INTRODUCTION: Medicine, Gender and Politics

Steve Osborn

I am a 58-year-old heterosexual male. History does not record when I first became aware of gender differences, but it was probably during my infancy, when I noticed that my mother looked and acted differently from my brother or father.

While growing up, my brother and I went through all the boyhood rituals of covering our eyes whenever actors and actresses kissed in the movies, followed in later years by ogling the Miss America contestants during the swimsuit competition. By the time I reached high school, I had basically one thing on my mind, and it wasn’t homework. My fellow male scholars were likewise monomaniacal, and we wished that our female counterparts would be as well.

During high school I had a friend whom I’ll call Alex who didn’t seem nearly as obsessed with Playboy bunnies as the rest of the boys. While not an outcast, he mostly kept to himself, preferring studying to partying.

I fell out of touch with Alex during college and graduate school, but I tracked him down shortly afterward on a rare visit home. Over drinks at a bar, he disclosed that he had finally realized he was gay while writing his dissertation, and that the revelation had changed his life.

Nowadays Alex is a full professor at a major university and a world-famous expert in his field. He has lived with the same man for several decades, but they have never been able to get officially married. They have also spent many fruitless years trying to adopt a child. In his last Christmas letter, Alex confessed that they had finally given up hope.

In this issue of Marin Medicine, local and nationally renowned physicians explore the complex interactions of medicine, gender and politics--the same kinds of interactions that prolonged Alex’s discovery of his sexual identity and continue to shape his struggle to be fully accepted into society.

We begin with an overview of lesbian, gay, bisexual and transgender (LGBT) medicine by Dr. Daniel Blumkin, a family physician in San Rafael. He notes that more than one-fourth of LGBT patients postpone care because of fear of discrimination, and that one way to make them feel welcome is to include a sexual-orientation question in the social history.

Dr. Ann Kao, a Larkspur cardiologist, offers a detailed review of heart disease in women. No longer considered a “man’s disease,” CVD in all its many forms is the No. 1 killer of women nationwide. Pregnancy is a particularly dangerous time for women at risk for CVD, but as Kao explains, much of that risk is preventable.

During the current presidential election campaign, politicians of all stripes have focused attention on gender-related medical issues, including the HPV vaccine and the Plan B morning-after pill. Rick Perry’s failed attempt to mandate HPV vaccinations in Texas contributed to his early departure from the race, and HHS Secretary Kathleen Sebelius drew both scorn and praise for prohibiting over-the-counter sales of Plan B One-Step to females younger than 17.

For perspective on those issues, we’ve included articles on both HPV and Plan B. Former Marin County public health officer Dr. Jason Eberhart-Phillips clears away the confusion surrounding the HPV vaccine by furnishing a point-by-point analysis of its purpose, efficacy and use. Prevention of HPV-related cancers is a tantalizing possibility, but much work remains to be done.

Dr. Vicki Darrow, a pediatric and adolescent gynecologist for Kaiser Permanente, minces no words in her condemnation of the Sebelius decision on Plan B, calling it “an unwanted intrusion of politics into public health.” She argues that unrestricted access to the medication could significantly decrease the rate of unintended pregnancies in adolescents.

We conclude the feature articles with an exclusive interview with former Surgeon General Dr. Richard Carmona, who completed medical school and residency at UC San Francisco. He gives an insider’s view of the role of politics in public health. Recalling the pressures he faced during his tenure with the Bush Administration, he offers potential solutions to the ongoing conflict between politics and science.

The diversity of the feature articles in this issue is matched by the departments, which range from a timely reminder by Dr. Jim Dietz about the proper use of emergency departments, to a set of poems about the ED and other medical settings by Dr. Catharine Clark-Sayles. In between are helpful comparisons of physician retirement options by Jonathan Leidy, an update on Kentfield Rehabilitation & Specialty Hospital by Simone Adams, and a review of local author Dr. Martin Rossman’s new book by the chair of our editorial board, Dr. Irina deFischer.

---

Mr. Osborn edits Marin Medicine.

Email: sosborn@scma.org