The Pathophysiology of our National Health Conversation


There's been a whole lot of press over the past few weeks about James D. Holsinger, the Kentucky physician who President Bush nominated in May to serve as the next U.S. Surgeon General. Most of the press has focused on "The Pathophysiology of Male Homosexuality," a controversial white paper Holsinger wrote for the United Methodist Committee in 1991 that argues, in essence, that homosexuality is unnatural and dangerous because it challenges the complementarity of the sexes. Holsinger draws on anatomy, physiology, epidemiology, and, perhaps most innovatively, nomenclature commonly used by plumbers, to establish this complementarity beyond a shadow of a doubt. In the paper's final paragraphs, he cautions his readers that, "When the complementarity of the sexes is breached, injuries and diseases may occur." One could argue quite convincingly, of course, that even when the complementarity of the sexes is maintained, injuries and diseases may occur—last I checked, men raping women was still more widespread than men raping men, and heterosexuals seemed to wind up with STDs too.

Understandably, Holsinger's paper, along with his personal record of anti-gay policy positions within the lay leadership of the United Methodist Church, raised a fair number of eyebrows. Several individuals rose to his defense, including a former lesbian colleague, who sent a letter supporting Holsinger to Sen. Mitch McConnell (R-KY), and another former colleague who cited Holsinger's willingness to defend funding for a 2002 women's health conference that included a panel on lesbian health. But despite this show of support, significant questions about Holsinger remained, particularly in light of former Surgeon General Richard Carmona's recent revelations that the Bush administration subjected him to intense political and ideological pressure during his tenure as Surgeon General. If, as a physician, Holsinger was willing to construct a "scientific" condemnation of homosexuality based on a less-than-comprehensive review of contemporary (even in 1991) medical literature, what would he be capable of justifying in the name of "science" as Surgeon General?

When this very question was put to Holsinger during his July 12 Senate confirmation hearing (full video available from C-Span), he distanced himself from the 1991 paper, arguing that it was a dated treatment of the issue, and that it should not be seen as a "scientific" document. But as Sen. Edward Kennedy (D-MA) pointed out, the paper was dated even in 1991, since it failed to reflect the contemporary medical consensus on homosexuality. As for the science issue, although the paper was clearly never intended for publication in a peer-reviewed medical journal, it explicitly identifies its arguments as scientific. To wit, Holsinger writes:

Although one could gather from the discussion of the consultants in scripture, theology, and Christian ethics that there may be some lack of assurance that the human sexes complement each other, I believe that it is possible to argue succinctly from an anatomical (structure) and physiological (function) point of view that the human sexes are indeed complementary.

During his hearing, Holsinger argued that the paper was written for a lay audience, and should not be judged as a scientific document. But as Surgeon General—a.k.a. "America's doctor"—a lay audience is precisely who Holsinger's work will be targeting. I don't want to judge the guy based on something he wrote 16 years ago, but he offered up a pretty weak defense, if you ask me—far from the reflective and forceful renunciation that would allow me to comfortably forgive him for past transgressions. Further, when asked to point out specific instances when he has supported gay and lesbian health, beyond a couple of platitudes about a commitment to addressing the health needs of all Americans, the only example Holsinger could come up with from his own record was an HIV research and training facility he helped set up in Sub-Saharan Africa. Sounds like a great facility, but I wasn't sure what it had to do with addressing the health needs of gay and lesbian people. Oh, right—AIDS is a gay issue. I almost forgot.

To be honest, however, even if Holsinger is confirmed, I doubt we're going to hear much from him about LGBT health, HIV/AIDS, or any of the other issues commonly discussed on this site. For a Bush administration nominee, Holsinger may verge on Marxism when it comes to sexual and reproductive health: he doesn't oppose condoms or emergency contraception. But here's the crux: none of this stuff will be a priority for him as Surgeon General. As Holsinger stated in his confirmation hearings, the three issues on which he plans to focus are combating childhood obesity (described by President Bush as a "serious epidemic that decreases quality of life and burdens our healthcare system"), "making America a tobacco-free nation," and strengthening the Public Health Service's ability to respond to emergencies. All important issues, to be sure, but as far as I'm concerned, any Surgeon General worth his or her salt would have also mentioned these:

  1. Addressing the stark racial and ethnic health disparities in the United States, which have existed for centuries, and to which shockingly few national policymakers have devoted sufficient (if any) attention. On the sexual and reproductive health front, for example, African-American women face HIV infection rates 13 times higher than white women, and women of color are several times more likely to die as a result of complications from pregnancy and childbirth than their white counterparts.
  2. Getting serious about the fact that even though the United States is the richest country in the world, we rank below 20 other countries in rates of pregnancy- and childbirth-related death, and we have the second worst infant mortality rate in the developed world.
  3. Calling for an end to abstinence-only programs, which, in addition to being utterly ineffective, are sexist, homophobic, and a clear violation of young people's human rights. Especially given our distinction of having the highest teen birth rate in the developed world (higher even than in 50 developing countries), we owe adolescents complete, accurate, and respectful information about sexuality and reproduction.

I know, I know, wishful thinking. But the YouTube presidential debate questions got me all excited (Would that this guy had been at Holsinger's confirmation hearing). Anything else you'd like to add to the new Surgeon General's agenda? Feel free to comment.

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  • invalid-0

    Holsinger was right about the complementarity of the sexes being relevant to the question of how intercourse can be experienced safely, and no one that I’ve seen so far seems to be rejecting that proposition in a rational or scientific way. It’s extremely easy to find information showing that disease rates are much higher among homosexuals and extremely difficult to find any information making the case that they are comparable.

  • invalid-0

    So-called complementarity of sexes is a spurious argument. All penetrative sex has disease risks whether hetero- or homo. Given that criteria the safest sex is lesbian sex as their STD rates are miniscule. The offending paper used the myths and stereotypes that have been around forever, and the author demeaned his credibility by using them. We expect better from a Surgeon General.