BY MARIE-JO PROULX
At its annual meeting held in Chicago June 10-14, the American Medical Association ( AMA ) discussed a number of LGBT-related issues. New policies were adopted, reports were submitted and an informational session exploring the pseudo-scientific claims of 'reparative therapy' was presented.
A resolution calling on the AMA to recognize National HIV Testing Day ( June 27 ) and to encourage its members to promote patients' participation in voluntary testing was adopted without any opposition. However, one entitled 'Anonymous HIV Testing on Undergraduate Campuses' generated considerable debate between the different state and specialty delegations.
Several groups were against endorsing anonymous testing because it precludes reporting, counseling and treating of HIV-positive individuals. They argued that the AMA should recommend confidential testing instead. Representatives of the Medical Student Section, who introduced the resolution, insisted that in a campus environment where young people are often reluctant to seek medical care, testing is more likely to be accepted if students know their identity will remain protected. In the end, the assembly voted to support confidential testing.
Granting hospital visitation privileges to LGBT couples is an issue on which there was overwhelming agreement. Physicians from Ohio, North Carolina, Georgia and Texas, as well as delegates from the American Academy of Pediatrics and other organizations, all expressed strong support for this non-discrimination measure. Thus, it is now new AMA policy to encourage all hospitals to add to their regulations and Patient's Bill of Rights language protecting the visitation privileges of same sex couples and their children. It was also pointed out that because documented advance directives can supersede hospital rules, doctors should urge their patients to designate in advance the people they wish to welcome in their hospital rooms.
The concepts of discrimination against individual patients and a physician's objection to treat gave rise to much discussion. The proposed resolution would have seen the AMA endorsing a doctor's right to refuse treatment on conscientious grounds only outside of emergency situations. Opponents contended that the wording acknowledged no distinction between existing doctor-patient relationships and new ones and so provided no clear guidelines as to when a patient must be attended to and when he/she can be referred to another physician. A decision on the matter was postponed to a later date.
Earlier this year, the Centers for Disease Control and Prevention ( CDC ) published a white paper entitled 'Expedited Partner Therapy [ EPT ] in the Management of Sexually Transmitted Diseases,' which offers guidelines as to when and how to use the therapy. The AMA voiced unanimous support for the CDC's recommendations. Essentially, EPT consists of a doctor prescribing medication for his/her patient's partner without performing a physical examination—most of the time without ever seeing the partner. The idea is for treatment to reach an infected individual even though he/she may not wish to see a doctor, or even be aware that he/she has been exposed to an infected sexual partner. The practice is not legal in most states but is widely used in California and New York.
The ethical issues raised by EPT are both obvious and serious. Writing prescriptions for strangers without first-hand knowledge of their medical history; current physical health and emotional state; possible drug allergies; and other relevant information has always been strongly discouraged. It is easy to see how attempting to treat one disease could potentially trigger or compound the effects of another condition. Moreover, EPT can put enormous strain on the patient who is given medication for his/her partner. Remembering specific instructions, answering medical questions, providing counseling and follow-up are not the responsibilities of a patient who is anxious about his/her own recovery.
Ironically, EPT was developed in the '40s as a strategy to combat the spread of syphilis but is no longer recommended by the CDC for this disease. While some data is available on the effectiveness of EPT for HIV among men who have sex with men ( MSM ) , it is mostly anecdotal and the CDC does not consider EPT as a routine partner management strategy for this population.
As is typically the case, on the third day of the AMA meeting, a morning of concurrent educational sessions was scheduled. The Advisory Committee on GLBT Issues offered a presentation under the umbrella theme 'meeting the Needs of our GLBT Patients and their Families.' It featured three physicians, each with considerable experience in serving LGBT patients. Committee chair Paul Wertsch, a Wisconsin doctor whose son is gay, narrated the history of homosexuality as a medical and social concept. Committee vice-chair Jason Schneider, an openly gay physician from Atlanta, gave tips on how to interact with LGBT patients and how to make the clinic environment more welcoming to non-straight patients ( posters of same-sex couples, gender neutral admission forms, etc. ) Renowned New York psychiatrist Jack Drescher debunked the pseudo-science of 'reparative therapies,' pointing out, among other flaws, the multiple methodological and statistical inconsistencies in the supposed results paraded by the religious proponents of the so-called therapy.
During the questioning period, one of the members of the committee, who is also a board member of the Gay and Lesbian Medical Association ( GLMA ) , got up to answer a question about sensitivity to pronouns when speaking to transgender patients. She advised doctors not to be afraid to ask when they are not certain which gender an individual identifies as and what name he/she prefers to use. She spoke from experience. Doctor Becky Allison is a cardiologist with 30 years of experience. After undergoing gender-reassignment surgery 14 years ago, she lost her job in the South and relocated to Phoenix, where she continues to practice today.
Following the educational session, when asked to describe what it is like to be a M2F physician among professional peers, Allison said that while she knows of no other transgender member of the AMA, 'there are allies.' Commenting on the policy goals she would like the committee to achieve, she wished that it would 'encourage the AMA to eventually take a position that the treatment of transgender people is legitimate and should be covered by insurance.'
Allison is in the middle of a two-year term on the committee. Her efforts and that of her colleagues could lead to further recognition and understanding of LGBT-related health issues by the medical profession. The AMA's 2007 annual meeting might be the next major forum for a breakthrough.