Public Release: 

ACP calls for policies to support transgender rights, same-sex marriage

Embargoed news from Annals of Internal Medicine

American College of Physicians

1. ACP officially supports transgender rights and same-sex marriage, opposes "conversion" therapy in new policy position paper

Free content: http://www.annals.org/article.aspx?doi=10.7326/M14-2482

A new policy position paper from the American College of Physicians (ACP) offers recommendations on how to achieve health care equality for lesbian, gay, bisexual, and transgender (LGBT) patients. Among its recommendations, ACP calls for comprehensive transgender health care services included in health benefits plans and civil marriage rights for same-sex couples. Lesbian, Gay, Bisexual, and Transgender Health Disparities: A Policy Position Paper from the American College of Physicians is published in Annals of Internal Medicine.

Evidence suggests that LGBT persons face a common set of challenges within the health care system. These challenges range from access to health care coverage and culturally competent care to state and federal policies that reinforce social stigma, marginalization, or discrimination. These policies often keep LGBT persons from accessing health care and are also associated with increased rates of anxiety, suicide, and substance or alcohol abuse. ACP is committed to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP's policy position paper aims to eliminate disparities in the quality of or access to health care for members of the LGBT community.

ACP's Health and Public Policy Committee reviewed published studies, reports, and surveys on LGBT health care and related health policy to inform its recommendations. The full recommendations can be accessed for free in Annals of Internal Medicine. In brief, some of ACP's key statements and recommendations include the following:

    * ACP recommends that gender identity, independent and fundamentally different from sexual orientation, be included as part of nondiscrimination and anti-harassment policies.

    * ACP recommends that public and private health benefit plans include comprehensive transgender health care services and provide all covered services to transgender persons as they would other beneficiaries.

    * ACP supports same-sex civil marriage rights and also recommends that the definition of family be inclusive of those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship. As such, patients should be able to determine who may visit and who may act on their behalf during their stay, without stipulation.

    * ACP opposes the use of "conversion," "reorientation," or "reparative" therapy for the treatment of LGBT persons.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact David Kinsman at dkinsman@acponline.org.

2. Young lesbians less likely than heterosexuals to be vaccinated for HPV

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2108 Adolescent and young adult lesbians may be less likely to initiate vaccination for the human papillomavirus, or HPV, according to a study published in Annals of Internal Medicine. Prevalent misconceptions about risk seem to dissuade women and health care providers from initiating the vaccine.

Nearly all cases of cervical cancer are caused by HPV, so it is recommended that all U.S. women and girls between the ages of 11 and 26 years receive the HPV vaccine, regardless of sexual identity or behavior. Lesbians may be at greater risk for cervical cancer than most heterosexual women for several reasons, including limited knowledge of female-to-female HPV transmission, a higher prevalence of smoking, and greater obesity rates. For this reason, vaccination against HPV may be even more critical in this population.

Researchers used data from the National Survey of Family Growth to examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls. They found that females who self-identified as lesbian were significantly less likely than their heterosexual counterparts to initiate HPV vaccination. The researchers suggest that targeted efforts may be needed to educate lesbians and health care providers about HPV and the importance of vaccination in preventing cervical cancer.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. For an interview with the lead author, please contact Todd Datz at tdatz@hsph.harvard.edu or 617-432-8413.

3. Vehicle for aggregate harm or the lesser of two evils? Experts offer opposing viewpoints on e-cigarette use

Free abstracts: http://www.annals.org/article.aspx?doi=10.7326/M15-0450 and http://www.annals.org/article.aspx?doi=10.7326/M15-0361

Electronic cigarettes are a new and divisive force in the struggle against tobacco-related morbidity and mortality. Two commentaries published in Annals of Internal Medicine offer opposing views on their use.

Thaddeus Bartter, MD, of the University of Arkansas for Medical Sciences suggests that a lack of regulation and oversight in e-cigarette marketing means that young people may be tempted by the glamorous images portrayed in e-cigarette advertisements. The aggregate harm is that e-cigarette exposure increases the desire to smoke cigarettes, which could lead to a lifetime of addiction for susceptible young people. Dr. Bartter warns that e-cigarettes have the capacity to disrupt a 50-year fight against smoking.

M. Bradley Drummond, MD, MHS, of Johns Hopkins Asthma & Allergy Center argues that e-cigarettes may be beneficial as a tool for helping smokers reduce their use of combustible cigarettes. Dr. Drummond suggests that the all-or-nothing approach to smoking cessation where complete abstinence is the goal may seem insurmountable to some smokers. E-cigarettes offer these smokers a way to reduce the harms of smoking by giving them a less toxic alternative. He argues that there is a tremendous amount of uncertainty about the harms of e-cigarettes, but the probability of harm from combustible cigarettes is certain.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. For an interview Dr. Bartter, please contact Liz Caldwell at liz@uams.edu or 501-686-8995. To interview Dr. Drummond, please contact Lauren Nelson at lnelso35@jhmi.edu or 410-955-8725.

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