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INDULGENCES health lab
by dr. joel
“A law which makes people
lie to their physicians
is a bad law.”
The AmericAn
Taking a Big step in the right direction
In recent months, LGBT causes have received support from some unexpected Traditionally, the phrase was used in discussing racial and ethnic minorities, or
sources. Cindy McCain, the wife of Proposition 8 supporter Senator John McCain, other traditionally underrepresented non-minority groups, like women. Recent
was photographed with the “NOH8” campaign in support of marriage equality. research has shown that a variety of conditions including age, geographic loca-
The current Chairman of the Joint Chiefs of Staff, Admiral Michael Mullen, and one tion, sexual orientation and gender identity can lead to differences in health care.
of his predecessors, General Colin Powell, both spoke out in favor or repealing Blatant discrimination is usually easy to spot, and sometimes to fix. State and
Don’t Ask Don’t Tell (DADT). Back in November, both of these causes got a boost federal laws do a pretty good job of making sure a doctor can’t refuse to treat you
from another unexpected source—the American Medical Association (AMA). because you are gay or African-American. Unfortunately, biases that are part of
For many years, the AMA was considered a fairly conservative organization, an accepted norm, like the legal system, or part of a special circumstance, like
representing rich doctors who wanted to protect their money. More recently, it marriage, can be more insidious, but no less damaging.
has supported progressive issues, such as health care reform. Their reasoning, In California, two single gay men with insurance probably have the same access
though, can sound like a conservative talking point: Don’t get between patients to health care as to two single straight men. If those gay men are in a committed
and their doctors. relationship, though, the better comparison is to a heterosexual couple. Since the
In general, doctors and hospitals can’t reveal your medical information to any- gay couple can’t legally marry, disparities start showing up. They may not be able
one without your permission or an imminent threat to you or someone else. The to share employer provided health care. They may not be able to legally adopt or
military, though, reserves the right to look at medical records to assess “combat parent children. They may be denied the right to support or make decisions for
readiness.” Under Don’t Ask Don’t Tell, a service member who tells a doctor about their family members. These limitations and concerns can lead to further stress
his or her sexual orientation could have it used against them in a hearing. and unhappiness. One study showed that in states where marriage bans were
As I’ve mentioned before, you need to feel you can trust your doctor. But we passed in 2004 or 2005, LGBT people had an increase in mood disorders, anxiety,
need to be able to trust our patients as well. Believe it or not, doctors make about and alcohol use.
75 percent of their decision based on the patient’s history and physical exam, Sadly, the AMA stopped short of calling for repealing marriage bans or fully
before any tests or scans are ordered. If they can’t tell us about their sexuality, we supporting marriage equality. But their willingness to look at health care dispari-
can’t serve our service members. As one doctor said of DADT, “A law which makes ties caused by not allowing same-sex couples to marry is a big step in the right
people lie to their physicians is a bad law.” So the AMA will advocate for its repeal. direction. Just as when the California Supreme Court made gays and lesbians a
The AMA’s stance on marriage equality is more nuanced, but no less important. “suspect class,” it means that laws affecting the LGBT community should be looked
Their policy states the “AMA will evaluate existing data concerning same-sex cou- at more closely, to prevent unfair treatment. It’s more evidence that people can’t
ples…to determine whether there is evidence of health care disparities for these look at marriage bans and DADT as a benign way to preserve traditions. They
couples and children because of their exclusion from civil marriage.” “Health Care have real impacts on the health of people and their children, and they need to go.
Disparities” are differences in medical conditions or outcomes in specific groups. Hopefully, voters will start listening to their doctors on their neighbors health as
To some degree, it’s a politically correct way of saying discrimination. well as their own.
48 RAGE monthly | MARCH 2010
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