A Stitch in Haste

Richard Swier, a retired military physician, has a modest proposal to help alleviate the health care finance crisis:

Reduce and eliminate health disparities? How about we eliminate gay, lesbian and bisexual behavior? Perhaps the Department of Health, Governor and Legislature should create strategies to reduce the number of gays, lesbians and bisexuals. That would solve this health crisis.

But don’t you dare call him a “bigot,” right?

The basis for Dr. Swier’s prescription — let’s call it “Operation Gas Chamber” — is a report prepared for the government of Massachusetts titled, “A Health Profile of Massachusetts Adults by Sexual Orientation Identity” (PDF – 30 pages). From the summary:

A growing body of research indicates that health disparities exist between gay/lesbian/bisexuals and heterosexuals. For the first time, population-based estimates of sexual orientation differences in adult health are available in the Commonwealth of Massachusetts. … Most (97.1%) self-identified as heterosexual or straight, while 1.9% identified as gay, lesbian or homosexual, and 1.0% as bisexual.

Results suggest that sexual orientation differences exist with respect to access to health care, overall health status, cancer screening, chronic health conditions, mental health, substance use including tobacco smoking, sexual health, and violence victimization. While gay/lesbian/homosexual adults evidenced poorer health and greater risk than straight/heterosexuals across several health domains, poorer health was observed most often for bisexuals.

The health profile of gay/lesbian/homosexual residents was poorer than that of heterosexual/straight residents on: self-reported health; disability-related activity limitation; asthma; current and past tobacco smoking; anxious mood; 30-day binge drinking and substance use; and lifetime sexual assault victimization.

I’m not sure what the connection is, if any, between sexual orientation and asthma. But I’m sure Dr. Swier can concoct one if he tries hard enough.

But let’s look at some of the other findings. First and foremost, Dr. Swier obviously didn’t read past the report’s summary, because he neglects to mention that almost all the differences between straights and gays are not statistically significant. Details, details…

Gays, we are told, have less access to health care (but, again, not by a statistically significant amount). What exactly does that have to do with “lifestyle choices”? I can imagine a gay, lesbian or bisexual having inferior access to health care because they’ve been disowned by their family. Or because they’re unemployed, underemployed or self-employed due to discrimination in the workforce. Or because they’re not welcome at hospitals or clinics run by religious charities. In any case, what bizarre leap of logic enables a physician to conclude that less access to health care is the patient’s fault?

As for cancer screening, I hope neither you nor Dr. Swier jumped to any conclusions when you read that “differences exist,” because actually the statistical difference is in the other direction: Gay men are more likely to screen for colorectal cancer than straight men and lesbians are more likely to have regular mammographies than straight women. Go figure.

Same for sexual health: The report finds that gays, lesbians and bisexuals are far more likely than heterosexuals to practice safe sex and get regularly tested for HIV. This is a damnable behavior — how?

Lastly, is Dr. Swier really suggesting that gays should be blamed for the fact that they are more likely to encounter “violent victimization”? (Note: The difference was only statistically significant for random violence; there is no statistically significant difference regarding domestic violence.)

Let us now turn to the true point of Dr. Swier’s post: The notion that gays, lesbians and bisexuals “lead unhealthy lifestyles.” Gays smoke more, binge drink more, are more likely to engage in substance abuse, etc. Moreover, gays must be doing something wrong, since they are more likely than straights to self-report their health as “poor” or “fair.”

But as Jacob Riis demonstrated over a century ago, doesn’t this reverse cause and effect? Are gays to be stigmatized because some lead such failed lives, or do some lead such failed lives because they are stigmatized?

If you are told, almost from the day you are born, that you are “wrong” or “defective” or “sick” or “sinful,” then you are of course more likely to believe it, and therefore more likely to drown your problems in a self-destructive pit of tobacco, alcohol, drugs and meaningless sex. Anything to make the pain go away (and anything means anything — up to and including suicide).

If you spend every waking moment in a society that portrays an ideal that is in many respects unavailable to you, where almost every television show, movie, novel, advertisement is “not you,” wouldn’t you be even a little bit lore likely to suffer from mental health issues, or to have your overall health deteriorate to “fair” or even “poor” status?

(And did I mention that this is Massachusetts, the state most infected with the worst font of systematic anti-gay bigotry ever conceived — the Roman Catholic Church? Goodridge notwithstanding, living in Massachusetts can’t be all that much fun for gays.)

One more statistical note: For whatever reason, the group that does show bona fide statistical differences in this study is not gay men and not lesbians, but bisexuals. I don’t know what the explanation is for that (and Dr. Swier was of course too busy calling for Operation Gas Chamber to address the question either). Perhaps it’s just the “Other Half” phenomenon escalated. Perhaps being caught between the “right” world and the “sick” world is the most stressful situation of all.

Via InterstateQ.

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I have forwarded a link to Dr. Swier’s vile, intellectually sloppy post to the authors of the study — at least one of whom is openly gay. I will update this post if they respond to my email. Meanwhile, here’s a special Kip Clip:

Previously:
–“Libertarian” Professor: Gays “Poor Planners with Risky Lifestyles”
–Hoppe’s Non-Apology for Anti-Gay Remarks