Republican senators pressed a Biden nominee this week on federal funding for research on gender “transitioning” for minors, as well as the usage of fetal tissue in health research, with the White House’s candidate at times dodging questions about irreversible transgender procedures and experiments involving human cells. 

Monica Bertagnolli, a surgical oncologist and President Joe Biden’s nominee for director of the National Institutes of Health, answered questions for about two hours on Capitol Hill on Wednesday before the Senate Health Committee.

U.S. Sen. Roger Marshall, R-Kansas, an obstetrician, predicted future historians will liken to bloodletting the current practice of gender transitioning for minors through pills and surgery, dubbing such procedures as among “the horrors of medicine.”

“Do you believe that it’s OK to fund this type of research where these irreversible procedures are being done?” Marshall asked Wednesday during a hearing of the U.S. Senate Committee on Health, Education, Labor, and Pensions. “Do you think there’s any experiment that you can think would justify irreversibly damaging these poor little boys and girls who are 14, 15 years old? Will you fund that type of research?” 

“Any research that we do, Senator, with regard to human subjects has to be done in a way that does no harm and produces the maximum benefit to the people that are participating in the research,” she said. “And that will be the principle with which I approach any research, especially for this vulnerable population.”

Bertagnolli told Marshall his questions made it “very clear that you share my concern over the well-being of the LGBTQ community, especially young, vulnerable people.”

The National Institutes of Health is a federal agency under the U.S. Department of Health and Human Services. With a current budget of about $47 billion, the National Institutes of Health is the largest public funder of “biomedical and behavioral” research in the world.

To lead the agency, Bertagnolli needs confirmation from the U.S. Senate. The Senate Health Committee chairman, U.S. Sen. Bernie Sanders, an independent from Vermont who caucuses with the Democrats, delayed scheduling a hearing for months while he worked out a deal on prescription drug pricing with the Biden administration.

While senators asked Bertagnolli about cancer, coronavirus, obesity, opioids, diabetes, and rural health care, among other things, gender transitioning and fetal tissue surfaced several times.

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The NIH funded a study published in January called “Psychosocial Functioning in Transgender Youth after 2 Years of Hormones,” which followed the cases of 315 “transgender and nonbinary participants 12 to 20 years of age” at children’s hospitals in Boston, Chicago, Oakland, and Los Angeles.

The study reported an increase in “life satisfaction” and a decrease in “depression and anxiety symptoms” during gender transitioning, but also acknowledged “suicidal ideation” in 11 participants and two suicides during the two-year period.

“That’s obviously a tragedy,” U.S. Sen. Tommy Tuberville, R-Alabama, said Wednesday. “But what concerns me even more is the fact that the NIH was funding this research, and beyond that I believe the NIH even called the study a success. That’s sick.” 

“It sounds to me like the NIH totally dropped the ball on quality control and oversight,” Tuberville said. “So if confirmed, how will you make sure nothing like that ever happens on your watch?”

Bertagnolli responded by saying the agency has “the greatest responsibility” to make sure “that we serve all people, all walks of life” and that “any research that we do that involves human beings, people, is conducted according to the highest ethical principles so that we make sure that the research is intending to do no harm, to achieve benefit, and is done in ways that have maximum respect for the dignity of people.”

Democrats asked Bertagnolli no questions about gender identity. Only one, U.S. Sen. Ed Markey, D-Massachusetts, addressed it, saying in his opening remarks that “LGBTQ people are living in a national state of emergency,” noting the high rate of suicide among “transgender and nonbinary youth.”

Markey expressed support “for essential research in the care” that he said people who identify as transgender “need to make sure that everyone is free to exist as their authentic selves.”

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“When elected officials use their bully pulpit to target gender-affirming care or create barriers to evidence-based life-saving treatment and fuel the fire of the youth mental health crisis, this is a driving force in a nationwide campaign of discrimination and it is unacceptable,” Markey said.

Fetal tissue and fetal pain

U.S. Sen. William Cassidy, R-Louisiana, a gastroenterologist and the ranking Republican on the committee, said he met previously with Bertagnolli and discussed “bioethical issues, including fetal tissue and embryonic stem cell research, and the use of hormones and other gender-transition interventions on children,” but that she “at times avoided getting into specifics, citing a lack of expertise.”

Cassidy asked how Bertagnolli would maintain “the Biden administration’s policy … that fetal tissue is only used as a last resort.”

“Understanding the great sensitivity of many people and passionate feelings of many people on the issue of fetal tissue research, I would want to be very respectful of that,” Bertagnolli said.

“We’re trying to cure major diseases,” she said a little later in her response. “That’s our highest goal, but we need to do it with respect.”

U.S. Sen. Ted Budd, R-North Carolina, asked Bertagnolli if she would “commit to requiring NIH contractors and grantees that they explicitly inform mothers that their child will feel pain during an abortion by 12 weeks of pregnancy.”

Bertagnolli didn’t address the substance of the question, focusing instead on fetal tissue research.

“I believe that the policies and procedures that govern any research with fetal tissues really prohibit any discussion whatsoever with the mother toward even the possible use of such tissue for research. So it would not be acceptable for me to affirm this — that interaction is not allowed to take place,” Bertagnolli responded.

Bertagnolli, who is in her mid-60s, is a native of Wyoming. She is the current director of the National Cancer Institute, which is part of the National Institutes of Health.

She previously worked in oncology at Brigham and Women’s Hospital and at Dana-Farber Cancer Institute, both in Boston. She told senators her research focused on how inflammation leads to cancer.

Sanders said Wednesday that senators on the committee will discuss her nomination again on Wednesday, Oct. 25.