Double Standard Highlighted by COVID19

Federal, state and local governments are implementing "contact tracing" in the effort to contain the spread of the Coronavirus. What that will look like is still being worked out, but basically when a positive COVID-19 test comes up, that person's friends, associates and any location they may have visited will be tracked (maybe through phone GPS?) and then those people and places will also be tested.


Okay, those policy decisions are above my pay grade. However, I would like to point out the extreme double standards associated with the decision making process, as described by Dr. Miriam Grossman in her book, "Unprotected: A Campus Psychiatrist Reveals How Political Correctness in Her Profession Endangers Every Student"*


This excerpt is from Chapter 4: Saving Private Brian.

Let's say Brian [is at risk for] HIV and Tom has Tuberculosis (TB). They may both be infected, capable of infecting others, and not know it...[this is] how I as a [university] healthcare provider am expected to manage patients at risk...


Brian has told me about his dangerous behavior. As we speak, he may be highly infectious, with a viral level that's through the roof. My role is to urge him to be tested, and openly and honestly discuss his HIV status with his boyfriend, to limit his casual contacts and to use condoms.


It's another story with TB. If Tom recently lived with an infected relative and was never screened, I am expected to give him a tuberculin skin test. If its positive, he gets a chest ex-ray. This is standard medical care. If the skin test and the x-ray lead me to suspect time may have tuberculosis, I am obligated by law to report him to the department of Health and I have one working day to do so. I must fill out a confidential morbidity report giving his name, date of birth, social security number, address, phone number, occupation, country of birth, date he arrived in the United States, race and ethnicity. If I delay or fail to report Tom, I will be in violation of state regulations and subject to citations and fines...


When the department of health gets my report, they start an investigation. A public health officer will visit Tom's dorm within three days to identify, examine and evaluate his roommates...


There's more. If Tom has TB and there's reason to suspect he is not taking his medications as directed, he may be required to have "directly observed therapy." That means the public health nurse will visit my patient twice a week for six months and watch him swallow his pills. If Tom remains uncooperative, and all alternatives have been exhausted, the state can detain him: he can, following due process, be confined in a locked facility. Justification for such an extreme measure? The protection of public health. Whether he likes it or not, the state sees to it that Tom is treated...


Why am I mandated to protect Tom, but not Brian? Why does the state send out public health officers in search of Tom's contacts, but not Brian's? Tom's roommates will be informed of their exposure; representatives from the department of health will show up at their door and tell them all about it. Brian, if he ever gets around to asking, will just have to trust that his boyfriend will tell the truth. And speaking of trust, I regret to inform you that when it comes to HIV, people lie.


Brian and Tom are both potential victims, as well as carriers of disease. I am their physician, ostensibly responsible to the same degree for each of them. But look at the contrast: with Tom, the steps I follow are defined and enforced. For carelessness, I face fines and citations and my patient faces a court order. So Tom will be treated, and he will be OK. But with Brian, I have no one to contact, no report to file. Brian can keep going like this for years, until he's able to "emotionally handle" bad news...


An alien arriving on our planet and surveying the situation would conclude we care more about Tom and his friends, than Brian and his. He would be astonished to learn this perplexing state of affairs is the result of gay activism during the early years of the epidemic...


Welcome to the bizarre world of politically correct medicine, where I am mandated to report Tom, but can only talk with Brian -- without being offensive, of course.


This isn't the only double standard with regard to policies surrounding sexual health issues. But it may be the most glaring. Another reason for parent's to be their child's First Best Source for information.


*"Unprotected" was originally published anonymously because she feared being fired from her job at UCLA.

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