Medical News & Perspectives
Gay Is Okay With APA—Forum
Honors Landmark 1973 Events
IT’S BEEN 25 years since the American
Psychiatric Association (APA) voted to
delete homosexuality from its official list
of mental disorders and issued a strong
statement of support for gay rights. A
forum marking this anniversary drew a
standing-room-only crowd at the APA’s
annual meeting in Toronto, Ontario, in
June.
Speakers discussed the controversy
that surrounded efforts to depathologize
homosexuality, traced the evolution of
psychiatric and psychoanalytic attitudes
toward homosexuality and explored the
significance of these changes for the
mental health of gay, lesbian, and bi-
sexual persons today.
Melvin Sabshin, MD, who recently re-
tired after 23 years as medical director
of the APA, recalled “tumultuous” dem-
onstrations by gay activists objecting to
the classification of homosexuality as an
illness and by Vietnam War protesters
at the APA’s annual meeting in San
Francisco, Calif, in 1970, a year when he
served as program director. “It was
guerrilla theater,” he said, “with lots of
hard words,” so disruptive, in fact, that
the APA hired a security consultant to
try to ensure more orderly demonstra-
tions at future annual meetings.
The screaming eased into discussion,
said Sabshin, now adjunct professor of
psychiatry at the University of Mary-
land School of Medicine, Baltimore. At
the 1972 annual meeting, a gay psychia-
trist, who feared professional repercus-
sions if his identity were known, spoke
while wearing a mask. By 1973, however,
there were exhibits at the meeting on
being “gay, proud, and healthy.”
Scientific Evidence Was Impetus
The social and political impetus for
change, Sabshin said, was supported by
scientific evidence. The APA’s Commit-
tee on Nomenclature reviewed numer-
ous studies that used standardized in-
struments and nonpatient populations
and showed that most gay persons were
satisfied with their sexual orientation
and were not impaired in their social
functioning.
JAMA, August 12, 1998—Vol 280, No. 6
©1998 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015
Pressure to abandon the psychoana-
lytic view that the “homoerotic level” is
simply a stage in development toward
mature sexuality, Sabshin said, was part
of a broader movement to reexamine
ideas about psychopathology in general,
“to accept that all of us have some prob-
lem or another,” and to redefine what is
and is not normal. “The development of
a rational approach to pathology,” Sab-
shin said, “was salient and helpful to the
gay group.”
Proposals to drop homosexuality from
the Diagnostic and Statistical Manual
of Mental Disorders, second edition
(DSM-II; Washington, DC: APA; 1968)
advanced within the APA from local to
national levels. In December 1973, Sab-
shin said, the APA’s board of trustees
voted in favor of the deletion. This event
drew national media coverage. The New
York Times headline, “Doctors Rule Ho-
mosexuality Not Abnormal,” Sabshin
said, focused squarely on the central is-
sue of normalcy. A newspaper aimed pri-
marily at gay readers cheered, “Gays
Leave Psychiatric Sicklist.”
The battle was not quite over. Psy-
chiatrists objecting to the board’s deci-
sion mustered support for a referendum
to be voted on by the full APA member-
ship in 1974. Some 58% of the members
favored the board, an indication, Sab-
shin said, that a turning point had been
reached.
At the December 1973 meeting, the
APA’s board also approved a statement
on homosexuality and civil rights (see
sidebar). This statement, according to
Robert Cabaj, MD, medical director of
the mental health services division of
San Mateo County Health Services
Agency in California and associate clini-
cal professor of psychiatry at the Uni-
versity of California, San Francisco, “is a
landmark and the cornerstone of all that
has happened since.” It fostered recog-
nition, he said, that many of the prob-
lems gays and lesbians deal with are the
result of societal homophobia.
Gay and lesbian psychiatrists, Cabaj
said, have worked within the APA, some
holding high elective offices, and within
Discrimination Deplored
THE APA’s 1974 statement on
homosexuality and civil rights reads,
in part, “Whereas, homosexuality per
se implies no impairment in judgment,
stability, reliability, or general social or
vocational capabilities, therefore, be it
resolved that the American Psychiatric
Association (APA) deplores all public
and private discrimination against
homosexuals in such areas as
employment, housing, public
accommodation, and licensing, and
declares that no burden of proof of
such judgment, capacity, or reliability
shall be placed upon homosexuals
greater than that imposed on any
other persons. Further the APA
supports and urges the enactment of
civil rights legislation at the local,
state, and federal level that would offer
homosexual citizens the same
protection now guaranteed to others
on the basis of race, creed, color, etc.”
(Am J Psychiatry. 1974; 131:497).—L.L.
the medical and larger community, to
raise awareness of gay and other minor-
ity concerns. The APA created a gay and
lesbian taskforce in 1978. That same
year, a group now called the Association
of Gay and Lesbian Psychiatrists was es-
tablished. Ensuing years have brought
more presentations at meetings on such
professional issues as what it is like to be
a gay or lesbian therapist or psychiatry
resident.
When homosexuality was deleted as a
disease category from the DSM-II, a
new diagnosis, “sexual orientation dis-
turbance,” was added to describe per-
sons attracted to members of the same
sex “who are either disturbed by, in con-
flict with, or wish to change their sexual
orientation.” This diagnosis was re-
named “ego dystonic homosexuality” in
the third edition of the DSM, DSM-III
(Washington, DC: APA; 1980). The cat-
egory was controversial, Cabaj said,
Medical News & Perspectives 497
 in earnest to revise its long-standing po-
sitions about homosexuality and about
It’s Okay to Say “Gay” training gay and lesbian therapists,”
Miller said. “The previous 20 years,” she
A PHYSICIAN’S CHOICE of words, especially on sensitive topics such as sexuality, maintained, “were trying ones.”
may enhance or undermine the patient-physician relationship. In 1984, Miller said, she applied for
training to a nonmedical institute that
“Gay” is the preferred term, said Robert Cabaj, MD, editor of The Textbook of practiced the “don’t ask, don’t tell” phi-
Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, losophy. That same year, she said, her
Inc; 1996). “Homosexual,” although still found in many medical texts, seldom is used partner, Maggie Magee, MSW, who also
by the gay community. Cabaj said he reserves the word “homosexual” for clinical applied to a nonmedical institute, may
settings and uses it as an adjective, not as a noun. have been the first openly lesbian or gay
candidate to be accepted for psychoana-
“When I talk about individuals,” Cabaj said, “I use ‘gay men,’ ‘lesbians,’ ‘bisexual lytic training in any institute. Magee, a
people or persons,’ and ‘transgendered people or persons.’ Bisexual persons may member of the faculty of the Los Ange-
feel okay about being part of the gay community,” he said, “but the transgendered les Institute and Society for Psychoana-
population truly is separate, the defining characteristics being those of gender lytic Studies, and Miller are coauthors of
identity and gender perception vs sexual orientation and sexual expression.” Lesbian Lives: Psychoanalytic Narra-
tives Old and New (Mahwah, NJ: Ana-
“Gay” commonly is used to describe both men and women, Cabaj said. Diana Miller, lytic Press; 1997).
MD, however, said she prefers using “gay” to refer only to men and “lesbian” to refer “In our training,” Miller said, “we
to women and to use both words only as adjectives. could not help noticing hostility toward
gay men and lesbian women, and stereo-
The media both reflect and shape societal attitudes. The National Gay and Lesbian typed and pathologizing views, even by
Journalists Association, Washington, DC, offers a stylebook with terminology supposedly liberal analysts.” Proposals
physicians may find helpful. “Sexual orientation,” it says, should be used instead of to the American Psychoanalytic Asso-
“sexual preference.” Other advice: avoid the term “lifestyle,” as there is no gay ciation, the nation’s largest psychoana-
lifestyle, just as there is no straight lifestyle. To describe a gay relationship, it lytic organization, to ratify the APA’s
suggests, follow the patient’s lead or use “partner.” The stylebook is online at 1973 position on homosexuality were de-
http://www.nlgja.org. feated. The association said, according
to Miller, that it did not take a stand on
The New York Times, according to Allan M. Siegal, the newspaper’s assistant social issues not directly affecting psy-
managing editor, ruled in 1987 that the word “gay,” meaning homosexual, was choanalysis.
accepted usage, but only as an adjective, not as a noun. “Even as an adjective,” In 1991, after 5 years of debate, the
Siegal’s memo to editors states, “homosexual will remain preferred in specific American Psychoanalytic Association
reference to sexual activity or psychological or clinical orientation. passed a resolution opposing public and
private discrimination against homo-
James Krajeski, MD, editor of the APA’s official newspaper, Psychiatric News, and a sexual persons. The words “including
psychiatrist practicing in Richmond, Calif, acknowledges the protean nature of training and supervising analysts,” how-
language. “Even within the gay community,” he said, “one hears a variety of terms.” ever, were not added until 1992, Miller
These change over time, he said, in the same way that different terms fall in and out said, after the group received a letter
of favor for different ethnic and racial groups. “Physicians should use terms that from the American Civil Liberties
suggest sensitivity to the sexual orientation of the patient,” Krajeski said. “If the Union.
physician has any doubt,” he added, “it is perfectly acceptable to ask patients which Efforts continue, Miller said, to up-
term they prefer.”—L.L. date information on homosexuality in
the analytic curriculum. Some signs of
progress: Publications by gay and les-
bian analysts offer new ways of under-
“since it’s normal for gays and lesbians lead to their discharge. After lobbying standing and working with gay and les-
to grow up wishing they were not hated unsuccessfully to keep military psychia- bian patients. The psychoanalytic “ob-
and reviled.” Presentations on the lack trists from being seated in the APA as- session” with finding the origin of homo-
of empirical data to support this diagno- sembly because they did not adhere to sexual identity, she said, is beginning to
sis were made to the work group charged the APA’s guidelines on gay rights, be replaced by efforts to explore clinical
with revising the manual in the mid Cabaj said, the gay groups sought to edu- experiences of gay men and lesbian
1980s, and the category did not appear in cate military psychiatrists about the women, such as “coming out” (publicly
the DSM-IIIR. In the fourth and most ethical bind they were in. acknowledging one’s homosexuality),
recent edition of DSM, DSM-IV, there is and factors that ease or complicate this
no reference to homosexuality, Cabaj Psychoanalysts’ Attitudes experience. The 1997 annual meeting of
noted, except perhaps under “sexual dis- Attitudes toward homosexuality have the American Psychoanalytic Associa-
order not otherwise specified” (Wash- changed more slowly in the psychoana- tion included a discussion group on the
ington, DC: APA; 1994). lytic community than among psychia- topic “a gay analyst presents a gay pa-
Concerns persist, he said, about prob- trists in general, according to Diana tient.” Also in 1997, the organization en-
lems faced by gay persons in military Miller, MD, a child and adult psychia- dorsed same-sex marriage, a step the
service. Before “don’t ask, don’t tell” be- trist and psychoanalyst, and assistant APA has yet to take.
came standard practice, he said, persons clinical professor of psychiatry at the Analysts with gay and lesbian chil-
in the military who told their psychia- University of California, Los Angeles. dren, Miller asserted, have not been
trists that they were gay might have in- “In the past 5 years, American institu- forthcoming about acknowledging these
formation put in their chart that could tional psychoanalysis has finally begun children’s orientation. If they were to do

498 JAMA, August 12, 1998—Vol 280, No. 6 Medical News & Perspectives

©1998 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015

 so, she said, their colleagues might be
less likely to attribute homosexuality to
“abnormal” family dynamics.
“Straighten Out” or Help?
Carolyn Robinowitz, MD, former
deputy medical director of the APA and
now dean-designate and professor of
psychiatry at Georgetown University
School of Medicine, Washington, DC,
used personal vignettes from her 30
years in psychiatry to illustrate the evo-
lution in attitudes toward homosexual-
ity during this time.
One of her first patients, she recalled,
was a young woman referred by a thera-
pist who had not been able to help her.
The therapist had focused primarily on
the woman’s homosexuality, hoping, as
he said in his notes, “to straighten her out
before it was too late.” Robinowitz fo-
cused instead on what brought the wom-
an to treatment: the loss of significant oth-
ers who had died or moved away and ca-
reer conflicts. Her success with this pa-
tient, she said, brought referrals of other
gay patients whose therapists also had
concentrated on their homosexuality at
the expense of current issues.
In the early 1980s, Robinowitz repre-
sented the APA at meetings of the
American Medical Association where
she met physicians in other specialties
who expressed surprise, she said, that
“it was okay to be gay in the APA.” They
told her, she said, that in their specialties
they could not be openly gay, that if they
were they would lose many opportuni-
ties for advancement.
Today, she said, even in the conserva-
tive atmosphere of Georgetown Univer-
sity, it is possible for same-sex couples to
appear at social events and for students
to be openly gay. People who don’t like
this, she said, know that it is not socially
acceptable to say so.
An Eye to the Future
Looking toward the future, Howard
Rubin, MD, health services research fel-
Persuading Youths That Hops Ain’t Hip
AS SOME HIP-HOPPING young
Americans help pack the Safari Club on
Tijuana’s Avenida Revolución chugging
beers, guzzling tequila, and “Gittin’
Jiggy Wit’ It,” one can understand if they
forget they’re helping advance medical
research. But they are.
Before entering Mexico, at the border
crossing on the California side, young
men and women under the age of 21 are
randomly selected and asked about their
motives and expectations for visiting
Tijuana. They face more questions upon
JAMA, August 12, 1998—Vol 280, No. 6
©1998 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015
low at the University of California,
Los Angeles, and a member of the APA’s
Committee on Gay, Lesbian, and Bi-
sexual Issues, ticked off educational
needs at all levels of medical training.
Many residency programs, he said,
provide little information about homo-
sexuality, often only “a day for the gay,”
with brief presentations and discussion.
This situation may change, he said, as
more gay persons in faculty positions
openly acknowledge their sexual orien-
tation.
More “gay-affirmative” medicine is
needed, Rubin added, urging that all
physicians adopt a gender-neutral ap-
proach in taking a patient’s sexual his-
tory. Residents and trainees, he said,
want more information on working with
gays and on issues of transference and
countertransference. Gay psychiatrists
want more information about the pros
and cons of disclosing their sexual orien-
tation to patients.
Psychiatrists also need to be involved,
Rubin said, at the intersection of per-
sonal, political, and community issues.
“The radical right,” Rubin said, “has
used homosexual issues to aid fundrais-
ing and to rally their forces, a stance that
has a negative effect on gay physicians
and on their patients.” On an interna-
tional level, he said, the APA was instru-
mental in having homosexuality deleted
from the Japanese version of the current
DSM.
“It was important 25 years ago,” Ru-
bin said, “for gays to say, ‘we’re not dif-
ferent, we’re like everyone else.’ ” But
today, he said, they are more willing to
explore whether problems such as sub-
stance abuse are higher in the gay popu-
lation and, if so, why that might be.
Gay psychiatrists are asking, he said,
“Do we focus on gay-specific issues or
just try to fit in? Are we a queer nation
or just people who happen to be gay who
are part of a larger nation?”
—by Lynne Lamberg,
JAMA contributor
their return. Their answers and blood-
alcohol levels are anonymously recorded
as part of an ongoing study by research-
ers from the Pacific Institute for Re-
search and Evaluation who hope to pro-
vide some data on why young people
binge drink. The information is passed
along to those hoping to curb such drink-
ing patterns.
Binge drinking (defined as 5 or more
alcoholic drinks in a row for men and 4 or
more for women by researchers with the
Harvard School of Public Health) among
Interest Groups
GAY, LESBIAN, bisexual, and
transgendered physicians and
medical students have formed
numerous professional organizations.
Some function within such specialty
organizations as the APA. Others,
such as the Gay and Lesbian Medical
Association (GLMA), span medicine
at large.
The GLMA reports that it has 2000
members in all 50 states in the United
States and in 12 countries worldwide.
Founded in 1981, the organization
aims to combat homophobia in
medicine and in the general
population and to foster quality health
care for members of the groups it
serves and for human
immunodeficiency virus–positive
persons. The group publishes the
peer-reviewed, multidisciplinary
Journal of the Gay and Lesbian
Medical Association. It also is a
resource for information about
regional or specialty-based
organizations serving health
professionals in its constituency. The
GLMA will hold its annual meeting
August 27-29, 1998, in Chicago, Ill.
For more information, send e-mail to
info@glma.org or visit the group’s
Web site: http://www.glma.org.
Parents, Families and Friends of
Lesbians and Gays is a Washington,
DC–based organization with 70 000
member households in 400 chapters
nationwide. Members often work with
health care providers to improve
communication with patients and
families. More information may be
obtained via the Internet at
http://www.pflag.org.—L.L.
young adults leads to impairment that can
result in drunk driving, sexual assault,
violence, and a host of other adverse ef-
fects. The Pacific Institute researchers,
who are working in collaboration with the
San Diego, Calif–based Institute for
Health Advocacy (IHA), are trying to
document the characteristics and moti-
vations of young Americans binge drink-
ing in Tijuana. At the same time, they are
trying to reduce the numbers of binge
drinkers and the severity of their alcohol
consumption. They hope their efforts are
Medical News & Perspectives 499
 successful and can be repli-
cated throughout the United
States.
“Our major goal is to track
change,” said James E. Lange,
PhD, a research psychologist
with the Bethesda, Md–based
Pacific Institute and coauthor
of a paper—presented in May
at the Alcohol Policy Confer-
ence XI in Chicago, Ill—docu-
menting initial research re-
sults from the border-crossing
effort. “But another important
component is to provide infor-
mation to those trying to ef-
fect change so they can use
that information to tailor their programs
and get results.”
The border isn’t the only place where
researchers are trying to reduce binge
drinking in young adults. The Robert
WoodJohnsonFoundation(RWJ)isfund-
ing a multiyear, $10-million national pro-
gram called “A Matter of Degree: Reduc-
ing High-Risk Drinking Among College
Students.” Administered by the Ameri-
can Medical Association (AMA), the pro-
gram forms college-community partner-
shipsdesignedtochangetheenvironment
and norms regarding high-risk drinking
by students. Six sites are currently
funded: the University of Colorado at
Boulder, University of Delaware, Uni-
versity of Iowa, Lehigh University, Uni-
versity of Vermont, and University of
Wisconsin at Madison. Two other colleges
are in the process of joining the program.
The RWJ effort doesn’t focus on why
students binge drink. These program
leaders want only to reduce the number of
binge drinkers and the secondhand dam-
age associated with such high-risk behav-
ior. Lange wants to know why these
peopledrinkthewaytheydo.Hesaidsuch
information should help in designing pre-
vention or reduced-drinking programs.
Lange’s preliminary results, from the
first few months of a 4-year study, found
that the motivation to drink is partly at-
tributable to expectations about the ef-
fects of alcohol. Those interviewed before
entering Mexico answer a word-associa-
tion question. Young adults who associ-
ated “drunk” with the words, “fight, hurt,
and knife,” expected to drink less then
those who associated “drunk” with “fun,
friends, and kiss.” And upon their return
those with negative associations did
drink less then those with positive ones.
Another point made by Lange is that
drinking isn’t the only reason young
adults go to Tijuana—they also go to meet
people, blow off steam, and “go a little
crazy.” Lange called this “social scene mo-
tivation.” He noted that those who asso-
ciated drinking with positive words also
planned to get drunk as part of the social
500 JAMA, August 12, 1998—Vol 280, No. 6
©1998 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015
Rights were not granted to include
this image in the online journal.
Please refer to the print journal
to view.
scene motivation. Interestingly, those
who associated drinking with negative
words sought the same social scene mo-
tivation without planning to get drunk.
“We may know this, but it hasn’t been
quantified—people are going down there
to drink and get drunk. It’s not just social
pressure or refusal skills that we must
focus on when trying to curb binge drink-
ing,” Lange said. “That’s something we
need to keep in mind when we think about
alcohol abuse and substance abuse in gen-
eral—it’s not just learning to say no, it’s
learning how not to say yes.”
Learning Not to Say Yes
Jeffrey D. Francis, deputy program di-
rector with IHA, is trying to get young
drinkers not to say yes. On a tour of Ti-
juana, Francis commented on some of
Avenida Revolución’s 35 discos or bars.
Henotedtheall-you-can-drink-for-$5spe-
cials and the women-drink-free opportu-
nities and showed a postcard mailed to
Californians on their 18th birthday tout-
ing the Tijuana scene as their local bar.
To combat the aggressive tactics of Ti-
juana bar owners, antibinge leaders are
using several approaches. One is an in-
creased police presence on the Califor-
nia side, where officers periodically
check IDs and administer Breathalyzer
tests on such “celebratory” occasions as
Labor Day weekend or during spring
break. Another, said Dana Stevens,
IHA’s youth services manager, is to
work with area colleges and military
bases to make them aware that their stu-
dents and enlisted people, not identified
by name, are going to Tijuana, getting
drunk, and driving back. “We’ve been
able to define this problem and put the
word out clearly,” she said.
Yet a third approach is working with
leaders on the Mexican side. These offi-
cials know that Tijuana’s growing repu-
tation as a binge-drinking party town is
affecting tourism by keeping older, and
more affluent, Americans away, said Saul
Cana, IHA’s international coordination
manager. “We try to focus this
as a Mexican solution,” said
Cana, who recently became a
US citizen but still practices law
in Mexico. “We’re trying to let
them know we’re supporting
their efforts and we’re trying to
help them with this program.
We’re not doing anything they’d
not do. This isn’t gringos trying
to take over Baja.” Some of the
Mexican efforts include stricter
ID checks, toning down the
marketing, and consideration of
raising the drinking age to 21.
While the Pacific Institute
and IHA continue their bor-
der research and initiatives, the RWJ pro-
gram is tracking the problem on college
campuses. Richard Yoast, PhD, the
AMA’s director of the Office of Alcohol and
Other Drug Abuse, said the “Matter of De-
gree” program language is simple, “We
want to change the community in which
drinking occurs to make it harder to binge
drink.” The program focuses on 3 main el-
ements: lessening availability; increas-
ing price (low prices up consumption); and
changing norms.
At the University of Wisconsin, a 21-
member partnership council made up of
students, faculty, and community lead-
ers is overseeing 3 task forces address-
ing campus policies and practices, media
and education, and community policies
and practices. The school’s Rob Adsit,
coordinator of the RWJ project, said
some of the plans include offering recre-
ational sports after 10 PM on Fridays and
Saturdays to give students a social op-
tion other than drinking. Another effort
includes working with some community
members to open a dance club with a
large nonalcohol section.
Rick Culliton, assistant to the vice presi-
dent for student affairs at the University
of Vermont, said actions his school is tak-
ing include elimination of alcohol adver-
tising from the athletic department’s me-
dia guides and changing the school year
to avoid opening around Labor Day and
giving a 3-day weekend for drinking. They
want students to have 5 full days of classes
at the beginning of the semester. “We’re
sending a message that a student’s aca-
demic experience will be rigorous,” he said.
The University of Iowa is creating an
alcohol-free parking lot outside the foot-
ball stadium for the first home game so
people can have tailgate parties and stay
sober, said Julie Phye, coordinator of the
Stepping-Up Project. The students are
also getting into the act. The fraternities
and sororities were supposed to go dry
by 1999, but the members, wanting to
take a stance against alcohol abuse,
moved the deadline up to this fall.
—by Mike Mitka
Medical News & Perspectives
 Medical Facilities to Focus on Cleaner Environment
A NATIONAL EFFORT is under way to
enlist medical research and health care fa-
cilities in programs to conserve energy
and control pollution. The move will in-
clude medical schools, hospitals, clinical
laboratories, and research institutions.
A proposal to get professional societies,
industry, and government agencies to de-
velop and implement environmental en-
ergy conservation and pollution control
programs was accepted by a leadership
group of members of the Rockville, Md–
based National Association of Physicians
for the Environment (NAPE) at a meet-
ing last month in Washington, DC.
“One seventh of the gross national
product of the United States is taken up
by health care products and services, yet
no organized national effort has been un-
dertaken to involve this massive system
in environmental concerns,” said John
Grupenhoff, PhD, executive vice presi-
dent of the NAPE, at the Washington
meeting. He described the association’s
move as the “greening” of health care
facilities and declared that “pollution
prevention is disease prevention.”
Urgency Impels Effort
There is some urgency driving the ef-
fort. Representative John Porter (R, Ill)
has promised that he will double the cur-
rent $13-billion budget of the National
Institutes of Health (NIH) in the next 5
years. “This will mean much greater ac-
tivity and therefore an increase in the
kinds of waste that can be very damag-
ing to the environment,” said Porter in a
taped interview played at the Washing-
ton meeting. Porter is chair of the Sub-
committee on Labor, Health and Human
Services, Education and Related Agen-
cies of the House Committee on Appro-
priations and was a major force behind
the 7% increase in the NIH budget for
next year.
“Wouldn’t it be a great irony if the
health care industry and the biomedical
research community in the United States
ignored environmental matters and
caused the kind of pollution that can ad-
versely affect the health of our country?”
he said.
“Obviously, it is a tremendous respon-
sibility on the health care industry and
research to take environmental matters
into account. I don’t think that either
health care workers or biomedical re-
searchers put this at a high enough pri-
ority. They need to look at the huge ef-
fect that their activities have on our
economy and on our environment. I
think they can begin to do that by focus-
ing on energy efficiency.”
JAMA, August 12, 1998—Vol 280, No. 6
©1998 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015
Porter noted that the NIH has taken
the lead in reducing the use of environ-
mentally damaging products, such as
mercury, and that during the past 3
years the institutes have saved several
million dollars through energy-effi-
ciency programs. “This is an effort that
must pervade the entire research com-
munity,” he said. Porter has been di-
rectly involved in establishing a pro-
gram of energy-efficient lighting in Con-
gress. “I believe that energy efficiency
has a great deal to do with environmen-
tal protection, and I understand that
NAPE is working with the Environmen-
tal Protection Agency [EPA] to bring
this message home to the health care and
research community,” he added.
Every 10 000 kilowatt-hours of elec-
tricity used means the generation of
55 lb of nitrogen oxides, 154 lb of sulfur
dioxide, and 15 000 lb of carbon dioxide,
according to Michael D. Maves, MD, chair
of the council formed by NAPE to ad-
dress the energy-efficiency issue. Maves
is executive vice president of the Ameri-
can Academy of Otolaryngology–Head
and Neck Surgery, which is based in Al-
exandria,Va. He was unable to attend the
meeting but said in a prepared statement
that, by upgrading facilities, as much as
40% of energy costs could be saved.
Previous attempts by the NAPE to
develop a broad-scale environmental
clean-up program among health facili-
ties failed because some health care or-
ganizations decided against joining a
physician’s organization. However, the
groups agreed to participate in a larger
coalition that embraces the interests of
all health care institutions.
National Council Proposed
The NAPE’s response was to propose
a National Council on Health Care and
the Environment that would include, in
addition to physicians, a broad spectrum
of such health professionals as nurses,
pharmacists, members of voluntary
health groups, public health officials, and
medical administrators. This proposal
was accepted at the Washington meet-
ing and, if comments from speakers are
any guide, the effort has every sign of
succeeding.
The National Institute of Environ-
mental Health Sciences at the NIH
strongly supports the concept, said
Samuel H. Wilson, MD, the environmen-
tal institute’s deputy director. Com-
menting after the meeting, Wilson said
that the NAPE’s move is an opportunity
to substantially enhance the research
environment and health care facilities.
“It makes a lot of sense to remove haz-
ards from the research facilities. At the
same time, developing a sense of com-
mitment and leadership in this area can
have a big benefit throughout society.
So I applaud the NAPE initiative, their
leadership, and their vision in identify-
ing this approach and this mechanism for
enhancing the status and environment
of our facilities.”
E. Lander Medlin, executive vice
president of the Association of Higher
Education Facilities Officers, also spoke
at the meeting. “We have much in com-
mon with you, we share a common goal
and we are interested in collaborating
with NAPE,” she said. “We see partner-
ship as a way of working with the bio-
medical research community in this
greening effort.” Medlin’s organization
represents some 3600 universities, col-
leges, and educational facilities, includ-
ing all US medical schools, as well as gov-
ernment laboratories and specialized
medical facilities.
“We have a wonderful opportunity
here working with the National Insti-
tute of Environmental Health Sciences
and with NAPE in an effort to provide
pollution prevention and medical waste
reduction and to provide for energy-ef-
ficient buildings,” Medlin said. She
pointed out that there is no need for en-
forcement regulations. “Although there
may be exceptions, in general, the cost
savings to be made are such that it is no
longer difficult to decide to spend funds
on conserving energy and reducing pol-
lution. Reducing energy consumption
reduces pollution. It also saves money.”
Medlin cited the results of a case study
done in 15 colleges and universities that
showed savings of $17 million in just 1
year from energy conservation projects.
“If you extrapolate that to 3600 institu-
tions, this translates into billions of dol-
lars of savings,” she said. “It is an invest-
ment in greening, and it is sound finan-
cial management as well.”
A few days after the NAPE’s Washing-
ton meeting, the American Hospital As-
sociation signed a voluntary agreement
with the EPA to reduce the waste gener-
ated by hospitals and, specifically, to
eliminate mercury from hospital waste by
2005. In discussions during the meeting,
hospitals had been criticized for unneces-
sarily burning their waste, including
medical devices that contain mercury.
Lynn R. Goldman, MD, the EPA’s as-
sistant administrator for prevention, pes-
ticides, and toxic substances , said at the
Washington meeting, “We believe that
only 2% of hospital waste needs to be in-
Medical News & Perspectives 501
 cinerated, yet some hospitals are inciner-
ating between 75% and 100% of their
waste. We are not yet seeing enough of an
efforttowardpollutionprevention,source
reduction, reducing waste at the source
rather than incinerating it.”
Looking Ahead
In addition to eliminating mercury,
cleaning up laboratory waste material,
Miscellanea Medica
Arnold J. Levine, PhD, the Harry C.
Weese Professor in the Life Sciences at
Princeton University, Princeton, NJ,
and a renowned cancer biologist, has
been elected president of The Rock-
efeller University, New York, NY.
Leo J. Dunn, MD, Medical College of
Virginia/Virginia Commonwealth Uni-
versity, Richmond, has been installed as
president of the American Board of
Medical Specialties, Evanston, Ill.
Nanette K. Wenger, MD, Emory Uni-
versity School of Medicine, Atlanta, Ga,
has received the Physician of the Year
Award from the American Heart Asso-
ciation.
Basil A. Pruitt, Jr, MD, University of
Texas Health Science Center at San An-
tonio, is the 1998 winner of the American
Surgical Association’s Medallion for Sci-
entific Achievement. For many years,
Pruitt was commander and director of
the US Army Institute of Surgical Re-
search, in San Antonio.
Brian Haynes, MD, McMaster Univer-
sity, Hamilton, Ontario, has been
awarded honorary status in the Medical
Library Association for his contribu-
tions to “improving medical care by im-
proving the quality of literature that
provides the knowledge vase for physi-
cians.”
Peter T. Scardino, MD, has been named
chief of the Urology Service and head of
its Prostate Cancer Program at Memo-
rial Sloan-Kettering Cancer Center,
New York, NY.
William H. Fleming, III, MD, clinical
assistant professor of neurology at the
University of Texas Health Science Cen-
ter in Houston, has been installed as
president of the Federation of State
Medical Boards of the United States Inc.
Alan E. Shumacher, MD, associate clini-
cal professor of pediatrics at the Univer-
sity of California, San Diego, School of
Medicine, is president-elect. Vice presi-
502 JAMA, August 12, 1998—Vol 280, No. 6
©1998 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/14/2015
and increasing energy efficiency, the
group plans to take steps to deal with gen-
eral solid waste, including the disposal of
paper, aluminum, plastics, and Styro-
foam. Another problem they intend to
tackle is the management of hazardous
chemical wastes, particularly so-called
mixed wastes: chemical wastes combined
with radioactive materials. These are ex-
pensive to manage and present complex
dent is George C. Barrett, MD, Bowman
Gray School of Medicine of Wake Forest
University, Winston-Salem, NC.
Gene Myers, MD, has been appointed
medical director of CPC of America
Inc, Sarasota, Fla, a medical technology
company.
Valentin Fuster, MD, PhD, Mount Sinai
Medical Center, New York, NY, has
been elected president of the American
Heart Association. Lynn A. Smaha, MD,
PhD, Guthrie Clinic Ltd, Sayre, Pa, is
president-elect.
William Henry Boyce, MD, emeritus
professor of surgery/urology at Bowman
Gray School of Medicine of Wake Forest
University, Winston-Salem, NC, and
now living in Stuart, Va, has received
the American Urological Association’s
most prestigious honor, the Ramon Guit-
eras Award.
J. Michael Bishop, MD, PhD, former
president of the American Society for
Cell Biology (ASCB) and new chancellor
of the University of California, San
Francisco, has been named a recipient of
the ASCB Public Service Award, to be
presented at the society’s meeting in De-
cember in San Francisco.
Sue Bailey, DO, has been sworn in as
assistant secretary of defense for health
affairs. Working from an office in the
Skyline complex in Falls Church, Va,
Bailey is the first woman to hold the top
health post in the US Department of
Defense.
Col Thomas A. Mikkelson, MD, has re-
tired as commander of the 375th Medical
Group, Scott Air Force Base, Ill, after 22
years of service. The new commander is
Col William J. Germann, MD.
The National Celebration of the Centen-
nial Anniversary of the US Navy Hos-
pital Corps took place in Washington,
DC, on Saturday, June 20. The Corps
was established on June 17, 1898.
disposal issues, coming as they do under
regulation by both the EPA and the
Nuclear Regulatory Commission.
Longer-range plans include encourag-
ing the development of new alternative
technologies for handling hazardous
waste and projecting the operational na-
ture and needs of laboratories and clini-
cal facilities a decade from now.
—by Charles Marwick
Capt James A. Johnson, MC, USN, is
the new commander of the San Diego
Naval Medical Center, San Diego, Calif.
He was formerly principal director of
clinical services in the US Navy health
affairs office in Washington, DC.
Robert J. Adams, MD, codirector of the
Cerebrovascular Section of the Depart-
ment of Neurology at the Medical Col-
lege of Georgia, Augusta, has been
named Regents Professor of Neurology
by the University System of Georgia
Board of Regents.
William R. Turner, Jr, MD, Medical
University of South Carolina, Charles-
ton, has been elected president of the
American Urological Association. Presi-
dent-elect is Lloyd H. Harrison, MD,
Bowman Gray School of Medicine of
Wake Forest University, Winston-Sa-
lem, NC.
Robert C. Aber, MD, Hummelstown, Pa,
has been named the Dr C. McCollister
and Nancy L. Evarts Professor of Medi-
cal Education at Penn State College of
Medicine in Hershey, Pa. The chair was
established by C. McCollister Evarts,
MD, dean of the College of Medicine, and
his wife.
Two departments at Walter Reed Army
Medical Center, Bethesda, Md, have new
chiefs. Col Louis F. Diehl, MD, will head
the Department of Medicine and Lt Col
Daniel P. Otchy, MD, will head the De-
partment of Surgery.
Richard Payne, MD, has been named
chief of the Pain and Palliative Care Ser-
vice in the Department of Neurology at
Memorial Sloan-Kettering Cancer Cen-
ter, New York, NY. He will also hold the
Anne B. Tandy Chair in Neurology.
Editor’s Note: Miscellanea Medica normally appears in
the Medical News & Perspectives section several times
each month. Items submitted for consideration should be
sent to Marsha F. Goldsmith, editor, Medical News &
Perspectives.
Medical News & Perspectives