top2.gif - 6.71 K

watermark3.gif - 15.76 K

lettertop.gif - 16.22 K Pen Points
Letters to
Gay Today


Johns Hopkins' Doctor Replies to BuckcuB

A piece appeared on Gay Today criticizing me for my recent response to a question appearing on The Patient Forum, an interactive question & answer forum on HIV infection at the Johns Hopkins AIDS Service website.

The editorial by "BuckuB" was based my observations regarding abuses of certain AIDS entitlement programs, which I mentioned as an example of inequities in the U.S. health care system and what is often called "AIDS exceptionalism." BuckuB has grossly distorted my comments in order to cast me as "merciless," "cold-blooded," and "frosty-hearted," to name just a few of my highly unpleasant personal attributes.
jgallant.jpg - 5.86 K Dr. Joel Gallant defends his comments on AIDS entitlement progams and tells BuckcuB that the columnist distorted his words to make him appear "cold-blooded" and "frosty-hearted"

Let me use this opportunity to reiterate a few of the points that BuckuB so conveniently left out. First, I clearly stated that abuses of entitlement programs are the rare exceptions, not the rule. The idea that I would somehow disapprove of the very programs that have kept my patients and friends alive is absurd.

I rely on the services of Maryland Community Kitchen, our own version of Meals-on-Wheels, and am a regular contributor to that cause. I fight to get my patients any entitlement that they qualify for and that will improve the quality of their lives.

The fact remains, however, that there are gross inequities in the so-called "medical system" in the United States. First, a large and ever-growing proportion of our population has no access to even the most basic health care.

But we don't have to look that far; we can look within our own community: There are HIV-infected people in this country who have access to Ryan White-sponsored massage and acupunture, while others are lucky to get a Bactrim for PCP prophylaxis.

When it comes to HIV infection, probably the single most important factor determining how well you do with your disease is not your sex, race, educational status, risk factor, or income, but the state that you live in. If you live in states like New York or Maryland, access to health care and services is pretty good. But there are other states, states which will remain nameless, in which even basic antiretroviral therapy is out of reach.

It's human nature to scream loudly when someone tries to take away something you that you want to keep. But sometimes I'm reminded of the Pilgrims, who fled religious persecution in England only to hang Quakers in Massachussetts. In no way am I blaming people for taking advantage of services offered in their community--who wouldn't?

Related Stories from the GayToday Archive:
Johns Hopkins' Dr. Joel Gallant: Not So Gallant After All

Do Doctors Decide Who Lives and Who Dies?

California League of Women Voters Praise Judge's View

Related Sites:
Dr. Joel Gallant

No on Knight
GayToday does not endorse related sites.

But all of us have to be mindful of the bigger picture: that resources offered to one group often mean resources denied to another group, and that Ryan White funding granted during liberal or prosperous times can be taken away just as quickly when the pendulum swings in the other direction.

AIDS activists should be on the vanguard of the fight for universal access to health care, not just trying to protect their own fiefdoms at the expense of other members of society and people living with AIDS in other communities.

There are two kinds of activists in this world: the brave ones who tackle real problems and take on real enemies in order to make meaningful changes, and the cowards, who erect easy but artificial targets, often people fighting the same battle but with different weapons.

In one out of the thousands of answers I have been providing as a public service over the last several years, I offended BuckuB's sensibilities, and he went ballistic. As a further example of his cowardice, neither he nor the editors of your magazine bothered to contact me about this piece or ask for my comments.

BuckuB said that I am "simply too much of a clinician to understand and appreciate emotionally, as a caregiver, the daily horrors faced by many people with AIDS." In my language, such a dichotomy would be inconceivable. A clinician is someone who cares not only for the medical needs of his or her patients, but also for their emotional well-being and quality of life.

Like all of you, I've wept at far too many funerals for someone of my tender age. Like you, I've been angry, angry enough to have written something as thoughtless and irresponsible as Buckub's editorial.

So I'm going to forgive him his callous remarks, ones which regular readers of my website would no doubt take exception to. All I ask is that instead of bickering over words with each other, we start trying to focus on REAL enemies from now on.

Sincerely,

Joel E. Gallant, MD, MPH
Associate Professor of Medicine
Director, HIV Clinic
The Johns Hopkins University School of Medicine


BuckcuB Responds to the Doctor:

BuckcuB's been spanked in public before, on occasion for good reason. But not this time, dear reader. Dr. Joel Gallant calls the GayToday article "irresponsible and thoughtless" and accuses BuckcuB of cowardice -- which he then oh-so-graciously forgives. Noblesse oblige, one supposes.

Which is "irresponsible and thoughtless": condemning the fact that a doctor -- an HIV specialist, no less -- could even suggest that people with AIDS are or should be responsible for the inequities in the way entitlements are doled out? Or branding as "abuses" the practice of PWAs taking services to which they're entitled, as Dr. Gallant writes, simply because not every PWA has those entitlements available to him or her?
buckcub.jpg - 16.88 K BuckcuB says Dr. Gallant still deserves a spanking

There is nothing "cowardly" about calling someone to task for an opinion hurtful, and potentially-harmful, to the very people he's supposed to be helping. The people Dr. Gallant should be fighting for -- his patients with HIV and AIDS. As director of Johns Hopkins' Moore Clinic, he must see the suffering and despair of many PWAs. Is it "exceptionalism" to try and grab a disproportionate piece of the entitlement pie for folks with a disproportionate degree of illness? Or should AIDS sufferers wait until every Eskimo in Alaska has aromatherapy coverage, before it will be okay for them to get a government- funded massage with a clear conscience?

BuckcuB agrees that inequities exist. A lot of them are perceived inequities -- the breast-cancer lobby rails that the AIDS lobby gets unfairly large funding. The multiple sclerosis lobby whines that breast cancer gets an undeservedly-big slice of the money. The diabetes lobby complains about the size of MS's allocations. And so it goes down the line, dear reader, each disease's funding advocates shrieking loudly that the others get more than is fair.

In that best of all possible worlds, we could treat each disease -- and the entitlements appending thereto -- equally, as Dr. Gallant argues. But this isn't the best of all possible worlds. Our legislators build highways to nowhere in West Virginia, vast tenantless office buildings in the District of Columbia. Hospital administrators channel income to the highly-profitable departments -- cardiology, oncology, even plastic surgery. So tax money is squandered on pork instead of medicine, and hospital funding goes where the money is. AIDS is not profitable; it's such an expensive disease that even wealthy PWAs are rapidly exhausted of their funds.

The sort of perfect equity that Joel Gallant insists on is impossible. Disease is not equitable. And BuckcuB does not feel it is "exceptionalizing" AIDS to suggest that the deadliest threat to the global population since the Black Death -- in the estimation of the renowned World Health Organization, for example -- deserves exceptional treatment and exceptional entitlements.

A doctor who, in Gallant's own words, "...cares not only for the medical needs of his or her patients, but also for their emotional well-being and quality of life," would never distress patients with the cavalier public attitude that those patients are undeservedly receiving some 'special' benefits. One doesn't insult the people one acts as caregiver for by suggesting they're unjustly getting more than their share.

And yet, Gallant writes, "I fight to get my patients any entitlement that they qualify for and that will improve the quality of their lives." Well, BuckcuB wonders, which is his real stance? Getting AIDS patients "exceptionalized" entitlements if they qualify for them and they'll improve their quality-of-life? Or condemning this practice as unfair, as Gallant did in his earlier comments?

More than any other profession except, perhaps, police officers, doctors are trained never to admit they've made a mistake. Such admissions can be both damaging and costly. But this attitude fosters a dangerous perspective: the notion that the doctor cannot and does not make mistakes. A perspective which some doctors come to believe themselves. Well, Dr. Joel Gallant, here's your wake-up call: you made a mistake. And instead of admitting it, you defended it. How much more you might have reassured both your regular readers and the vast numbers of frightened "lurkers" if you'd simply admitted that you overstated the case, and wrongly suggested that some PWA's were unfairly receiving benefits at the expense of others.

If Joel Gallant is truly concerned about the "bigger picture," then BuckcuB hopes he's in the administrative offices of Johns Hopkins on a daily basis, loudly remonstrating with his superiors to "exceptionalize" the Moore Clinic, and get more funding for AIDS patients.

But there is nothing -- NOTHING! -- PWAs receive as entitlements that they do not deserve, and Dr. Gallant should begin believing that right now, if he wants to be a real caregiver. The real inequity here is that those entitlements are so few and so wretchedly-small. Millions of Americans don't have "basic health care?" A crime, to be sure -- but he's a doctor, let HIM fight that battle! Are we supposed to expect sick people who can barely get out of bed some days to wage the war for universal health care?

So who's the "coward" here? BuckcuB took extreme exception to an AIDS doctor's cruel comments, publicly. Dr. Gallant, a medical caregiver by profession, says he weeps at the funerals, but some PWAs "abuse" the entitlement system. Crocodile tears, crocodile tears. People who truly care -- and have the power to change the way things get done -- don't weep. They fight!

When the medical profession becomes perfect -- a long way off, given the recent reports that doctors' mistakes cause more hospital deaths than auto accidents -- then, perhaps, BuckcuB will feel that the public spanking administered by Dr. Gallant is deserved. In the meantime, let's see a little more willingness among our medicos to admit a mistake. Especially a mistake that likely disheartened thousands, and may have hardened the hearts of docs who take their cues from the Johns Hopkins AIDS website.

BuckcuB


Come Out! Come Out!
Wherever You Are-- in California

senknight.jpg - 7.11 K Anti-gay California State Sen. Pete Knight: Rotting flesh never made such a big stink No we are not talking about any game here, but rather the battle to beat back California's Initiative 22, the Limit on Marriage initiative. Can we beat this vicious anti-gay legislation? You bet we can, despite what the political experts are saying. Support for it has already fallen from 59 percent to 50 percent. But if we are going to win this battle, we must start fighting now. The vote comes in little over three months.

As those who have been watching this battle shape up know, the anti-gay forces are going to be able to outspend us mightily. The Catholics and the Mormons are literally putting the fear of God into their memberships, using the power of the pulpits to finance this morally bankrupt agenda. We can expect to see TV, newspaper and radio ads blanketing the state as a result.

We may not be able to match the number of ads aired or printed, but we do have a more powerful weapon if we only can work up the courage to use it. That of course is coming out to everyone we know. My personal experience in the 30 years that I have been out and engaged in this equal rights struggle is that by far the most effective weapon at our disposal when our community comes under this type of attack is personal dialogue with every straight person we know.

Those straight people who think they don't know any gays find themselves visualizing some awful stereotype as they are standing in that voting booth, and they vote against our interests. On the other hand though, when we have come out to those folks before the election, and explained that their votes will have a profound effect on our lives, this puts a face on the issue, and they do the right thing.

Yes, coming out is sometimes uncomfortable, no matter how out we are. Even after 30 years I find it gets old having to speak up. But the other side of that of course is the support we get, sometimes from very unexpected sources. I can remember a ballot issue in Seattle in the '80s which would have rolled back hard earned rights for our community. I approached my neighbors, a bunch of CB'ers, whose pickups sported not only huge antennae but gun racks in the back window. They turned out to be great. In fact after I came out to them they even invited me to join their CB club. I ended up presenting the case for voting against the measure on their CB channel. We won the election, too.

So yes, to defeat the Knight Initiative the campaign needs donations of money and time, but most of all it needs each and every one of us to get up and come out to each and every straight person we know, and to ask them for their support. As the National Gay and Lesbian Task Force says: "Equality begins at home."

To mangle a phrase; "If anyone knows why these folks should be joined in matrimony, speak up now or forever hold your peace."

Related web sites: www.noonknight.org and www.samesexmarriage.org

Paul Barwick
San Francisco



bannerbot.gif - 8.68 K
© 1997-99 BEI