Illinois Pediatrician Circumvents Soft Censorship with Substack

Illinois pediatrician & Urgency of Normal doctor Todd Porter is drawing attention to (what I would call) “soft censorship” on the part of a medical journal, via his new Substack.

In June 2021, Dr. Porter and Nicole Hughes, a mom whose toddler died in a tragic drowning accident, published a commentary in Contemporary Pediatrics that included criticism of the American Academy of Pediatrics messaging to parents on formal swim lessons for children age 1 to 4.

Dr. Todd Porter, Pediatrician, Quincy Medical Group

A group of AAP doctors responded to the article with a letter to CP editors. Lois Levine, associate editorial director, sent the response to Dr. Porter, saying, “This letter, from the writers of the AAP guidelines on drowning prevention, came to myself and Morgan (the new managing editor of Contemporary Pediatrics); we are still unsure of how to handle, but we did want to send to you for any rebuttal/comments you might want to have in response.” (Why the staff of a medical journal isn’t sure how to handle letters to the editor is perplexing, to say the least.)

Dr. Porter & Ms. Hughes responded to the AAP doctors’ critique, fully expecting CP would publish both letters on the journal’s website. (The AAP authors had the same expectation, I’m told.)

Instead, CP assistant editor Celeste Krewson wrote and posted her own summary of the letters. In response to an inquiry from Dr. Porter about why the journal took this approach, Lois Levine cited the letters’ length:

“When Morgan Petronelli, the managing editor of Contemporary Pediatrics, and I thought it would be best to represent both the original letter from you, Dr. Yusuf and the rebuttal from you, Dr. Porter and Nicole, in an article summarizing the finer points of the conversation, as both letter and rebuttal tended to get quite lengthy. I have included contact information from Dr. Yusuf, Dr. Porter, and Nicole Hughes, so that you can feel free to continue the conversation as well.”

While CP’s letter summary is devoid of color commentary, even selecting the points to highlight involves judgement that may not reflect the respective letter-writers’ intentions or emphases. Sure, some readers may want a summary to save time or get a preview, but why not link the full text of each letter, even as PDFs?

It’s possible a publication like Contemporary Pediatrics isn’t used to controversy, and/or risks financial or professional interests by highlighting it. There isn’t an explicit policy on the website about publishing letters to the editor per se, so I reached out to Ms. Levine with an inquiry about how the journal handles such letters. I’ll share any response I receive in an update to this page.

In the meantime, I’m delighted to connect all readers interested in dialogue over drowning prevention for young children to Authentic Pediatrics, where Todd Porter has posted both letters in full. (Follow him on Twitter, too, if you don’t already.)

Drowning Prevention: How the American Academy of Pediatrics is failing our children

UPDATE: In a 10/7/22 response to me, Lois Levine said letters to the editor are published online “in some rare cases.”