“Sex designations on birth certificates offer no clinical utility, and they can be harmful for intersex and transgender people,” says the abstract of the article, authored by doctors Vadim M. Shteyler and Eli Y. Adashi, and lawyer Jessica A. Clarke, and tweeted out by NEJM on Thursday.

“Moving such designations below the line of demarcation would not compromise the birth certificate’s public health function but could avoid harm,” the trio argue in the article, titled ‘Failed Assignments’ and published on December 12.

While the rest of the article is behind NEJM’s paywall, the tweet quickly got ratioed by an incredulous public, wondering if the journal had been hacked, or if it the article was a prank by ‘Titania McGrath’, a famous ‘woke’ online persona invented by a British comedian.

Shteyler and Adashi are affiliated with Brown University in Providence, Rhode Island, while Clarke lists as her affiliation the Vanderbilt University Law School in Nashville, Tennessee.

Dating back to 1812 and operating under its current name since 1928, the NEJM is the oldest continuously published medical journal in the world, and is considered one of the most prestigious peer-reviewed publications in the US.

That hasn’t prevented it from wading deep into controversial political waters, however. In October, the journal issued a veiled political endorsement of the Democrats in the upcoming US election, echoing Joe Biden’s talking points about the Covid-19 pandemic without naming any names.

At the end of September, the NEJM published a study advocating for mandatory vaccinations against Covid-19 under penalty of job loss or home confinement, but stopping short of criminal charges as they would “disadvantage the poor” and minorities.