A New Dilemma for Doctors

In browsing The New York Times online several weeks ago, I read an article about a new dangerous MRSA bacteria (a multi-drug resistant staph infection) spreading primarily among homosexual men in San Francisco. I thought little more about it until about a week later, when, on January 20, an article entitled “After Linking New Strain of Staph to Gay Men, University Scrambles to Clarify” appeared. In reading this article, I was shocked by the fallout that had occurred after the previous article. Many homosexual men in the area were offended by the study, and national interest groups reacted vehemently about what they termed a new “stigma.” The uproar surrounding the report convinced me to do some research on the study and its potential implications. What I found worried me: a striking example of special interest groups potentially hampering public health efforts. 

According to a January 14 article on the University of California, San Francisco website, where the research was conducted, the study found that: “men who have sex with men were at higher risk for infection with a multi-drug-resistant variant of the so-called MRSA USA300 bacteria,” noting that it is “transmitted most easily through intimate contact.” The information came from hospital records in San Francisco medical centers, an HIV clinic, and “a clinic serving a predominantly lesbian/gay/bisexual/transgender population in Boston.” This strain is drawing particular attention because of its multi-drug-resistance; the article remarks that it is otherwise similar to other MRSA bacteria. 

The most stunning result of the study was that “HIV-positive patients who reported their risk factor for HIV as being men who have sex with men were about 13 times more likely to be infected with the multi-drug-resistant variant than patients who reported some other risk factor for HIV.”  This indicates that for the San Francisco population, gay men were 13 times more likely than other patients in the HIV clinic to be infected with the bacteria. The study noted that around one in 588 residents of SF’s Castro district, a historically gay enclave, had the bacteria, while the rate for San Francisco residents in general was about one in 3800. Binh Diep, PhD, the lead author of the study, remarked that both were “surprisingly high numbers.”
His comment on the matter? “These multi-drug-resistant infections can affect men who have sex with men at body sites in which skin-to-skin contact occurs. However, these same body sites can be infected by MRSA in other individuals as well, so it is not possible to determine from the study what role sexual transmission plays per se.” He advocates washing well after exposure to reduce transmission. This was hardly a political statement, and reflected no bias against the homosexual community. Dr. Diep was merely treating this as any other dangerously infectious disease. 
The end of the article is relatively unexciting; it discusses the development of MRSA and its spread into the general public from hospitals, where it developed resistance to methicillin and other antibiotics. This has caused significant concern in the scientific community, as many current drugs are unable to cure such infections that are so easily spread. Thus, the article is ultimately about the public health concern inherent in a dangerous disease for which our health system essentially lacks treatment, not a condemnation of any particular behavior or lifestyle.
Yet, the Times article in response to this ignited a fierce reaction in the San Francisco gay community. One man responded, “The way they keep targeting gays as if gays alone are responsible for it, it's like H.I.V./AIDS all over again. And we’re sick and tired of it.”
According to the Times, “National gay rights groups were quick to label such talk as ‘hysteria,’ even as researchers as the university scrambled to clarify their findings.” The researchers issued an apology that the article “contained some information that could be interpreted as misleading,” stating “We deplore negative targeting of specific populations in association with MRSA infections or other public health concerns.”
It is a worrisome trend if scientists have to apologize for their findings; researchers should never feel political pressure in reporting data. Having read the article, I can say without any doubt that there was no indication of “hysteria” about the gay community. There was only due concern for a serious public health threat, which should never be termed as “misleading.” The fact remains that the bacteria does exist in specific communities, and no amount of political correctness is going to change this. If the problem exists mainly in this specific community, asserting that it does not is counterproductive and even dangerous.

The political implications of this announcement or, more precisely, the aftermath, led to an amusingly placating response by the Centers for Disease Control and Prevention to the forces of political correctness. In a January 16 statement, the CDC declared, “The strains of MRSA described in the recent Annals of Internal Medicine have mostly been identified in certain groups of men who have sex with men (MSM), but have also been found in some persons who are not MSM. It is important to note that the groups of MSM in which these isolates have been described are not representative of all MSM, so conclusions cannot be drawn about the prevalence of these strains among all MSM. The groups studied in this report may share other characteristics or behaviors that facilitate spread of MRSA, such as frequent skin-to-skin contact.”

This statement is a bit ridiculous in its attempt to remain politically correct; I would assume it would be unnecessary to point out that these particular strains “have also been found in some persons who are not MSM.” The article never said it was found exclusively in MSM; it didn’t even imply it.  Why did the CDC find it necessary to point out this rather obvious statement? The following sentence also raises doubts about the supposed intelligence of the audience of this press release when it says, “conclusions can not be drawn about the prevalence of these strains among all MSM.” The original study found that this particular bacteria was prevalent in one particular area of the country; I doubt that many people would assume that the mere fact of a person’s sexual identity would imply they had a certain disease, especially if they didn’t even live near the disease. 

The next statement is also relatively obvious: “MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including sex.” The CDC’s admission that contact occurs during other activities than sex is more amusing than helpful.

While the article seems harmlessly banal, it represents a worrying trend. The political spin placed on this report is attempting to downplay the fact that this bacteria is found in much greater proportion in areas with a high concentration of homosexual men. The doctrine of political correctness insists that we minimize the offense to the homosexual community. However, this disease is not an offense; it is a fact. There is nothing wrong with calling a spade a spade; this disease is more common in homosexual men in certain areas, and this fact should not be inherently offensive. 

In fact, by refusing to see the situation for what it is — a potentially threatening public health crisis — many people are more concerned with the possibility of insulting someone than the possibility that the health care system may have a real crisis on its hands, which is a worrying thought, especially in its current state of disarray. This could do a great disservice to the community it is trying to defend. 

Money for public health is crucial, yet scarce.  If those more concerned with political correctness than health manage to keep organizations from the CDC from focusing on this area, they are actually doing themselves a great disservice. A 1997 Hastings Center Report mentions the idea that “excessive respect for human rights crippled public health efforts and is therefore responsible for the intensifying and expanding AIDS epidemic.” If this statement is true, it has momentous implications for public health efforts in response to politically charged diseases.

Health officials, obviously, should not discriminate against anyone, regardless of their identity, and people should be careful not to stereotype members of certain groups. However, when political correctness gets in the way of truth, especially regarding anyone’s health, the American public has a serious problem. Health officials should not be spending time and energy on worrying whether facts are offensive. Instead, the CDC should step in quickly and contain a threat such as this before excessive concern for political correctness (and the resulting cautiousness in locating and aggressively treating this disease) hampers public health efforts. The health community has a chance to stop a dangerously aggressive bacteria from causing a major health threat, and it should not let political correctness stop it before the job of containment becomes impossible.