MD Fort Myers, FL 33919

To the Editor.—

The apparent endorsement by the American Academy of Pedi-atrics of a parenting role by homosexual singles or couples either by biological birth or adoption is very disturbing to me. If, on the basis of the report by the Committee on Psychosocial Aspects of Child and Family Health, the Academy is proposing a policy of “acceptance” for this phenomenon, I am concerned as well as saddened that there was no apparent consultation or vote by the membership of the Academy. Clearly there is in homosexual parenting a radical departure from the heterosexual “traditional family” model that has been the accepted practice since time immemorial. How is it that the Academy is prepared to blithely endorse this new model with the acknowledged limited research and evidence reflected in this report?

The Committee does provide some level of evidence to suggest that children nurtured in the context of same-gender parents do not appear to have been damaged by the experience when con-sidering the 4 topic areas that were the focus of the report. How-ever, I wonder whether the Committee considered any of these issues that are concerns I have.

1. Whether constitutionally or socially induced, promiscuity has tended to be a characteristic of at least the male homosexual. Granted the break-up of heterosexual marriages and families in this country is of epidemic proportions, but do we wish in any way to further aggravate an already bad situation, especially when the welfare of the child is at stake?

2. The human immunodeficiency virus (HIV) rate among male homosexuals is still a serious problem, especially when promis-cuity is a factor. At the present state of medical knowledge, HIV-infected persons die on average within 10 years. If these males adopt children, wouldn’t this be similar to allowing adults over the age of 60 or 70 to become adoptive parents? 3. The Committee report does not take into consideration moral or

religious values and perspectives on homosexuality. Should it have done so? I think yes. The moral teachings of most main-stream Christian denominations, of Orthodox Judaism, and of Islam regard homosexual genital acts as morally wrong. The individuals embracing these faith traditions are not a minority population in the United States. Teaching children, at least implicitly, that such actions are morally neutral or an accept-able alternative to heterosexual intercourse within marriage is not acceptable to many in our society. Should the Academy not acknowledge that its new stance runs counter to these religious teachings and values, especially when many in the Academy’s membership espouse them? Closely allied to this concern is that having to do with the report’s going on record as moving away from support for the traditional family module and accepting on equal footing a same-gender parent model.

4. Finally, reference 10 in the report does suggest that there may be a tendency for children raised in a same-gender parent

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household to be more likely to consider a same-sex partner. Does the Academy wish to be understood as viewing this as “neutral” or at least not problematic?

I believe that the kind of research the Committee has done is important and will, in time, be quite interesting, even relevant. It strikes me that the kind of conclusions suggested is a bit prema-ture. The Pennsylvania Medical Society has a policy on abortion that is “no policy.” Perhaps the American Academy of Pediatrics should follow this example. Research is one thing. Proposing a new policy, especially in the name of an unsolicited membership, is at least risky.

Gilbert A. Friday, Jr, MD Pittsburgh, PA 15241

To the Editor.—

The term “parent” has been stretched to new limits. Originally, it was defined as the biological father or mother of a child, the progenitor. These traditional parents ordinarily cared for and raised their child(ren). Situations arose, most frequently death of 1 or both parents, in which surrogate “parents” would take on the role of the missing parent(s). These include stepparents who came into that role through marriage to a true parent and adoptive parents who take on the role of parents in situations in which children are separated by death, abandonment, or relinquishing of rights of their true parents.

The recent technical report1 and committee statement2 ad-dressed the role of professed homosexuals as surrogate “parents” or “coparents.” The very nature of homosexuality goes against the qualifications of true parents who in all cases are male and female. To say that a homosexual partner of a true parent is a parent to the child is a misuse of the word “parent.”

It is true that any number of adults of any sex who get along well together and are nurturing to a child make up a better social environment than adults who are antagonistic toward each other and the child. That fact does not justify giving same sex or oppo-site sex partners entitlement to the legal rights of parents. Step-parents should only be granted parental rights when the true parent being replaced is dead or has forfeited his or her rights by being negligent or abusive. The moral decay of our society is directly related to the breakdown in the traditional nuclear family structure and function. Extramarital sex whether in homosexual or heterosexual contexts is a major factor in this breakdown and should be condemned by anyone interested in the welfare of children and society. The Committee on Psychosocial Aspects of Child and Family Health were out of line in both their recommen-dations that undermine the moral fiber of our society and their speaking on behalf of the American Academy of Pediatrics. It is an outrage to me as well as to many if not the vast majority of sensible parents in this country.

Scott S. Field, MD, FAAP Huntsville, AL 35801

REFERENCES

1. Perrin EC and the AAP Committee on Psychosocial Aspects of Child and Family Health. Technical report: coparent or second-parent adop-tion by same-sex parents.Pediatrics.2002;109:341–344

2. American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. Coparent or second-parent adoption by same-sex parents.Pediatrics.2002;109:339 –340

To the Editor.—

The AAP mission is summarized by the declaration “Dedicated to the health of all children.” But is the recent AAP statement entitled “Coparent or Second-Parent Adoption by Same-Sex Par-ents,” which advocates for the adoption of children by homosex-ual couples, really advocating for children or homosexhomosex-ual activ-ism? The AAP position seems based less on science than on homosexual advocacy. After opening with the statement that “ac-curate statistics regarding the number of parents who are gay or lesbian are impossible to obtain,” the authors then go on to state that there is a “considerable body of professional literature”

show-ing no differences in children raised by lesbigay parents versus heterosexual. How can we be so sure if we don’t even know how many children are being raised by homosexual couples? A mere 9 references are cited to support the statement and yet a review of this literature leads to conclusions far less certain than Perrin et al would have us believe. A recent review of this literature by Stacey and Biblarz,1who readily acknowledge their bias toward open promotion of homosexuality and advocacy for lesbigay parental rights, admit that it is not “intellectually honest” to state that “no differences” exist in child or parenting outcomes for 2 reasons: 1) Because only a handful of children and families have been eval-uated, the statistical power of these studies was far too weak and many important outcomes may have been missed. 2) Despite the small number of studies and children involved, there actually have been some statistically significant differences. The most con-sistent is that children raised in lesbigay households are more likely to be sexually promiscuous and to be homosexual them-selves. Whether or not one feels that this is “good” or “bad,” it does give one pause to consider whether the AAP as an advocate of children should embark on such a radical social experiment given the dearth of evidence to support its claims and the enor-mous social consequences. We agonize and spend millions of dollars studying thousands of children to make even the most minor adjustment in the immunization schedule. Should we not do at least the same preparation before embarking on the blanket advocacy of homosexual coparenting and adoption?

Stephen C. Riggs, MD, FAAP Department of Pediatrics Covenant Medical Center Waterloo, IA 50701

REFERENCE

1. Stacey J, Biblarz TJ.Am Sociological Rev.2001;66:159 –183

In Reply.—

We are pediatricians. Our expertise is in child health. It is not my job, nor the job of my fellow pediatricians, to pass moral judgment. Our job is to make evidence-based decisions about what is best for the health and well-being of our nation’s children. That is why the Committee on Psychosocial Aspects of Child and Family Health of the AAP released its new policy statement, “Coparent or Second-Parent Adoption by Same-Sex Parents.”

The release of this policy statement, along with a technical report illustrating the scientific reasons beyond our stance, re-ceived considerable public attention. As is common in emotional issues such as this, many misinterpreted the true intent of the statement. Contrary to misconceptions, this statement was not designed to either endorse or condemn homosexuality. Indeed, its purpose was to focus solely on what is best for the increasing number of children who are being raised by same-sex couples.

Here is the abstract that begins the policy statement: Children who are born to or adopted by 1 member of a same-sex couple deserve the security of 2 legally recognized parents. Therefore, the American Academy of Pediatrics sup-ports legislative and legal efforts to provide the possibility of adoption of the child by the second parent or coparent in these families.

Our recommendation seeks to guarantee the children of same-sex parents the same rights and protections that other children have. There are many types of nontraditional families in American culture; this is just another. All children deserve the right to health insurance benefits from both parents, survivor benefits if a parent dies, and legal rights if the parents break up. This will make custody arrangements, visiting rights, and child support easier on the family and the child.

The Committee on Psychosocial Aspects of Child and Family Health tackled this topic because homosexual families with chil-dren have increased and all of us now see firsthand how these issues (especially regarding health insurance) affect our child pa-tients with gay parents. Most states make custody decisions re-garding same-sex coparents on a case-by-case basis.

Only California, Connecticut, and Vermont have enacted laws that specifically allowed gay men and lesbians to adopt their

LETTERS TO THE EDITOR 1193 at Viet Nam:AAP Sponsored on August 30, 2020

www.aappublications.org/news

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partners’ children. Florida specifically prohibits adoption by even one gay parent. Utah bans lesbian and gay couples and unmarried heterosexual couples from state-sponsored adoptions.

Our technical report reviewed the growing body of scientific literature regarding children who grow up with gay or lesbian parents. Only studies published in peer-reviewed journals were considered. And while some criticize the inclusion of journals from the psychology, sociology and social work literature that specifically address issues regarding homosexuality, all the jour-nals cited are commonly found in conventional medical school or university libraries.

The technical report recommends caution in interpreting these data, as the majority of these studies are of short duration and small numbers. But these studies dispute and disprove the com-monly held prejudice that homosexual parents are poor parents. Rather, the literature suggests that children who grow up with gay

or lesbian parents fare just as well in emotional, cognitive, social, and sexual functioning as children whose parents are heterosex-ual.

That being said, the AAP statement does not address gay adoption in general. It addresses the legislative status ofchildren who have same-sex parents. This policy statement is not about lifestyle; it is about health insurance. This statement is not about homosexuality; it is about kids. It is our mission to promote the health and safety of our nations’ children, and we feel strongly that no child should be penalized due to controversial or uncom-mon family circumstances.

Joseph F. Hagan, Jr, MD, FAAP, Chair

AAP Committee on Psychosocial Aspects of Child and Family Health

DEMYSTIFICATION OF THE PLACEBO?

“We found little evidence that placebos in general have powerful clinical

effects. . .the use of placebo outside the aegis of a controlled, properly designed

clinical trial cannot be recommended.”

Hrobjartsson A, Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment.N Engl J Med.2001;344:1594 –1602

Submitted by Student

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DOI: 10.1542/peds.109.6.1192

2002;109;1192

Pediatrics

Gilbert A. Friday, Jr

Coparent or Second-Parent Adoption by Same-Sex Parents

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DOI: 10.1542/peds.109.6.1192

2002;109;1192

Pediatrics

Gilbert A. Friday, Jr

Coparent or Second-Parent Adoption by Same-Sex Parents

http://pediatrics.aappublications.org/content/109/6/1192.1

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The online version of this article, along with updated information and services, is

by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2002

has been published continuously since 1948. Pediatrics is owned, published, and trademarked by

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it

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