LGBT

The National Academy of Sciences recently celebrated its 150th birthday by, among other things, conferring membership on Ben Barres, MD, PhD. Additional NAS admittees from Stanford were sleep scientist Emmanuel Mignot, MD, PhD, and bioengineer Steve Quake, PhD.

A distinguished scientist by anybody’s yardstick, as well as the chair of Stanford’s ironically named neurobiology department, Barres is a leading light in the study of glial cells (collectively known as glia), the 90 percent of all the cells in the brain that aren’t nerve cells.

The term”glia” is derived from the Greek word for glue. Like Rodney Dangerfield, glial cells once got no respect. They were thought of, in fact, as not much more than “brain glue”: mere structural scaffolds for the organ’s much more revered nerve cells.

Barres’ research has proved that hypothesis incorrect, to say the least. (For details, click here.) Discoveries coming out of his lab include, to name one example, glial cells’ crucial role in determining exactly when and where nerve-cell connections in the brain are made, tweaked to strengthen or weaken them, or destroyed.

You don’t get much more respectable than that: Those connections pretty much define the thoughts we have, the emotions and sensations we experience and the actions we take.

The man who, as much as anyone, has brought a set of unsung cells a newly elevated status would like to see another group get more respect: the estimated 0.3 percent of Americans who are transgender.

“I’m the first transgender scientist to make into the National Academy of Science,” says Barres, who began life under another first name: Barbara.

“We don’t know if other members past or present are or were transgender,” demurs an NAS representative. And after all, how would they? What kind of statistics could be compiled by an organization that doesn’t ask or track the sexual orientations, much less the gender identities, of its membership? Who would have even considered asking such a question 20 or 30 years ago, much less running sex-chromosome tests on cheek swabs from prospective, current or posthumous members?

But it’s a pretty safe bet that if any previously admitted NAS member were openly transgender, we’d have heard about it. (Transgendered computer scientist Lynn Conway was admitted to the National Academy of Engineering in 1989.)

One is tempted to compare Barres to Jackie Robinson, who broke the Major League Baseball’s color barrier in 1947 - except that the latter had to put up with a whole lot more grief from his fellow major-league ballplayers than Barres is likely to encounter from his peers.

“We heartily congratulate Prof. Barres on his election,” says NAS spokesperson Bill Skane.

In science, if anywhere, diverse perspectives drive innovation. ”Don’t ever let anyone make you feel bad about being different,” Barres tells young scientists. “Your difference is your greatest advantage.”

Previously: Malfunctioning glia - brains cells that aren’t nerve cells - may contribute big time to ALS and other neurological disorders, Neuroinflammation, microglia, and brain health in the balance and Unsung brain-cell population implicated in variety of autism

The need to better train future physicians on how to care for lesbian, gay, bisexual and transgender patients is the subject of an American Medical News story today. Citing research showing that medical schools spend on average just five hours on LGBT health issues, writer Carolyne Krupa includes the thoughts of a Stanford expert:

LGBT patients face numerous disparities, such as limited access to employer-based health care, lower rates of screening for common health conditions and higher rates of mental health issues, said Gabriel Garcia, MD, a gastroenterologist/ hepatologist and professor at Stanford University School of Medicine in California. He is faculty adviser to the school’s LGBT Medical Education Research Group.

Lack of training in LGBT health perpetuates inequities in health outcomes through continued stereotyping and stigmatization, he said. A 2007 survey of 736 California physicians found that at least one in six felt uncomfortable providing care to gay patients.

“Quality patient-provider relationships are the foundation for good health outcomes,” Dr. Garcia said. “LGBT people, as all others, need health care providers they can trust and with whom they can develop genuine, respectful and mutually beneficial relationships.”

Previously: Medical schools neglect LGBT issues and Gay, lesbian, bisexual and transgendered health issues not being taught in medical school

Obtaining appropriate health care - including adequate medical insurance coverage - has often proved challenging for patients who may identify with one gender, yet still have body parts of another gender. A trans man who still has breasts may not get coverage for a mammogram, for example.

But that may now change: The Department of Health and Human Services has confirmed that the Affordable Care Act prohibits federally funded health-care programs from discriminating against transgender people. ABC News reports on this today and highlights the case of Jay Kallio, who faced discrimination when he sought treatment for breast cancer:

At the age of 50, Kallio transitioned from female to male, but never had gender reassignment surgery, only hormone treatment. ‘I accept my body as I was born,’ he said. But when a suspicious lump was found in his breast and tested positive for cancer, the surgeon was so shocked that Kallio’s body didn’t match his gender identification — not knowing whether to address him as ‘he’ or ‘she’ — that he couldn’t bring himself to tell his patient the grim biopsy results.

Due to the doctor’s mistake, Kallio was late in receiving treatment.

In a story on transgender health care for the recent issue of Stanford Medicine, I highlight the barriers facing the patients and the importance of doctors providing prejudice-free care. A Stanford physician also emphasizes the unique needs of transgender patients:

Physicians should be cognizant that sex-change surgery patients often still carry reproductive organs from before, and these may need continuing medical attention. That’s something that can be easily missed, says Nelson Teng, MD, associate professor of obstetrics and gynecology at Stanford, who has treated several female-to-male transsexuals for endometrial cancer — cancer of the lining of the uterus. “Many male transgender patients still have a uterus and still should see gynecologists.”

Previously: Gay, lesbian, bisexual and transgendered health issues not being taught in medical school
Via ThinkProgress

So far, the spread of HIV in China has remained at levels less than one-fifth that of Europe and the United States, but now researchers warn that discomfort over discussing sex is a major problem. According to the Chinese Ministry of Public Health, the transmission of HIV between homosexuals has risen (.pdf) from 0.3 percent before 2005 to 13.7 percent in 2011.

In a comment published online today in Nature a consortium of Chinese researchers compare attitudes toward sexuality in China today to those in Western countries a quarter of a century ago. They write:

Chinese people aren’t uncomfortable just in discussing homosexuality — sex in general is still considered extremely personal and is rarely addressed openly or directly, irrespective of orientation. This discomfort has resulted in a pervasive stigma against people with HIV, a lack of general sex education for young people and poor epidemiological data about the spread of HIV in some populations around the country.

The result is a hidden population of individuals who are afraid to seek out HIV information resources or testing and counselling centres. Poorly educated, unaware of their HIV status and under pressure to conceal their sexual encounters, these men often engage in high-risk behaviour. And once one man hiding his activity becomes infected, the disease will spread among his partners, in an ongoing cycle. It is therefore no surprise that incidence of HIV has skyrocketed in this population.

Although cases of HIV among homosexual men represent a much smaller portion of those infected, (just 13.7 percent compared to 50 percent in the U.S.) the researchers say there is cause for concern. They call for more testing and public programs as well as better social and media awareness:

Leading by example is one of the most powerful ways to combat stigma … In 2003, a man stood up during an AIDS summit with former US President Bill Clinton at Tsinghua University in Beijing, and in doing so became one of the first Chinese people to publicly reveal his HIV status. Clinton embraced the man, named Peng-fei Song, bringing him positive media attention. Song later became a strong advocate for HIV awareness and prevention. China needs to encourage more individuals affected by HIV/AIDS to step up and help to change people’s perception of the disease.

Ready to be moved? Take a few minutes to read this touching essay, which CommonHealth posted today, on being gay in the medical field. Written by Mark Schuster, MD, PhD, the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of general pediatrics at Children’s Hospital Boston, the text is based on a speech the author gave in 2010 at the Children’s Hospital Boston GLBT & Friends Celebration.

Schuster records incidents of discrimination he faced or observed during his medical education in the 1980s and in his early career. He also remarks on how the field has progressed in its treatment of gays and lesbians and brings to light issues that still need addressing. From the piece:

It may seem odd that I didn’t complain to anyone, but there was no one at the medical school or the hospital to whom I or my gay classmates thought it was safe to complain. There were no policies to protect us; no grievance boards; no mechanisms in place. Times have changed, but I still have undergrads ask me if they can come out in their medical school applications and medical students ask if they can come out in their residency applications. Yes, times have changed, but they have not changed enough.

…

I could not believe that in a mere two decades we had gone from “I’ve decided not to write you a recommendation” to “Your job is to get this guy’s partner a fellowship.”

…

It’s easy for me to think that my experiences two decades ago are ancient history. For me, they are. I’ve been lucky enough to construct a life that does not involve a daily fear of being outed, of being beaten, of being fired, or of having my children taken away from me. But many people still live with such fears. My experiences wouldn’t sound so quaint to them.

Coming out isn’t always a party. It gets better, according to a project that aims to inspire hope among LGBT youth facing harassment, but the teenage years can still prove painful and lonely. Last week’s episode of Glee, in which the former bully Dave Karofsky (played by Max Adler) attempted suicide after being outed as gay by his high school peers, voiced the issue on a major media platform. The fictional TV show’s winter finale surprised viewers with its heavy subject matter.

Today, an article from The Atlantic reports the real-life statistic that LGBT youth are twice as likely to commit suicide as their heterosexual peers. And it discusses new research (subscription required) published in the American Journal of Preventive Medicine that followed 246 LGBT participants, aged 16-20 years, and found:

General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.

In the piece, Brian Mustanski, PhD, lead author of the study and a psychologist at Northwestern University, also lists ways that parents can demonstrate support of their gay children. He asserts that family love can provide the most important protection from the path toward suicide and even lessen the effects of bullying at school:

If your child does come out to you remember that he’s sharing a core part of his identity, so react with acceptance, not judgment. This lets him know that your love is unconditional and that you’re available for support as he faces the trials of growing up as a minority.

Bullies: Stand down. Dave Karofsky: Life gets better after high school.

Previously: Medical schools neglect LGBT issues, Gay, lesbian, bisexual and transgendered health issues not being taught in medical school, Apple employees tell bullied teens “it gets better”, Advances being made for LGBT medical students and Tim Gunn speaks to depressed LGBT youth in ‘It Gets Better’ video
Photo by Eddie S.

Yesterday on Well, Pauline Chen, MD, recounted the story of a doctor who unknowingly treated a transgender woman. Because of a lack of communication between doctor and patient, it wasn’t until the physician began an operation on the patient and pulled down the sheets that he discovered she had male genitalia.

Not a confidence inspiring story for any physician. Chen writes it’s a story that continues to haunt her and other colleagues because it could have happened to any one of them. Medical schools need to do a better job of training students on how to care for transgender, lesbian, gay, and bisexual patients.

Chen refers to a recent Stanford study that showed one-third of all medical schools in the U.S. and Canada have no training at all for this population and, on average, schools provided only five hours of curriculum devoted to the topic.

Chen describes her own medical education:

While we had been trained well in treating cancer with the best chemotherapy regimen, curing flesh-eating infections with the most powerful antibiotics or transplanting organs with the greatest of ease, when it came to caring for patients who were transgender, we were lost. For many of us, the same could be said for lesbian, gay and bisexual patients as well. The only thing most of us knew how to do was ask about a single issue: “Whom are you having sex with? Men, women or both?”

Previously: Gay, lesbian, bisexual and transgendered health issues not being taught in medical school

In 2007, four students at Stanford medical school founded the Lesbian, Gay, Bisexual and Transgender Medical Education Research Group with plans of working toward bolstering LGBT curricula in medical schools. They approached one of the deans at Stanford who showed some interest but wanted to first know what exactly was being taught elsewhere.

“We found that that information was really hard to find because it didn’t exist,” said Mitchell Lunn, MD, an internal medicine resident at Brigham and Women’s Hospital/Harvard Medical School who was a medical student at Stanford at the time. “It just wasn’t known what exactly was being taught in medical schools, so we decided to do some research and find out.”

Four years later, results of that research are being published in the Journal of the American Medical Association. Based on data from a survey sent to deans of all the medical schools in the United States and Canada, Lunn and his colleagues show that the average medical student spends just five hours in medical school learning about the health-care needs of the lesbian, gay, bisexual and transgendered community.

And this is despite evidence that LGBT patients often face a unique set of health risks, which as I explain in a release, include increased risk factors for breast cancer among lesbians, higher rates of depression and anxiety due to homophobic discrimination, and increased rates of hepatitis among gay men.

The authors’ next step, they told me, is to take this information and move forward with their original hope of bolstering LGBT curriculum in medical school:

“This is really about visibility and partnering with other organizations to get a better sense of how we can train a next generation of providers to be really sensitive and competent in meeting the needs of the LGBT community,” said first author Juno Obedin-Maliver, MD, a Stanford graduate now doing an ob/gyn residency at the University of California-San Francisco. “These issues are something that every health-care provider will encounter.”

Related: Advances being made for LGBT medical students

One of my current projects is an upcoming Stanford Medicine article on cancer survivorship. (Given a recent report showing there are more than 12 million former patients in the United States, I thought it was a timely topic.) I took notice, then, of a new study in the journal Cancer describing the differences between straight and gay cancer survivors. Among them: Lesbian and bisexual survivors are more than twice as likely to report fair or poor health after cancer than are heterosexual ones.

MSNBC.com has a nice write-up here.

I’m a couple of days late to this, but earlier this week Apple, Inc. employees shared a message for the It Gets Better Project. I thought their message was so touching and so perfectly stated that I’m sharing it here.

Previously: Tim Gunn speaks to depressed LGBT youth in ‘It Gets Better’ video