Tag Archives: Politics & society

Political and social events in the news that involve LGBTQI and/or women’s issues.

Gay doctor? Why I’m out, loud and proud


To this day I do not know a single LGBTQ* person from my youth. I was not privileged to have understanding parents nor to have role models with whom I could connect. Many youth today find themselves in a similar position.

Growing up as an LGBTQ* person is rarely easy. Rejection, isolation, discrimination, harassment and physical violence are all too common. Understandably this results in low self-esteem, risky self-destructive behaviors, homelessness and suicide. Hope for a better future is often an essential lifeline to those of us who are hurting. We need to know that suffering will end and that we can be happy.

I choose to be visible for this reason. As many others have said, I want you to know that life does get better. So much better!

If you are struggling please know that you are not alone. You are precious and you are loved. There are many resources available to you. All you need to do is reach out.

  • The Trevor Project (http://www.thetrevorproject.orgis a 24 hour help line that is available to anyone who needs a listening ear.
    • 866-4-U-TREVOR (866-488-7386)
  • Parents, Families and Friends of Lesbians and Gays (http://www.pflag.org) provides support and resources for families and friends of LGBT people.

In a better world

Reproductive choice would be reproductive freedom.

Sex education would be nonjudgemental and complete and contraception would be accessible to everyone.


Pregnant individuals would find support to scale financial hurdles that threaten lives, families and futures.

They would not have difficulty paying for services that align with their decisions and the futures that they envision.


Protesting would focus on the harms committed against living children.

Not on the individuals who find themselves facing difficult decisions.


Kickstarter film: “American Secret: The Circumcision Agenda”


“American Secret” examines the history behind popularizing male infant circumcision in the United States and the economic and cultural incentives responsible for its continued practice. The film pushes back against this rarely questioned cultural norm, which, though ingrained domestically has long since fallen out of favor abroad.

On the face of it, “American Secret” is about circumcision. At core the film is an examination of how memes proliferate, how ideas spread, and how thought patterns take hold. The film also explores questions we rarely ask ourselves, such as how we decide what we’re going to think about, what we’re going to reconsider, what we’re going to resist, and what we aren’t. The film’s overarching questions being: “How do we come to believe what we believe?” and “What role do reason and fact play in establishing or changing our beliefs?”

We do NOT want to cut your beautiful baby boy!

IMG_5505Dear Dr Pate,

I’m a third-year medical student who is strongly considering going into OBGYN. Unfortunately, I’ve been really dismayed to discover how common it is for OBGYN residency programs to require their residents to perform circumcisions. I’ve begun to worry that my moral opposition to circumcision might be incompatible with going into OBGYN. I don’t want to get into a situation where I might be fired if I don’t perform circumcisions because I would rather get fired–and if that’s the case then why go into that field in the first place. I started to google about the topic and your blog was one of the first to come up.

Do you have any advice for a student in my situation? Should I try to seek out OBGYN residency programs that don’t require residents to circumcise? Should I just match into OBGYN and then refuse once I already have the job (can I be fired for that?).


Dear MS3,

Thanks for writing! I find it so refreshing to hear more and more from students, such as yourself, who desire to refrain from performing circumcision. Clearly you are not alone but tradition is deeply engrained in culture and deviation therefrom is considered illogical and threatening. If you are interested in OB/GYN, don’t worry about circumcisions. I wouldn’t even bother mentioning it in your interviews — it falls under the same legal protection as beliefs about abortion.

I encourage you to check out my post — Do medical students have to assist circumcisions? There are links to resources available to you. Hold you head high! Where there is a will there is a way. You don’t have to compromise yourself.

Some will tell you that refraining will limit your career opportunities. It is true that some jobs will try to push you. You can take either approach — put it out there so that potential problems will fall away before you become too invested or discuss it after the fact and assert your rights.

I chose to be proud and loud throughout my process; I stirred controversy and rocked the boat. This did result in expected consequences and more than a few blows to my ego however it was the right path for me. At least one attending physician and another resident refuse to do circumcisions because of my example. And that, for me, made the pain and suffering worth it.

And I have not been pushed aside by all employers as I was warned. One recruiter even told me that I didn’t have a chance landing a job in a major city. I dropped him like a rock. Instead I have joined a phenomenal group practice in a very coveted location just 20 minutes north of Manhattan.

So my advice to you is this: Follow the path that feels right for you and do not fear the obstacles that you will find. Be true to yourself and work hard and your path will continue to unfold before you. Keep your eyes on that path and drop the rocks!

James Pate, MD

Young women are in danger

I have begun the first rotation of my last year of residency: Pediatric and adolescent gynecology with reproductive endocrinology and infertility. Today when I was reading I came across some sobering statistics regarding young women (see below). As it is Father’s Day, I would like to encourage all parents to take the time to talk with your children as they honor you. Talk to your kids about dangerous activities their peers are definitely participating in. Give them encouragement to swim against the powerful current of peer pressure. Educate them on what to do when various situations arise. Give them information that they can use personally as well as to share with their peers who choose to engage in risky behaviors. Though both of my kids are steadfast in their personal decisions to “wait till marriage” before having sex, they have both been educated all about condoms and birth control and know where to go for more information should they or their peers require it. There are a lot of excellent resources online, links to several of them follow below. Don’t ignore the elephant in the room! Be the “Best Dad in the World” and protect your daughters (and sons) by arming them with education!

Young women, grades 9-12 (2009 CDC data)

Physical danger
–  83% rarely wear bicycle helmets
–  23% have been in a physical fight in the past year
–  8% attempted suicide in the past year
–  8% rarely wear seat-belts

Substance use
–  43% drank alcohol in the post 30 days
–  34% have used marijuana
–  19% currently smoke cigarettes

–  59% are actively trying to lose weight
–  33% think they are overweight
–  24% are actually overweight
–  15% have gone 24+ hours without eating to try to lose weight
–  6% have taken diet substances without doctor supervision
–  5% have intentionally vomited or taken laxatives to lose weight

–  32% watch at least 3 hours of TV every school day
–  30% do not ever participate in physical activity lasting longer than an hour

Sexual activity among young women aged 15-17 years (2006-2008 CDC data)

–  27% have had vaginal intercourse with a male partner
–  21.5% did not use contraception the first time they had intercourse
–  13.1% still do not use contraception though they continue to be sexually active

–  In 2006 there were

–  349,145 new infections with chlamydia
–  246,250 reported pregnancies
–  59,648 new infections with gonorrhea
–  28,388 emergency room visits for sexual assault
–  344 new infections with syphilis
–  185 new infections with HIV/AIDS

Death per 100,000 women aged 15-19 years (2006 CDC data)

–  36.8 all causes
–  18.9 accidents
–  2.9 murder
–  2.8 suicide
–  2.5 cancer

Youth resources

The Birds & Bees Project provides comprehensive reproductive health information to youth and adults. The message in all materials is positive, respectful, developmentally appropriate, and aims to compliment the education and values that people receive from their families and communities.

Born This Way Foundation is building a braver, kinder world that celebrates individuality and empowers young people.

Center for Young Women’s Health provides education, clinical care, research, and health care advocacy for teen girls and young women.

girlshealth.gov was created by the U.S. Department of Health and Human Services’ (DHHS) Office on Women’s Health (OWH) to help girls (ages 10 to 16) learn about health, growing up, and issues they may face.

Girls Incorporated inspires all girls to be strong, smart and bold through a network of local organizations in the United States and Canada.

Gay, Lesbian and Straight Education Network (GLSEN) is the leading national education organization focused on ensuring safe schools for all students.

I wanna know! offers information on sexual health for for teens and young adults. This is where you will find the facts, the support, and the resources to answer your questions, find referrals, and get access to in-depth information about sexual health, sexually transmitted infections (STIs), healthy relationships, and more.

It Gets Better Project is an inspiring collection of over 10,000 user-created videos from around the world that was created to show young LGBT people the levels of happiness, potential, and positivity their lives will reach – if they can just get through their teen years. The It Gets Better Project wants to remind teenagers in the LGBT community that they are not alone — and it WILL get better.

National Suicide Prevention Lifeline at 800-273-TALK (8255) is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress.

Planned Parenthood: Info for teens provides information about STD testing, pregnancy tests, sexual orientation and more. You can even chat live with a trained counselor.

The Trevor Project at 866-4-U-TREVOR (866-488-7386) is a 24 hour help line that is available to anyone who needs a listening ear.

I’m on the hunt

On 6/11/12 I officially enter my LAST year of residency and am finally starting to see the light of a very long and arduous tunnel. My senior resident colleagues and I are just now starting to be inundated with emails and phone calls from recruiters and practice representatives from across the nation. As the Baby Boomers move into retirement, and along with them the physicians of the same generation, the demand for new recruits continues to grow. As is true of real estate, for many of us it’s all about location, location, location! Positions in coveted downtown city locations are never short of applicants but beyond the cityscape and adjacent suburbia lies an ever expanding need for medical professionals.

The Washington Post recently posted the above image generated with esri software that geographically identifies areas of increasing medical need. Areas that are dark orange are already in great need of medical providers and they are likely to continue to grow in dimension.

Having grown up in a suburb of Seattle (Kent, WA), I don’t think I would have given rural medicine any consideration prior to medical school which I completed at Oregon Health & Science University in Portland, OR. OHSU prides itself in fostering a love of primary care among its students as well as an appreciation for rural medicine. During my time there I completed 4 rural rotations in primary care, family medicine, neurology and surgery lasting approximately 8 weeks each.

I was required to complete a community project in my primary care rotation in Coos Bay, OR. I elected to research the issue of rural physician shortage in terms of physician recruitment and retention. I had the opportunity to interview local recruiters as well as rural physicians of multiple specialties. I also conducted a survey of the 3rd and 4th year medical students regarding their experiences with and interest in rural medicine. I then compiled this data into a written manuscript: Recruiting and Retaining Physicians in Coos Bay: Assessment of Medical Student Interest in Rural Medicine and Rural Physician Perspectives on Their Practice. I later presented this data at the 25th Annual Oregon Rural Health Conference. My presentation can be found here.

I discovered that there are a lot of benefits to working rural areas including making a difference for an underserved population, becoming part of a “close-knit” community and having a larger scope of practice. Fringe benefits include outdoor activities, simpler lifestyle, lower cost of living and potential student loan repayment.

Some of the more challenging aspects of working in a rural area are cultural and political differences. It seems that the more diverse and populated communities are, the more liberal and tolerant they are as well. Rural America is more homogenous in character and conservative in opinion. White Anglo-Saxon Protestant (WASP) physicians tend to find a home away from home more easily, especially when they share the same values as the communities they enter. Those of us who are different often feel like outsiders who are simply extended cordial hospitality with an arms-length handshake. The vast difference between city and rural amenities can also contribute to culture shock, homesickness and isolation.

My partner and I are willing to consider rural locations among our opportunities. Both of us have moved extensively, Patrick more than I, and we enjoy the adventure of new experiences and making new friends. The issues I foresee being problematic pertain to the differences I alluded to: I am a partnered gay father in addition to being an OB/GYN resident physician; my personal life cannot be separated from my professional life. Patrick and I have been committed to each other for the past 10 years. I have been a father even longer. I feel that it is a travesty that we live in the 21st century yet continue to be treated as a second class citizens. Because our relationship is not recognized in the majority of States we suffer mentally and financially. Although more and more insurance companies are choosing to include same-sex partners, many do not. I have worked too long and too hard to accept employment with a group that will not allow me to insure my family.

Another issue is abortion. The Republican-lead War on Women is in full force and a record number of anti-choice ballots continue to make their way through state and federal legislatures. We are rapidly returning to the pre-Roe Vs. Wade era. Some sobering statistics are the following:

  • Approximately 1/3 of women require an abortion procedure over their lifetime.
  • Over 90% of OB/GYNs have had patients request abortion services.
  • ONLY 14% of OB/GYN providers provide them.

While this may be great news for the anti-choice audience, women AND children are already suffering much and may be soon forced to suffer more. The U.S. foster care system is overflowing with abused, neglected and unwanted children. Shall we increase their numbers? Women have many deeply personal reasons for seeking abortion. Sometimes they are truly in danger of dying because the pregnancy is too great a strain on their pre-existing medical conditions. Other times they simply cannot afford yet another mouth to feed. Although abortion access isn’t really one of my soap boxes, I cannot consider myself a defender of social justice and turn a blind eye to this dilemma. Abortion is legal in this country and is a part of comprehensive OB/GYN practice. I cannot ethically permit my scope of practice to be limited by religiously or politically motivated restrictive work covenants.

And then there are my professional interests which include issues pertaining to the LGBTQI (lesbian, gay, bisexual, transgender / transsexual, queer / questioning, intersex) communities, Mayer-Rokitansky-Kuster-Hauser syndrome (Mullerian anomalies) and polycystic ovarian syndrome (PCOS). The majority of gender and sexual minority patients receive sub-optimal and inadequate care. And although PCOS affects around 7-8% of women it is often the elephant in the exam room that is repetitively ignored. I must also make myself available to these underserved populations.

One recruiter wrote to tell me that “the 232 clients my colleagues and I are working with nationwide will not be able to provide you with all of those items. If they are really non-negotiable factors, I will not be able to assist you with your search.” Fortunately there are many other recruiters that do not share his lack of vision.

Although my personal life and professional ambition may “offend” some I am confident that I will find the right place for me. The map is wide open and opportunity calls.

Bankrollers of hatred

“Therefore whatsoever ye have spoken in darkness shall be heard in the light; and that which ye have spoken in the ear in closets shall be proclaimed upon the housetops.” — Luke 12:3

It’s been quite some time since I’ve chosen to quote the bible however I just couldn’t resist the irony. In 2008 the Mormon church (Mitt Romney’s church) bankrolled / steamrolled the California Proposition 8 election in order to eliminate the rights of same-sex couples to marry. This blatant act of discrimination by a politically-motivated religious entity is without precedent in modern history. Mormon temples across the nation were picketed and even a documentary, 8 : The Mormon Proposition, was released in 2010.

Though the Mormon church continues to try to clean up its post-8 image, the church continues to be associated with anti-gay extremism in addition to its history of polygamy. For more information about Prop 8, check out the Human Rights Campaign (HRC) Prop 8 decision analysis or Wikipedia.

Though I cannot remember the source, I recently downloaded a pdf of the 2008 IRS schedule B of the National Organization for Marriage, Inc (NOM), another anti-gay group. Here is some interesting data from that form:

  • $2 million was collected from a list of 50 contributors.
  • 41 individuals with 29 unique last names contributed $1.5M (74% of the pot).
    • 36 individuals (88%) were from CA and contributed $806,000 (54% of individuals’ contribution and 40% of the total pot).
    • 4 others were from AZ, 3 from PA, 2 from CT, 2 from NY and 1 each from MA, RI and VA.
    • One extended family of 9 gave $265,000.
    • A man in his 70s living in PA gave a whopping $450,000, the largest individual donation. His wife contributed another $100,000 making their combined contribution 37% of the individuals’ contribution and 27% of the total pot.
    • Only 10 women contributed, and of these only 2 were living independently and not obviously related to other male contributors. This pair of women had an average age in their 70s and their contribution was $14,500 (less than 1% of the pot).
    • The average age of contributors was early 50s and no one under age 50 lived independently of an older contributor.
    • The most expensive home owned by a contributor appraises at $3.8 million. The average appraisal of contributor homes is $1.2 million.
  • 9 companies donated $525,000 (26% of the pot), 5 of which are based in CA.

Enough data crunching. Clearly the bulk of anti-gay legislation funding provided to NOM is from so-called “christian” organizations and their largely older, male, affluent members in CA. Oh, and one elderly, very affluent couple in PA.

Contrary to marketing in Africa, circumcision does NOT prevent HIV transmission and may increase it

Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. Journal of Law & Medicine. 19(2):316-34, 2011 Dec.
“In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain.”

If the WHO/UNAIDS really wants to turn the epidemic tide, distribute free condoms!

Is it lawful to use Medicaid to pay for circumcision? NO!

Is it lawful to use Medicaid to pay for circumcision?.
Journal of Law & Medicine. 19(2):335-53, 2011 Dec.

“Since 1965, tens of millions of boys have been circumcised under the Medicaid program, most at birth, at a cost to the United States Federal Government, the States and taxpayers of billions of dollars. Although 18 States have ended coverage since 1982, the United States Government and 32 States continue to pay for non-therapeutic circumcision, even though no medical association in the world recommends it. Many cite American medical association policy that the procedure has potential medical benefits as well as disadvantages, and that the circumcision decision should be left to parents. This article shows that Medicaid coverage of circumcision is not a policy issue because it is prohibited by federal and State law. As American medical associations concede, non-therapeutic circumcision is unnecessary, elective, cosmetic surgery on healthy boys, usually performed for cultural, personal or religious reasons. The fundamental principle of Medicaid law is that Medicaid only covers necessary medical treatments after the diagnosis of a current medical condition. Physicians and hospitals face severe penalties for charging Medicaid for circumcisions. Medicaid officials and the Federal and State Governments are also required to end coverage. It is unlawful to circumcise and to allow the circumcision of healthy boys at the expense of the government and taxpayers.”

Don’t waste taxpayer dollars on destructive “cosmetic” procedures on un-consented infant boys!

Dr Cary Gabriel Costello: Intersex Fertility

Dr Cary Gabriel Costello

Dr Costello writes in his blog entry, Intersex Fertility, that “My daughter was not of woman born. That is a concept that has fascinated people through the ages. My daughter’s gestation was perfectly ‘natural,’ I should point out–but I carried her, and I was never of the female sex; I am a so-called ‘true hermaphrodite.’ I was assigned female at birth, and was living as such when I gave birth to her, but I never identified as a woman, and am now legally male.”

He continues, “I’m glad that I was able to become a parent, but believing that this should have ‘cured’ me of my distress with my assignment is magical thinking along the lines of believing that procreating will ‘cure’ a lesbian or gay man and make them heterosexual. Gender identity, sexual orientation, and procreative status are independent characteristics. Lesbians and trans men and intersex individuals aren’t mystically “converted” by pregnancies. Gay men and trans women and intersex individuals who inseminate someone aren’t thereby made straight or cis or dyadically-male-sexed.”

He concludes: “Most of us who do reap the rewards of fertility do this in private, with no medical journal articles trumpeting a star in the east. In fact, some medical ‘corrections’ of our physical differences render us infertile, and I don’t see why that’s treated as unimportant when doctors are so very willing to write articles about their ‘cases’ who do prove fertile. And the magical thinking behind the idea that doctors can validate a sex assignment through the intersex person contributing the ‘correct’ component, egg or sperm, to a conception just boggles my mind. It’s time for some more sophisticated thinking about intersex fertility.”

I couldn’t agree more. Ready more about Dr Costello, his experiences and his scholarly opinions regarding intersex and trans issues on his blogs: