The Road to Legalizing Medical Marijuana in New York

Legal Driving Marijuana

On April 25 I took part in a press conference on the steps of New York City Hall, hosted by New York State Assemblyman Richard Gottfried and State Sen. Diane Savino, the sponsors of the medical marijuana bill. I was asked by Janet Weinberg, Chief of Operations at GMHC, to offer my opinion on medical marijuana as it relates to patients suffering with complications from cancer and HIV. There I met with other supporters of the Compassionate Care Act, including members of Compassionate Care NY, a group of patients and health care providers. The purpose of the bill is to allow New Yorkers with serious medical conditions access to medical marijuana under the supervision of their health care provider. According to the bill, a “serious condition means a severe debilitating or life-threatening condition, including, but not limited to,” cancer, glaucoma, HIV, Parkinson’s disease, multiple sclerosis, epilepsy and neuropathy, to name a few. Designated caregivers must be registered by the Department of Health and possess a registry ID card for each patient, and they can serve no more than five certified patients.

On June 3 the New York Assembly passed the bill in an overwhelming vote, but the bill was stalled when the State Senate adjourned on June 22 without taking action on this important reform. Advocates vow to try again in 2014.

Despite a poll conducted in May 2013 by Siena College Research Institute and Drug Policy Alliance, 82 percent of state and 79 percent of city registered voters support medical marijuana, yet New York is not among the 20 states that have already legalized its use. This disconnect between public and political points of view doesn’t seem so perplexing if you review the history of medical marijuana. The United States has had a love/hate relationship with this plant going back to when it was first recognized for its medicinal use in 1850.  However, the Marihuana Tax Act of 1937 deterred physicians from prescribing it. In 1944 New York City Mayor Fiorello LaGuardia commissioned the New York Academy of Medicine to study marijuana, and their finding debunked many claims that inspired the Marihuana Tax Act: Marijuana did not lead to significant addiction in the medical sense, nor did it lead to morphine, heroin or cocaine addiction. In 1970 the federal Controlled Substances Act classified marijuana as a Schedule 1 drug, banning it from medical use. But by 1982 more than 30 states had passed laws recognizing the medical value of marijuana.

On Aug. 29 New York City Comptroller (and mayoral candidate) John Liu held a press conference at New York Downtown Hospital and announced the release of a report calling for legal access to medical marijuana. The comptroller stated that more than 100,000 New York City residents would benefit from legalized marijuana. His report recommends seeding a $100-million public-private research fund, establishing city-owned and -operated medical marijuana growing sites, and requiring insurance providers to cover medical marijuana. I stood alongside Comptroller Liu to share my own story of a patient with metastatic cancer who traveled to Arizona in order to receive medical marijuana.

Opponents of medical marijuana are concerned that sanctioning the medical use might increase its use among the general public, even though the 1999 Institute of Medicine report found that not to be true, stating, “No evidence suggests that the use of opiates or cocaine for medical purposes has increased the perception that their illicit use is safe or acceptable.”

My patient was not a drug addict. She was not seeking to get high. She merely wanted to live out the remainder of her life pain-free so that she could spend that time with her family. Medical marijuana alleviated her pain. It also stimulated her appetite, and she was no longer constipated, because she didn’t have to rely on opioids.  But more importantly, she was present and able to communicate with her loved ones.

After she died, I imagined how differently her final days would have been had she remained in New York. I’ve known many other similar patients suffering from cancer and HIV who were too nauseated to eat, in too much pain to sleep and too weak to get out of bed. Everyone has the right to live a pain-free existence and should not have to worry about wasting due to loss of appetite or being bedridden due to pain. My patient certainly deserved that, and so does everyone living in New York.


Pee-Shy Book Trailer

Trailer for my upcoming book entitled, Pee-Shy: A Memoir due on December 2013, published by Kensington Books.

In his stunningly honest and poignant memoir, Frank Spinelli recounts a childhood marked by trauma and of finding the courage that ultimately transformed his life…

Frank Spinelli grew up on Staten Island in the 1970s to Italian-born parents who viewed cops and priests as second only to the Pope in infallibility. His mother, concerned that her son was being bullied at school for being “different,” signed Frank up for Boy Scouts when he turned eleven. For the next two years, Frank’s life had two realities—one lived in full view of his family, and the other a secret he shared with his Scoutmaster that he couldn’t confess to anybody.

Eventually Frank went to college, established a thriving medical practice, and found a home in Manhattan. But the emotional and physical effects of his past continued to shadow every aspect of his life. Then a shocking discovery gave Frank the opportunity to overturn thirty years of confusion and self-blame—for himself, and for other boys like him.

Pee-Shy is a remarkable story of overcoming the unimaginable to choose resilience over darkness, and love over loss.

“A devastatingly heartbreaking look at life after childhood abuse, with wit and piercing insight that can only come from a place of brutal honesty.” —Josh Kilmer-Purcell

“This is a memoir about a grown-up boy’s generous—and healing—heart.”—Kevin Sessums

“This is one of those horrific, true stories that Dr. Spinelli so courageously reveals. With raw honesty he makes us understand that monsters do exist and a child’s innocence is precious. His story is one of too many, but maybe, this one will help open our eyes a little more and shine a light on a taboo subject that many chose not to see or believe.” —Whoopi Goldberg

Welcome to Hong Kong Fong!

Check out my good friend, Deb Fong’s new blog. A must for anyone thinking about a trip to China.


Photo Jul 12, 3 46 25 PM

Welcome to WanderFong! My name is Deb Fong, and I am a Hong Kong-based expat relocated from NYC.

Funny where life takes you – I never expected to actually live here, although I have always treasured trips throughout Asia. Here with my husband Mark now, I am incredibly excited as I discover the big city draws and the hidden little gems, the old and the new, the local nuances and the more western influences, the traditional and the edgy – and as I meet and learn from true locals and fellow expats. I immerse myself in everything – the amalgam of cuisine, culture, the incredible natural surroundings, the promise of new friends with their own unique stories.

HK is also an incredible base for the rest of Asia, and I am thoroughly enjoying my deeper explorations of the region. As one example, one of my most recent regional trips took me to Singapore. I…

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Tips for parents on how to deal with child molestation


                                                                                                                                                                                            Pee-Shy: A Memoir

TATL (pronounced tattle)

T – Talk to your child. Ask them about what happened.

A – Authorities. Don’t go to the principal. Don’t go to the head coach. Go to the police. They are trained to deal with sexual predators and are very compassionate.

T – Therapy. It will be the best investment you make toward your child’s betterment.

L – Love your child. Let them know they did nothing wrong. Tell them it wasn’t their fault and that you are there for them.

Meningococcal Vaccine Update

New York State Department of Health Expands Meningococcal Vaccination Recommendation Statewide

ALBANY, N.Y. (March 25, 2013) – The New York State Department of Health (DOH) is expanding a recommendation issued earlier this month by the New York City Department of Health and Mental Hygiene (NYCDOHMH) regarding meningococcal vaccinations for men who have sex with men (MSM). These meningococcal vaccine recommendations have been issued in response to an outbreak of invasive meningococcal disease (IMD) in New York City.

Meningococcal disease is a severe bacterial infection of the bloodstream. Common symptoms include high fever, headache, vomiting, stiff neck, and a rash. Symptoms may occur two to 10 days after exposure, but usually within five days. Since 2010, 22 men residing in NYC and one man who resides outside the City, but spent significant time there, have become ill in this outbreak, seven have died.

The recommendation by DOH has been expanded to include MSM residing outside NYC who have traveled to the City and engaged in the risk behaviors described below since September 1, 2012.

The following groups were identified by NYCDOHMH as being at highest risk of IMD and are being advised to obtain a quadravalent meningococcal vaccination:

  • All HIV-infected MSM
  • MSM, regardless of HIV status, who regularly have close or intimate sexual contact with men met through an online website, digital application (“app”), or at a bar or party. (Previously, meningococcal vaccination was recommended only for those with contact in certain high risk areas in New York City)

HIV positive individuals who do not have a health care provider or whose provider does not currently have the meningococcal vaccine can use the following link to find locations that offer vaccinations and/or health care services: Other individuals can visit www.nysacho.organd use the directory to find contact information for their local health department, which also may have the vaccine.

Additional provider information can be found on the statewide HIV provider directory at:

More information about the meningococcal disease outbreak among at-risk men is available at:

AIDS Walk New York

Click here to donate to AIDS Walk

Play with me

“I wish my partner were as playful with me as he is with our dog,” I thought to myself one evening as we both were lying in bed watching television. During a commercial, my husband, Chad, spontaneously lept up and maneuvered himself so that he could nuzzle his nose up against our dog’s snout, whispering, “You’re the best little doggie in the world,” and calling him nicknames like “Bubbly-boo” and “Cutey-cute.” I stared at them, thinking how great it was that my husband loved our dog so much that he could show him such affection. Then, when it happened again later that week, I started to wonder why my partner, the overly efficient and regimented vice president of a pharmaceutical company, could slip so easily into the role of child with our dog but not with me.

Thinking back, I remembered when we first started dating. We seemed more spontaneous then. Going to the movies meant holding hands in the dark, dinner was a chance to flirt at the table of some trendy restaurant, and strolling through a gallery was an opportunity to sidle up against each other while staring at a piece of art.

Five years later, now happily married with a four-legged child we call Hoffman, our lives have settled comfortably into a common phase of marriage. We opt to order in rather than trying to score a reservation at the newest restaurant. We get excited by the arrival of new things to watch on Netflix in lieu of fighting crowds at the movie theater, and now we walk past gallery windows on our way to the dog park. I try to make excuses for our behavior: We work hard, we don’t like leaving Hoffman alone, we’re tired, and, admittedly, we’re getting older.

I kept thinking of the quotation by George Bernard Shaw: “We don’t stop playing because we grow old; we grow old because we stop playing.”

The truth is that Chad and I are suffering from midlife marriage malaise. Apparently it’s quite common. Friends who are in long-term relationships tell me that their priorities changed after being together for years. I’m told that it’s less about going out and being seen than it is about building a life with your partner and savoring the quiet times at home. I suppose there is some truth in that. But what about the adage “the couple that plays together stays together”?

My therapist assured me that many couples experience a loss of playfulness, but not due to complacency as much as fear of rejection. I thought back to that night when Chad snuggled with our dog. I wondered what would have happened if Chad had spontaneously rubbed his nose up against mine and called me “Bubbly-boo.” Depending on my mood (and yes, believe it or not, I’m moody), I probably would have stared back at him with an odd expression on my face and said something like, “Are you having a stroke?”

It occurred to me that if my relationship was lacking playfulness, then it was just as much my fault as it was his. All at once I saw myself in bed playing Words With Friends on my iPhone with people who weren’t really my friends, as Chad read a magazine. Now it made sense that he would choose to play with Hoffman, with his unconditional love and nary a snarky comment to be heard, over me, someone whose personality is as temperamental as that of a 2-year-old.

It was then that I realized that if I wanted more playfulness in my relationship, then I was going to have to do something about it. But how do you initiate fun without coming across as desperate? And what if my lame attempt at playfulness yielded rejection from Chad? With all these questions swirling in my mind, it didn’t take long before I talked myself out of making any playful attempts with my partner.

A week later I was working at my computer one night. Chad was in the bedroom reading a magazine, with Hoffman by his side. Suddenly I was startled by the sound of Hoffman leaping off the bed to retrieve a ball that Chad had thrown. Soon they were in the throes of a game of fetch, but as usual, Hoffman’s interest waned after the sixth throw, and they began wrestling. I listened in envy as my husband began calling my dog those same cute affectations that I longed to hear him say to me. Sitting there, I felt as abandoned as that ball lying on the floor.

Regardless of gender, marriage is about communication and compromise. Of course, priorities change after being together for years. In that regard I agreed with my friends in long-term relationships. And yes, perhaps we do become slightly insecure with our loved ones out of fear of rejection, like my therapist so insightfully pointed out. But these observations shouldn’t prevent us from taking risks.

In that moment I knew I had to show Chad that I was up for fun. I wouldn’t allow myself to be discarded like that ball, because I was better than that, and so was my relationship. So I surprised everyone, including myself, by jumping up on the bed and proclaiming my rightful position next to Chad and Hoffman, smothering them in kisses and calling them every cute name I could think of. I didn’t care if they thought I was crazy, silly or experiencing an attack of apoplexy, because I had been fearless and, more importantly, fun.

GMHC | Gap Commemorates World AIDS Day with Special Edition T-shirt Benefitting GMHC

GMHC | Gap Commemorates World AIDS Day with Special Edition T-shirt Benefitting GMHC.

Media Contacts:
Krishna Stone | 212.367.1016

New York, NY—Starting on Tuesday, November 27, Gap will present a special edition t-shirt in honor of World AIDS Day.  For every shirt sold online at, $12.00 will be donated to GMHC, the oldest AIDS service organization in the country.

“New York City continues to be the epicenter of the HIV/AIDS epidemic in the United States with more cases than San Francisco, Los Angeles, Washington, DC and Miami combined,” said Marjorie J. Hill, PhD, Chief Executive Officer of GMHC.  “With a cure still out of reach, education and support are critical to reducing new HIV infections, and providing care for those living with HIV and AIDS. That is why, in GMHC’s 30th year, we are so grateful for the longstanding generosity and leadership of Gap to help raise much-needed funds.”

For 22 years, Gap has been a sponsor of AIDS Walk New York, benefiting GMHC.  Since 1986, AIDS Walk New York has raised more than $128 million for HIV programs and services in the tri-state area, and has grown into the largest AIDS fundraising event in the world.

Shoppers can purchase the World AIDS Day t-shirt priced at $29.95 at


About GMHC
GMHC is a not-for-profit, volunteer-supported and community-based organization committed to national leadership in the fight against AIDS.  We provide prevention and care services to men, women and families that are living with, or affected by, HIV/AIDS in New York City.  We advocate for scientific, evidence-based public health solutions for hundreds of thousands worldwide. 

Pee Shy

Approximately 7% of the population, or 21 million people suffer from Paruresis, a condition in which a person can not  urinate in the presence of others, either in their own home or in a public facility. For more information go to

Below is a cute video about a serious problem.

<p><a href=”″>Pee Shy</a> from <a href=””>Rubber House</a> on <a href=””>Vimeo</a&gt;.</p>

Nocturnal Tumescence

Morning Wood,” has always been a source of jokes, but medically, it is very telling if a man has morning erections or not. Loss of morning erections could be a sign of aging or low testosterone, which often accompanies aging but also premature aging.

Whenever a man comes into my office complaining of erectile dysfunction, the first thing I ask is, “Do you get morning erections?”

That’s because loss of morning erections usually indicates a physiological versus a psychological cause. However, loss of morning erections doesn’t prove you have a physiological problem. You could be still experiencing normal nocturnal tumescence. So how do you know if you are having normal periodic erections while you sleep? Well, there is something called the tape test.

During my urological rotation, I remember one urologist instructing a patient to place tape on the shaft of his penis before going to bed. If the tape was broken when he woke up that would indicate he had normal nocturnal tumescence. The tape test also works by using a stamp.

So you see, “Morning Wood” isn’t just some cosmic punch line. It actually means something.

Robotic Prostatectomy for Prostate Cancer


Scott Tully, MD, of Urology Centers of Alabama, describes the surgical process for robotic prostatectomy. He explains the various phases before and after the procedure, and how this new technology is more advantageous than the prior 2-D flat screen approach. This advancement in visualization allows his team to perform more accurate and precise procedures.

Prostate cancer, a malignancy that develops in the prostate gland, is often treated successfully in its early stages with surgery. Surgeons who treat prostate cancer have two goals: eradicating the patient’s cancer while safeguarding the nerves that control urinary and sexual function. Surgeons with the most extensive experience performing robotic prostatectomy are more likely to achieve these goals.

Robotic prostatectomy, also know as robot-assisted laparoscopic prostatectomy, is the most advanced treatment option for patients who are candidates for surgery. Operating through five or six tiny holes in the abdomen, surgeons remove the cancerous tissue while preserving the vital nerves and arteries that control bladder and sexual function. This nerve sparing prostatectomy approach helps men retain their urinary control and sexual function.

In the past year I had three patients undergo this procedure with great results.

Meningococcal Meningitis

CASES: There have been 13 cases of Neisseria meningitidis reported in MSM in New
York City since 2010; eight of these cases were in 2012. All cases were men between
21 and 59 years old. Eight cases are HIV-infected. Four patients have died, 3 were HIVinfected.
This is neither a gay – specific disease, nor it is a sexually transmitted disease.
BACKGROUND: A bacteria called Neisseria meningitidis, also known as
meningococcus can cause a range of diseases, and the illness most people are familiar
with is meningococcal meningitis, often called just “meningitis”. This usually means the
lining of the brain and spinal cord have become infected with these bacteria. But these
bacteria can also cause other severe illnesses, like bloodstream infections.
TRANSMISSION: Meningococci are carried only by humans in the nasopharynx—their
only reservoir. Overall 5%-10% of the population carries the bacteria. Meningococcus
bacteria are spread through the exchange of respiratory and throat secretions like spit
(e.g., living in close quarters, kissing). Transmission occurs when close, face-to-face
contact permits the exchange of salivary secretions from people who are ill or are
carriers. Fortunately, these bacteria are not as contagious as what causes the common
cold or the flu. Also, the bacteria are not spread by casual contact or by simply
breathing the air where a person with meningococcal disease has been.
CLINICAL: Symptoms are usually sudden onset of fever, headache, and stiff neck. It
can start with symptoms similar to influenza (flu), and will often also cause nausea,
vomiting, increased sensitivity to light, rash, and confusion. Quick medical attention is
extremely important if meningococcal disease is suspected.
VACCINE: Meningococcal vaccines protect against most types of meningococcal
disease, although they do not prevent all cases. There are two kinds of vaccines that
protect against Neisseria meningitidis available in the United States: (1) meningococcal
polysaccharide vaccine (Menomune®) which is recommended for individuals aged over
55 years, and (2) meningococcal conjugate vaccine (Menactra® and Menveo®) for
persons 9 months–55 years of age.
RECOMMENDATIONS by NYC – DOH (10/4/2012): Meningococcal vaccine should
be administered to HIV-infected men who are NYC residents and who had
intimate contact with a man met either through an online website, digital
application, or at a bar or party since September 1, 2012. HIV-infected patients
should receive two doses; the second dose should ideally be administered eight weeks
after the first dose but no less than six weeks.
These vaccines are available to our patients at 155 West 19th
Street, 4th Floor, NY, NY. Call 212/929.2629

National Gay Men’s HIV/AIDS Awareness Day

Gay Men’s Health Crisis commemorates National Gay Men’s

HIV/AIDS Awareness Day;

Launches New HIV Testing Campaign, “Address the Stress Around the Test”

New York, NY–National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD) on Thursday, September 27, helps to raise attention to the critical issues faced by gay and bisexual men, and other men who have sex with men (MSM), who are living with and at risk of HIV.

Last year, the Centers for Disease Control and Prevention released its estimates of HIV incidence in the United States for the years 2006-2009. MSM represent approximately 2% of the US population, but accounted for 61% of new HIV infections in 2009. Blacks/African American MSM represent approximately 14% of the US population, but accounted for 44% of new HIV infections in 2009. Hispanics/Latinos represent 16% of the US population, but accounted for 20% in 2009.

These estimates also markedly showed there was an estimated 21% increase in HIV incidence for people aged 13-29 years, driven by a 34% increase in young MSM–the only group to experience a significant increase in incidence in this age range. Among MSM aged 13-29, HIV incidence among black/African American MSM increased significantly (48%) from 2006 through 2009 with a 12.2% estimated annual percentage increase.

“Gay men, especially those who are young and black, continue to face a serious uphill battle in the fight against HIV/AIDS,” said Marjorie J. Hill PhD, Chief Executive Officer of GMHC.  “We must develop more targeted and empowering HIV prevention messages, tailored to these populations.”

GMHC recently launched a public service campaign, “Address the Stress around the Test,” noting that staff members in the David Geffen Center for HIV Testing and Health Education offer stigma-free counseling about feelings such as fear, anxiety and shame that may be connected to taking the HIV test, and are sensitive to the particular issues about sex, relationships and health related to gay men (as well as heterosexual women).

Also for NGMHAAD, GMHC partnered with Amida Care to update our HIV prevention campaign “Kiss & Tell” initially targeting young black and Latino gay men, but now reaching older black and Latino gay men.

“At GMHC, we work with our clients and program participants to create social marketing campaigns that highlight our target populations with visual messages emphasizing they are important and they matter,” added Hill.


Veria TV

I am so excited to be working with Veria TV on a series called House Calls with Dr. Frank. I will be taping ten episodes to air on Veria TV throughout the year along with ten accompanying segments for the web. Topics will include the following just to name a few:

1. Sleep

2. Depression

3. Migraines

4. Healthy Heart

5. Healing Power of Good Sex

I’ll keep you all posted with a full report after we shoot these interstistials on Thursday along with some photos.

Women and heart disease

We all know that Rosie O’Donnell is one tough cookie but last week we almost lost the Queen of Nice. In her own blog, O’Donnell wrote that she developed chest pain but didn’t call 911. The next day she went to a cardiologist who confirmed that she had an acute coronary event and was immediately sent to the hospital where a stent was placed in her left anterior descending (LAD) coronary artery because it was 99% blocked.

O’Donnell went on to write that “50% of women who have heart attacks never call 911 and 200,000 women die of heart attacks each year in the United States. By some miracle I was not one of them.” Blockage of the LAD is referred to as the “widow maker” because near complete occlusion of this artery may result in sudden death.

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. A hard substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of plaque buildup. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and that area of the heart dies.

A heart attack is a medical emergency. If you experience chest pain, call 911 right away. Do not drive yourself to the hospital and do not wait it out like Rosie O’Donnell because your greatest risk of sudden death is in the early hours of a heart attack. Chest pain is the most common symptoms. Pain commonly radiates down your left jaw, shoulder or arm. Other symptoms include sweating, shortness of breath and symptoms suggestive of indigestion.

Risk factors for heart attacks include:

–          Men older than 45 years old and women older than 55.

–          Smoking increases the risk of clot formation and heart attacks.

–          Having diabetes, high blood pressure and high cholesterol increase your chances of having a heart attack.

–          Having a first degree relative who suffered from a heart attack.

–          Other than smoking, two important modifiable risk factors to prevent you from having a heart attack are an inactive lifestyle and obesity. People who get regular aerobic exercise and maintain their weight decrease their risk of heart attacks.

1 in 4 women dies from heart disease. Coronary heart disease is the #1 killer of both men and women in the United States.

Headaches and Migraines

Headaches and Migraines Headaches are either primary like migraines or tension headaches. Secondary headaches are due to underlying conditions like meningitis and temporal arteritis More than 90% of primary headaches are migraines. 18% of migraine sufferers are women and 6% in men. Migraines are recurrent headaches that last 4 to 72 hours.

Symptoms include one-sided, pulsating with associated nausea, vomiting and light sensitivity. 1/3 of migraine sufferers have an aura which consists of a flash of light or some visual symptoms before the migraine begins. A migraine is an abnormal electrical activity of the brain that causes levels of serotonin to rise and then drop suddenly making blood vessels swollen and inflamed. Though most migraines are genetically inherited the triggers are either dietary or environmental.

Triggers of Migraines:

Alcohol especially beer and red wine

Erratic sleep or meal patterns

Artificial sweeteners that contain aspartame

MSG Foods with tyramine like aged chedder or phenylethylamine like chocolate

Cigarette smoke



High altitude

How to avoid migraines?

1. Maintain regular sleep schedules- don’t sleep in on weekends. Boo!

2. Drink plenty of water when you travel and avoid alcohol during the flight

3. Regular exercise and enjoy other stress relieving time (listen to music, play with your dog)

Dr. Frank’s Tips to treat migraines

1. Lay down in a dark room

2. The herb feverfew available at health food stores

3. Magnesium and fish oils

4. Acupressure – press the web between your index finger and thumb on the same side of your headache for five minutes.

Kristen Stewart take off your scarlet letter

If I listen closely, I can still hear my seventh grade teacher Sister Dorothy telling my class the story of how a group of men were about to punish a woman who committed adultery. Jesus intervened by saying, he who is without sin may cast the first stone.

Several hundred years later, it appears we haven’t come very far when it comes to our views of “sinful” women. When a woman commits an act of indiscretion, particularly adultery, she is treated as the devil herself, and it is the public’s duty to reprimand her so severely that her punishment serves as an example for other women who might be contemplating the same act.

Growing up with two older sisters in an Italian-American family, I saw firsthand how women were treated differently than men. When my older sister divorced her husband to be with another man, my grandfather refused to speak to her. That Christmas he presented her with a gift. Wrapped inside a box, was a red ceramic bull smashed into pieces – a dramatic gesture and fittingly Italian. I watched as her eyes welled up with tears because my grandfather’s gift served as a cruel reminder that adulterous women were not to be tolerated or forgiven.

But what is it about cheating women that propels the public to react so swiftly and harshly?

It’s called misogyny.

For centuries men have cheated on women. Most recently, former Governor of California Arnold Schwarzenegger not only carried on an affair with a household staff member, he secretly fathered her son and only admitted to it after his wife Maria Shriver discovered the truth. Schwarzenegger didn’t make a tearful public apology, and he didn’t stop making movies. In 2005, heartthrob Jude Law made a public apology to his then fiancée, actress Sienna Miller once his infidelity with former nanny Daisy Wright was publicized in a tell-all interview she gave to Britian’s Sunday Mirror. In 2003, his former wife Sadie Frost split from Law due to reports of his infidelity. That didn’t stop him from having a successful career either. Why even former President Bill Clinton committed adultery with White House intern Monica Lewinsky. News broke in January 1998, but President Clinton publicly denied the affair while his wife Hilary Clinton stood by his side. It wasn’t until Lewinsky turned over DNA proof that the truth finally came out. Clinton was impeached but then later acquitted.

Unfortunately, the same is not true for women. Actress Kristen Stewart had an affair with director Rupert Sanders during the filming of Snow White and the Huntsmen. Stewart admitted to her “crime.” She even made a public apology (not that I think she needed to). Now I can’t go online or look at a magazine cover without seeing a picture of her appearing forlorn and depraved.

You are no man’s Hester Prynne, Kristen Stewart. You do not live in a 17th Century Puritanical world. Write your own ending to this story. Don’t drop out of film commitments or press junkets. Don’t let public scrutiny dictate how you feel about yourself. You did a bad thing. You apologized. Now move on.

The media is turning Kristen Stewart’s lapse of judgment into a cautionary tale for other little girls. Ms. Stewart is reportedly the highest paid female actress in Hollywood after playing Bella Swan, the title character from a very popular young adult book series, which were made into the highly successful Twilight Saga films. Demonizing her behavior only perpetuates the Scarlet Letter legacy. But Kristen Stewart is not Hester Prynne or Bella Swan. She is an actress and more importantly, a person. Whatever act of betrayal she committed is between her and Robert Pattison to resolve. It’s not for us to judge her, unless of course you are without sin.

Curing HIV with Nature

Bringing HIV Out Of Hiding

Drug Discovery: Bryostatin analogs fight dormant HIV, may be key to HIV/AIDS cure

The synthesis of analogs of a bryostatin natural product could advance the eradication of AIDS by ferreting HIV out of its hiding places in immune cells.

Highly active antiretroviral therapy (HAART), the current standard for HIV drug treatment, fights the virus by attacking it in multiple ways simultaneously. But HAART drugs are toxic and attack only the active virus. People infected with HIV must take the drugs for life because of HIV’s latency—its tendency to adopt a dormant provirus form in immune cells, from which the virus emerges over time to reestablish active infection. If HIV latency could be eliminated, HAART could actually cure patients.

Certain natural products can bring the provirus out of dormancy. Obtained from the bark of a Samoan tree, the natural product prostratin is being considered for clinical testing even though its potency in activating latent HIV is low.

The natural product bryostatin 1 has similar activity and about 1,000 times the potency of prostratin. Coming from an aquatic invertebrate, it is difficult to obtain and hence expensive. Bryostatin 1 also causes side effects such as muscle pain.

Now, Jerome A. Zack, codirector of the UCLA AIDS Institute; Paul A. Wender, a synthetic organic chemist at Stanford University; and coworkers report the synthesis of promising analogs. In vitro tests show that the analogs, dubbed “bryologs, ” are at least as potent as bryostatin 1 in activating dormant HIV (Nat. Chem., DOI: 10.1038/nchem.1395). They are also readily accessible by synthesis, easily modifiable, and seemingly nontoxic. Studies of the bryologs in an animal model are in progress.

The work is “a significant accomplishment, since prostratin is too impotent,” says Douglas D. Richman, director of the UC San Diego Center for AIDS Research. The bryologs are “a promising class of drugs for activating the latent HIV reservoir, but animal and clinical confirmation of the agents’ activity is still needed,” he says.

“The new bryologs are an important discovery, and I am intrigued with their improved potency,” says Warner C. Greene, director of the Gladstone Institute of Virology & Immunology at UC San Francisco. “They could well become part of a cocktail of drugs. Of course, two important issues are whether they will synergize with other agents and have acceptable toxicity profiles.”

“The tour de force complex synthesis of bryologs is a brilliant realization of the goals of function-oriented synthesis,” says synthetic chemist Erick M. Carreira of the Swiss Federal Institute of Technology, Zurich. “This strategy brings the viral terrorists out of hiding, where they can be targeted for destruction. The combination of the new bryologs with other current antiretroviral therapies is highly promising and offers new hope for treatment.”

Nutritional Assessment

Every physical exam should include a nutritional assessment. Currently, over 58 million Americans are clinically obese. A sedentary lifestyle and a poor diet contribute to obesity. I often wish I had a dollar for every time I heard someone tell me that the reason they are fat is because they have a thyroid or “glandular” problem. For the majority of people this is a falsity. Eating poorly and not exercising makes you fat. True, there is some validity that obesity has a genetic component, but there are things you can do to achieve a healthier body.
A nutritional assessment consists of the patient’s height, weight, and blood chemistries. For most people, stepping on a scale is torture. However, for those who struggle with weight, it is important to know that monitoring trends is more valuable than any one particular measure.
Ideal body weight for a man is estimated as 106 pounds for the first five feet and then six pounds for every inch over that. For example, a 5- foot, 7- inch man should weigh approximately 148 pounds. However, there is a range of roughly 20 percent above and below this number, depending on bone structure and muscularity, that would still be considered normal. A very muscular male will weigh more because muscles carry more mass then fat. In order to assess if an individual is obese or underweight, it is better to use the body mass index, or BMI, which measures weight in kilograms divided by height in meters squared: BMI=kg/m2. These measurements may be reserved for extreme cases, especially HIV- positive men who also need input from a nutritionist. In HIV-positive patients BMIs have become a very useful tool because in advanced cases, patients lose lean muscle mass, and as a result standard weights are not completely accurate to assess for wasting.
Furthermore, bioelectrical impedance analysis (BIA) is another simple technique used to determine body composition. Four electrodes are attached to the patient’s wrist and ankle on the same side of the body while a painless alternating current is passed through him. From the BIA, it is possible to estimate body cell mass, fat-free mass, and other useful parameters.
In assessing nutritional status, a conversation about a patient’s diet and exercise regimen should be established. A major concern for most men over forty is getting their bodies back into shape. Relevant lifestyle modifications can be discussed, but it is essential that in order to achieve a better body that you understand the basics.
No discussion about your physical well-being can begin without asking a patient what it is about their body they are not happy with. For the majority it means either losing weight or gaining muscle mass. In order to do this, you need to establish realistic goals. Losing ten pounds in one week is neither realistic nor healthy. Most become frustrated at the thought of changing their bodies. Many people are scarred by memories of extreme diets and torturous exercise plans. The important thing to remember before you begin any program is that this is not supposed to be a painful journey. Changing your body requires learning healthier habits. Lifestyle modification has to be your mantra. You are embarking on a new way of life, not a crash course in body shaping.

Boy Scouts’ Gay Ban Breeds Intolerance

Published in the Huffington Post

After 102 years the Boy Scouts of America (BSA) is reconsidering its policy banning gay scouts and scout leaders from the organization. Deron Smith, a spokesman for the BSA, said, “While we’ll carefully consider this resolution, there are no plans to change this policy. We do not believe that the issue of same-sex attraction should be discussed in our youth program. That right belongs to families.” Smith added, “We are not making a social commentary.”

The BSA’s recent decision came after a group of Eagle Scouts banded together to form Scouts for Equality, a group whose mission is to challenge this century-old policy. The group’s co-founder is Zach Wahls, an Eagle Scout from Iowa with lesbian parents. He delivered a petition with 275,000 signatures that called for an end to the anti-gay policy and for the reinstatement of Jennifer Tyrrell as a den mother after she was ousted in April 2012 because she is gay.

“The BSA needs to get with the times,” said Herndon Graddick, President of GLAAD. “It’s time for the Boy Scouts of America to stop teaching discrimination and join organizations like the 4H Club, Boys and Girls Club, and the Girl Scouts of the USA in accepting all Americans.”

The unjust nature of the BSA’s stance goes back as far as 1998, when it announced that it would fire any trooper leader who came out as gay. The BSA claims its purpose is to protect young boys from any pederasts who may be drawn to them. In 2000 the Supreme Court ruled in a narrow decision (5 to 4) that the BSA had a right to exclude gay leaders because opposing homosexuality is part of the group’s “expressive message.” Then, in 2002, Manhattan District Attorney Robert Morgenthau indicted 42-year-old Jerrold Schwartz, a now ex-scoutmaster, for repeatedly sodomizing a young teenager in his group over a three-year period during the mid-’90s.

The real issue is that like other male-dominated organizations, including the Catholic Church and, most recently, Penn State, the BSA has a notorious reputation for harboring child molesters. In his book Scout’s Honor, author Patrick Boyle chronicles the history of sexual abuse within the BSA by child molesters who became scoutmasters to gain access to boys. Although the BSA hasn’t officially acknowledged this problem, in the current Boy Scout Manual there is a section warning scouts about sexual predators. But the BSA still maintains “confidential files” containing information regarding pedophiles within their organization and refuses to release their identities to the authorities.

From the ages of 11 to 13, I was molested by my scoutmaster, William Fox, who also happened to be a police officer. When I told my parents, they confronted the leadership of Troop 85 and were convinced by the assistant scoutmasters not to press charges. In exchange, my scoutmaster was made to step down. In 1983 he went on to adopt a suicidal teen and wrote a memoir, The Cop and the Kid. In 2008 I accidentally discovered this book and learned that over the past 25 years, he adopted a total of 15 boys, most of whom are mentally challenged.

As a young gay boy in 1978, I was teased by the other scouts, and during a ritual called “The Order of the Flies,” I was branded “Fairy Fly” and made to grovel on my hands and knees through the forest after dark while senior scouts taunted and flashed lights in my eyes. If the BSA had openly accepted gays in their organization, I might have been protected from these homophobic bullies. Certainly, the BSA was no different from my Catholic school or sports teams, where anyone who seemed different was branded “gay,” and any adult who was suspected of being gay was a “pedophile.”

It is time for the BSA to adopt a contemporary view of gay people. Gay people love members of the same sex. To equate them with child molesters is scientifically and culturally inaccurate. For the BSA to refuse to take a stand against anti-gay bullying of scouts and instead insinuate that banning gay people from serving as leaders will protect boys from being molested is ridiculous. The BSA needs to focus on keeping children safe and growing tomorrow’s leaders, not teaching discrimination by denying a mom the same opportunities to tie knots, earn merit badges, and participate in her son’s life. That’s what scouting is about.

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In Support of the Annual Physical Exam


Published in the Huffinton Post

Why the hell did I go to medical school?

That’s the question I asked myself after reading the New York Times this weekend. On the front page of the Sunday Review there was an article entitled, Let’s (Not) Get Physicals in which Elisabeth Rosenthal listed the pointless and dangerous reasons why a routine physical exam – and many of the screening tests that routinely accompany them – are useless.

I spent most of my twenties in medical school and then in residency. I took a class called Physical Diagnosis and spent the last two years of school working in a hospital and a clinic. Prior to graduation, I had to perform a full physical exam on an actual patient in front of my medical professor in order to graduate. Like me, medical students around the country are brainwashed every year into thinking that preventative healthcare and annual physical exams will not only uncover some hidden illness but potentially save and prolong the lives of our patients. As a board certified internist, I have been performing routine annual physical exams nearly every day of the week for the past eleven years. Then in one full swoop Elisabeth Rosenthal, a medical doctor and environmental reporter for the New York Times crushed everything I believed to be true with her two page article.

But in all honesty this was not the first time I had heard this.

For many doctors, the physical exam is a perfunctory exercise we perform on our patients because that’s what we were taught to do. Rarely, have I discovered something critically wrong with one of my patients during a well visit. Yes, I did find a melanoma the size of a grapefruit on one young man, and I did detect blood in another gentleman’s urine, which led me to discover he had a kidney tumor. Just this year I diagnosed two men with invasive prostate cancer during their routine physical where I drew blood to measure their prostate specific antigen (PSA). Both men went on to have radiation therapy and are now cancer free. They were fortunate. Then, just just last month the Preventative Service Task Force stated that they no longer recommend screening men over fifty years old with PSA’s. As a doctor I’m suppose to strongly discourage my male patients when they ask for a PSA to be included in their annual labs. Just like I’m not suppose to perform an EKG, routine blood tests, annual cholesterol, annual Pap smears on my females and pre-operative chest x-rays (can’t wait to fight with surgeons about that one).

So is that all the annual physical comes down to? A dog and pony show of palpation and auscultation, superfluous blood tests and unnecessary recommendations to specialists my patients shouldn’t see?

I don’t think so.

Annual physical exams are also reminders to discuss diet and exercise. Routine weights and measurements allow us to track trends to monitor for obesity, a huge problem in America.  I also use the annual physical exam to discuss smoking, alcohol consumption and recreational drug use. The annual physical exam is an opportunity to initiate a conversation about sexual practices and depression. Doctors couldn’t possibly be expected to cover all this in a fifteen minute visit.  

Of course I understand the U.S. spends nearly twice as much per person as other developed countries on health care. Unneeded blood tests during a physical exam alone cost $325 billion a year. Perhaps that’s why managed care limits which prescription medications doctors can order. Most insurance companies will only allow doctors to pick from their list of medications that appear on their formularies. And all because doctors spend too much money, choosing the latest designer drugs and ordering the coolest and newest tests. But is that completely true? What other country allows direct to consumer marketing? I can’t watch CSI or Grey’s Anatomy without being inundated with commercials for prescription drugs. How could any patient resist taking a pill to kill that horrible gastroesophageal cartoon character that’s causing peptic ulcers or feel sympathy for that poor little Pristiq wind-up doll that just can’t make it through her day because of depression? Walking to work I see billboards and posters on train stations and bus stops urging people to, Ask Their Doctor about…

Now I don’t disagree completely with the article in the New York Times. When patients come in with back pain or knee pain and demand an MRI, I try my best to discourage them, saying it’s not a first line test. I also know that I run the risk of losing that patient, like many others, when I don’t give them what they want. Not so shocking when you really think about it. Just as the article suggested that surgeons are inclined to operate and radiologists inclined to order scans, patients will also find a new doctor if they don’t get their prescription for Xanax or that MRI. Yes, that’s right; patients will leave a physician who does not accommodate their needs.

But more than anything, shouldn’t we be focusing on preventative healthcare instead of discouraging patients to see their doctor annually?  Aside from the unnecessary blood tests, overly prescribed medications and needless radiological scans, what’s so wrong with fostering this basic human interaction?

But I’m an old school physician, one that harkens back to the days of Marcus Welby. I like the concept of a small town doctor who knows everyone in the community by name and has their medical history memorized and not stored away in their iPad. Then again, it’s not 1950 and I don’t practice medicine in Port Charles or some other mythical town.

Then in the same issue of the New York Times there was another article entitled, Salt, We Misjudged You. Sitting there at the breakfast table drinking my protein shake and coffee with soy milk, I thought, “My things are changing.”

What’s next?

If there’s no need to touch a patient then perhaps I could just stay at home  in my apartment and see patients virtually through Skype on my iPad?

Maybe that’s where this is all headed.

‘None of us knew that Bob was depressed’

Tim Teeman
Published at 12:01AM, May 14 2012 in the Time of London

He wrote a book on gay middle-age happiness, then he killed himself. The tragic life of Bob Bergeron

Four months after his death, Bob Bergeron’s suicide note remains stubbornly haunting. Bergeron, a handsome 49-year-old New York psychotherapist, killed himself some time around New Year: on Saturday a gathering in his honour was held at an East Village hotel.

His friends and clients remain baffled by his death. Bergeron was living some people’s idea of a dream gay life: sexy, outwardly optimistic, an apartment in the gay-popular neighbourhood of Chelsea and about to publish a book, The Right Side of Forty: The Complete Guide to Happiness for Gay Men at Midlife and Beyond.

If ever there was a poster boy for the book, it appeared to be its author. However, a New York Times article in March revealed that Bergeron felt he had “peaked” at 35, and described his worries over ageing, loneliness and whether his book would bring fame. Scott Boute, a former partner, found Bergeron dead in his apartment on January 5, a plastic bag over his head.

On Bergeron’s counter was a piece of paper with an arrow pointing to the title page of his book. On the paper was a note beginning: “This is what my strategy for a great future was based on and it was built on false information.” His death was ruled as suicide due to asphyxiation.

A 57-year-old friend told me: “If he couldn’t get it right, what hope is there for the rest of us?” Bergeron’s death has led many gay men to ask how they can age healthily and sanely, especially when a strand of gay culture loudly valorises youth, and maintaining one’s sexiness, above all else.

James Sackheim, a former partner, chatted with Bergeron by phone on January 1 for two hours; Bergeron didn’t seem unhappy. They talked about Sackheim, 50, being in a gay club. Sackheim recalls that they discussed “how hard it was. In my twenties I was a shirtless bartender. I’ve aged well, I’m told, but it’s hard. These kinds of conversations formed the catalyst for Bob’s book.” Sackheim doesn’t relish ageing and talks of once planning to kill himself at 65 (“I thought I didn’t need to be 85”), although Bergeron’s death has made him think that suicide “is a selfish act. It’s devastating. I’m not sure I could now.”

Sackheim has Bergeron’s journals and his computer: “Maybe there are more answers there, but I can’t face looking yet.” The alarm around Bergeron’s death, Sackheim says, is misplaced. “Everyone has taken Bob’s issues with ageing as symbolic of all gay men,” he says. “But maybe it’s just symbolic of a person like Bob, whose looks are so important it’s devastating to think you’re losing them. Bob’s suicide should inspire people to age as well as they can.”

Stanley Siegel, an author, therapist and Bergeron’s mentor, says: “None of us knew Bob was depressed. He seemed to be ageing extremely gracefully.” With his clients, Bergeron “was practical, directive. He didn’t go deep. Bob lived in a positive space. He seems to have been floating out there cheerfully, but with no anchor when the darkness came.” The speeches by friends on Saturday focused on Bergeron’s (nickname “Fluffy”) reputation as a party boy.

Bergeron’s blog is relentlessly upbeat, especially around feeling sexually attractive when older. The last entry, dated December 15, reads: “In 2012 I want to: take better care of myself; spend more time out of the house interacting and having fun; find happiness with getting older and stop lying about my age.” Another entry majors on how to remain a “sex object”. Siegel recalls that when they met a decade ago Bergeron “had a pretty face and long bleached hair. One day the hair was gone. He still wanted to be sexually attractive but in the leather community as a ‘dominant top’. I admire sexual exploration, but for Bob sex was a way to experience power.” Siegel believes that Bergeron committed suicide after a drugs binge, “going to a dark place and not able to find his way out of it”.

Dr Frank Spinelli, a Chelsea physician who referred patients to Bergeron, says: “This has made many people ask: ‘At what age do you accept the ageing process?’ A lot of gay men fall prey to the stay-young, look-good thing with fad diets, Botox, the latest haircuts, steroids. But I would never have imagined Bob was wrestling with those demons as hard as he was.”

Bergeron’s clients, Siegel says, initially felt “shocked, saddened, abandoned, betrayed and angry”, and are bridging the disconnect between the man who counselled them and the man who couldn’t seek help, or help himself. Bergeron had broken up with Boute in 2009, although it “was never like: ‘I can’t take it.’ ” Spinelli says. “But breaking with a boyfriend in your mid-forties is different to in your twenties. Writing the book was tough. He struggled to find the right medium between the clinical and personal.”

Don Weise, Bergeron’s publisher, said Bergeron was “always upbeat”. He had taken gruelling edits in his stride and was looking forward to publicising the book. “I wish he could have said how he was feeling,” Weise says. “I’ve told all my writers if they ever feel like that to tell me or reach out to someone.” Weise cancelled publication after Bergeron’s suicide, although he has received e-mails from gay men asking him to publish the book and offers from writers to compose an introduction: “But I can’t. It wouldn’t be right.”

What pain was Bergeron concealing, Spinelli wonders, “and who better, given our experiences of being closeted when young, at concealment than gay men?” Ageing is tough, “especially in big cities where there is such an emphasis on appearance,” Spinelli says. “I have a patient in his early thirties who wants to get his eyes done. We’re all, gay and straight, consumed by anti-ageing. We’ve been sold this idea that 60 is the new 40. It’s a lie, and gay men are especially hard on each other. My friends and I have a phrase, TOFA: ‘Too Old For Abercrombie’. There’s a certain age when wearing tight T-shirts is not appropriate. We live in an ageist society, but need to accept the ageing process without going crazy.”

Christopher Murray, a therapist who knew Bergeron and wrote an eloquent appreciation of him in the newspaper, Gay City News, says there can be a “chasm between a gay man’s real persona and ‘stage’ persona which can cause a dislocation of the self”. For Murray, the homophobia and bullying suffered by many young gays (and the self-hatred that comes with it) is often a dark ghost beneath the surface of the most apparently gilded life. He says: “I’ve had good-looking clients who say people don’t believe they can have problems because of their looks.”

Bergeron’s death shouldn’t obscure that many gay men are growing old happily, Siegel says: “I’m 65 and my life has gotten better as I have gotten older. I’m single, having great sex, a lot of it with younger guys, but I’m open to sex with men my own age and older. So was Bob — in fact, he wasn’t attracted to guys younger than him.” Siegel says that Aids, “decimated a generation of gay men who would have shown today’s younger generation how to age with strength and creativity”.

In February, SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders) opened a drop-in centre for its clients, aged 60 and over, in Chelsea — the first of its kind in the US. Tom Weber, SAGE’s director of community services, says that “again and again” the message in gay venues and magazines, with six-pack models, is: “ ‘You should be in this age-range looking like this.’ When you no longer do, our clients ask themselves: ‘What value do I have? How can I be loved and accepted?’ Older gay people may not be as physically beautiful as they once were but they have a lot to live for.”

Sex can be an issue “when older gay men are attracted to younger if the latter doesn’t reciprocate, which can be the case,” he says. Gay older women and men may be more isolated than straight ones.

Weber knows that there is work to be done, including the promotion of lesbian and gay retirement homes, and in making existing institutions as gay-friendly as possible. SAGE offers meals, outings and talks, and a sizeable proportion of its volunteers who visit members at home are young, although Weber has seen young gays “veer around” SAGE’s stall at events “as if they can catch ageing. I’d say to younger gay people that those who came before you know a lot and fought battles so you could have bars and gay marriage. Find out more about them. Help them if they need it.”

Chatting together over their evening meals in SAGE’s dining room are Michael Feuerstein, 70 (who recently lost his partner of 21 years), Gregory Terry, 65, and Guy Laurence — who whispers his age into my ear. Gay culture is not welcoming to older men, they say: bars are for the young and are too expensive. Laurence smiles that “in the past young people and old people mixed more: the interaction is less now”.

Sex? “If it happens, wonderful,” Terry says.

“But companionship and friendships are more important,” Feuerstein says.

Four years ago, Dom Tolipani, 64, lost his partner of 42 years: “It is a youth culture out there,” he notes, but he would like to meet someone if he can “let” himself.

Patricia DeGaetani, 43, and her wife Louise Avanzato, 71, met 19 years ago and married in New York this year. The accumulation of shared experiences conquered their age difference, DeGaetani says. “We’re still on our honeymoon,” beams Avanzato.

In his final blog entry Bergeron wrote: “I’ve got a concise picture of what being over-40 is about and it’s a great perspective filled with happiness, feeling sexy, possessing comfort relating to other men and taking good care of ourselves.” Perhaps his best legacy is that gay men believe in those words more than Bergeron seemed to.

His memorial on Saturday, appositely, was partly organised by SAGE.

Physician compensation

Few Doctors Consider Themselves Rich, Survey Says By Sarah Barr April 25th, 2012, Source: Medscape Physician Compensation Report Few doctors think of themselves as rich, and only about half think they’re fairly compensated, according to survey results released this week by Medscape. The annual survey isn’t scientific – and perhaps, not surprising, either — but it offers insights into what nearly 25,000 physicians earn, and how they view that number. In 2011, compensation self-reported by surveyed physicians ranged from an average of $156,000 for pediatricians to $315,000 for radiologists and orthopedic surgeons. The survey showed that 51 percent of all physicians — and 46 percent of primary care physicians – think they’re compensated fairly. Only about 11 percent of doctors consider themselves rich, mostly because of their debts and expenses, according to Medscape. The survey also offers a glimpse at how physicians view coming changes to the health care system, such as efforts to improve quality or offer care through accountable care organizations, which are integrated systems included in the federal health law. More than half said they expect their incomes to decline because of ACOs (although very few were participating in such a system), and only 25 percent said quality measures and treatment guidelines will improve patient care. Overall, 54 percent of physicians said they would choose medicine as a career again. Only 41 percent said they would choose the same specialty and 23 percent would choose the same practice setting. Others groups that survey physicians about their income include the Medical Group Management Association and Merritt Hawkins. A 2011 MGMA report, for instance, which looked at data from 2010, found the median compensation for radiologists was $471,253 and $192,148 for physicians in pediatric/adolescent medicine. Medscape surveyed 24,216 physicians across 25 specialty areas from Feb. 1-17, 2012 using a third-party online survey collection website.

Bareback porn


Early this past March, the L.A. Times wrote about a new city ordinance requiring porn actors to wear condoms during filming.

The Los Angeles City Council approved the ordinance in January, following several high-profile instances of porn performers becoming infected with HIV. The Los Angeles-based AIDS Healthcare Foundation (AHF) has been advocating for the public health measure for years. The ordinance is believed to be the first of its kind. It requires adult film producers, when seeking a filming permit in Los Angeles, to have actors wear condoms. The porn production companies, which are largely based in the San Fernando Valley, opposed the ordinance. The AIDS Healthcare Foundation is now collecting signatures for a countywide initiative, said President Michael Weinstein. “This is definitely a milestone in this long battle for safety in adult films, but we still have a long way to go,” he said.

The initiative, which was organized by the AHF, feels they have won an important victory. The porn industry argued that the consumer will not go for it. What will be the end result remains to be seen. Will studios simply opt to move their production to cities with less stringent laws? Or will they ignore the ordinance? AHF stated they will be performing “spot” checks to ensure studios remain compliant, but as one commentor stated, it would be difficult since many films are not staged in studios but on location. 

After the peak of the AIDS epidemic, condoms starting showing up in porn, but not just gay porn but ALL porn. It seemed the industry recognized the impact of their films and was attempting to promote a healthier attitude toward sex. Over the years, HIV has become a chronic, more manageable disease, and bareback films have seen a rise in popularity, mimicking a climate among men who have sex with men who complain of “condom fatigue”. Although safe sex films are mainstream, barebacking has re-emerged by popular demand. Porn studios in Los Angeles argued that AHF’s initiative goes against their civil liberties, stating that if two consenting adults agree to engage in unsafe sex during a movie shoot then that should be their choice. AHF argues that the mandate protects performers who might opt to take roles in bareback films because the pay is higher. 

Some studios based outside of Los Angeles, like Treasure Island Media, have jumped on the bareback bandwagon and have even taken it a step further, showing multiple partner condomless penetration even with exchange of bodily fluids. Some have raised the question whether an all HIV positive cast should be required to wear condoms. If that’s the case, the question that comes to mind is if the cast is already HIV positive is it necessary to show them using a condom or does serosorting in adult films falls outside the parameters of AHF’s initiative? 

My own opinion is no. AHF’s initiative is set up to protect actors not only from HIV but all STD’s including Hepatitis A, B, C, syphilis, gonorrhea, Chlaymdia, herpes and the Human Papilloma Virus.

But let’s take a step back. Is it the porn industry’s responsibility to promote safe sex when the genre was establish to oppose mainstream films? Isn’t porn the punk rock of music?

During the 1960-1970’s there were crops of films that dealt with adult content that weren’t considered porn but were given an X-Rating. Films like Midnight Cowboy starring John Vioght received an X-Rating for its subject matter. The sex in the movie was more along the lines of a late night movie on Showtime but with a great story and good actors. The film, which came out in 1969, went on to win three Academy Awards including Best Film. But it was 1969, well before the peak of the AIDS epidemic. Condoms weren’t part of our social dialogue. Since then, HIV has emerged as the most deadly sexually transmitted disease of our time with over 600,000 deaths since 1981. Isn’t it time for Hollywood to share the burden of responsibility?

Whether you’d like to admit it, you’ve seen a romantic comedy. You know those films with Jennifer Aniston, Kate Hudson or Katherine Heigel. We all know the story: boy meets girl, girl falls on the ground, boy picks her up, they laugh and then cut to them lying in bed, breathlessly post-orgasmic. Rarely, if ever, does the script call for these actors to suggest condoms were used. 

Remember movies like 9 1/2 Weeks or Body Heat?

They just don’t make movies like that anymore, possibly because these  films relied on fantasy, domination/submission, passion and arguably the rawness that spontaneous, condomless sex exudes. This is exactly what porn producers are referring to when they argue that the public won’t go for it. Hollywood could make the same claim. No one would pay to see Brad Pitt pull out a condom before he banged Helena Bonham Carter in Fight Club. The public just wouldn’t buy it. And yet, by mandating that porn producers use condoms, we’re saying that with regard to certain public health issues, pornographers don’t have the same rights as Hollywood.

Now I’m not condoning condomless porn, particularly since the fastest rising rate of HIV sero-convertors is among men who have sex with men ages 13-29 years old. These young men are probably watching porn. It has been suggested that gay men learn about sex through pornography. 

But what about young females?

My friend Kelly called me one night crying after she was told by her GYN that she had contracted the Human Papilloma Virus and had a highly dysplastic Pap smear. She met a man on eHarmony and had been dating him for several months. Like most girls her age, she thought she was in a monogomous relationship. The truth is she probably was, and like many girls, Kelly decided to go on the pill instead of using condoms. Her boyfriend probably had HPV and didn’t even know it. When I asked her why they didn’t use condoms, she stared at me like I was speaking Mandarin. Many girls like Kelly don’t consider the possibility of contracting an STD when they’re in monogomous relationships. Most girls like Kelly aren’t taught to protect themselves by using condoms and think that if they’re in a monogomous relationship then they’re safe from STD’s. Maybe if Katherine Heigel pulled out a condom out of her purse in one of her movies, Kelly might have thought twice about just using the pill. Come to think of it, the last time I saw  a woman on film pull out a condom out of her purse I was watching Kim Cattrall in Sex and the City. Unfortunately, she’s the slutty one. Kelly underwent a colposcopy followed by a LEEP procedure and now has a normal Pap.


Kelly’s story had me worried about my own niece. She’s thirteen and a huge fan of the Twilight films. I watched the last one and thought, wow, Bella married Edward and got pregnant with a vampire baby that started to feed on her from inside the womb. I wondered what kind of message that was sending to my niece – have sex with the wrong guy and get something that can eat away at your cervix like HPV? 

I doubt that’s what the Twilight author, Stephanie Meyers had in mind. But shouldn’t Edward have known better? I mean he’s like hundreds of years old. And imagine how the story would have ended if Bella had been taught to protect herself by using condoms. She might not of had to become a vampire. Regardless of whether or not Stephanie Meyers was using vampirism as a metaphor, a young girl made a sexual decision that changed the course of the rest of her life.

And she wasn’t even watching porn.

Sleep No More

News of Whitney Houston’s death was shocking. Moreover it was it was sad to think she drowned in a bathtub of all places. The toxicology report listed a variety of substances including, cocaine, a muscle relaxant, Xanax, Benadryl and marijuana, which more than likely contributed to her death. The first question that came to mind when I read the story was why did Houston take a bath after having ingested a sedative, a muscle relaxer, antihistamines and a hallucinogenic? Worse still, there were reports that Houston had been drinking alcohol. Over and over it was reported that she was extremely anxious and was trying to quell her nerves with alcohol and prescription medication. It would seem reasonable to a sober person that taking a bath in this state wouldn’t be a wise decision. Of course, Houston wasn’t sober and her lack of judgment led to this fatal outcome.

In light of Michael Jackson’s recent death related to the administration of propofol, an anesthetic that should only be used for surgical purposes, I wondered if these two celebrities were victims of an even bigger issue related to sleep and anxiety.

According to a new study in the Journal BMJ, people who took sleeping pills were nearly five times more likely to die over a two and a half-year period that those who didn’t.

This left me stunned especially when it occurred to me that I write prescriptions daily for Ambien, Lunesta, Ambien CR and Xanax. The addiction potential for sleeping pills and sedative hypnotics are well-known, and so are the risks. Sleep medications can adversely affect memory and coordination, especially in the elderly. Sleep medication can be addictive and tolerance may develop over time.

But what about the alternative – insomnia?

Loss of sleep is associated with lower levels of growth hormone, increased levels of stress hormones like cortisol, and impaired immune systems. The University of California published a study that showed sleep deprived individuals had significantly reduced white blood cell activity (WBC), which are known to aid the body against infection. This cell line is crucial especially in individuals who have chronic diseases like HIV or diabetes. The drawbacks of sleep deprivation also include an inability to focus, loss of creativity, motivation and poor judgment.

The study of sleep has emerged as a growing field particularly as the number of prescriptions for sedatives and sleeping aids rises. The same can be said for stimulants like those prescribed for Adult Attention Deficit Disorder. Combining them has become popular and as in the case of Whitney Houston, the results can be disastrous.

The Spanish artist, Goya, created a famous etching in the late 1700’s called, The Sleep of Reason Breeds Monsters. Thought to be a commentary about the suppression of reason so that emotions, enlightenment and even demons could arise for the sake of creativity, Goya’s iconic work has often been misunderstood. Sleep for the sake of rest often yields productivity. The argument that using sleep medication to function the next day is understandable yet, we have to acknowledge that in this 24/7 society, keeping up doesn’t necessarily equate with staying awake. We have to learn to shut down and taking sleep medication doesn’t always provide recuperative sleep.

Modifiable factors that could contribute to sleep include avoiding stimulants, particularly coffee later in the day, limiting alcohol consumption and avoiding nicotine. Behaviorists recommend going to bed around the same time each night to establish a pattern. If you do use prescription sleep medication, try to avoid them on days off or weekends. Give you body a rest so that you won’t develop tolerance or resistance.

Sirius XM and GTA Launch Show on AIDS in Gay America

Sirius XM and GTA Launch Show on AIDS in Gay America.

Sirius XM and Greater Than AIDS Launch Show on AIDS in Gay America
The premiere of “SpeakOUT: Real Talk About AIDS in Gay America,” a new radio show encouraging honest and challenging dialogue about HIV/AIDS, airs March 17 from 9-11 AM EST on Sirius XM OutQ.

The SpeakOUT quarterly show is a new partnership between Sirius XM OutQ, the satellite radio company’s gay and lesbian community channel, and Greater Than AIDS. SpeakOUT will encourage gay and bisexual men to voice their opinions on the factors that drive the epidemic in the gay community–like stigma, denial, substance abuse and misinformation.

The first installment focuses on relationships and HIV, tackling such issues as how to ask a partner to get tested and use condoms, and how to disclose your status to a new partner. It will also explore the effects GrindR and other popular social networking sites have on HIV/AIDS among gay men.

Co-hosts Dr. Frank Spinelli, author of The Advocate Guide to Gay Men’s Health and Wellness and Clinical Director of HIV Services at New York City’s Cabrini Medical Center, and Larry Flick, host of OutQ’s The Morning Jolt, both pictured above, will lead the conversation.

Guests include Greater Than AIDS representatives Marteniz Brown and Larry Hammack, both gay men who have personal stories connected to the HIV epidemic, and Dr. Mary Ann Chiasson, a professor at Columbia University’s Mailman School of Public Health who is currently researching the relationship between the Internet and high-risk sexual behavior among gay and bi men.


“This year, over 13 million American kids will be bullied at school, online, on the bus, at home, through their cell phones and on the streets of their towns, making it the most common form of violence young people in this country experience. BULLY is the first feature documentary film to show how we’ve all been affected by bullying, whether we’ve been victims, perpetrators or stood silent witness. The world we inhabit as adults begins on the playground. BULLY opens on the first day of school. For the more than 13 million kids who’ll be bullied this year in the United States, it’s a day filled with more anxiety and foreboding than excitement. As the sun rises and school busses across the country overflow with backpacks, brass instruments and the rambunctious sounds of raging hormones, this is a ride into the unknown. For a lot of kids, the only thing that’s certain is that this year, like every other, bullying will be a big part of whatever meets them at their school’s front doors. Every school in the U.S. is grappling with bullying-each day more than 160,000 kids across the country are absent because they’re afraid of being bullied-but for many districts it’s just one more problem that gets swept under the rug. BULLY is a character-driven film. At its heart are those with the most at stake and whose stories each represent a different facet of this crisis. From the first day of school through the last, BULLY will intimately explore the lives of a few of the many courageous people bullying will touch this year.”

The movie Bully, produced by the Weinstein Group was given an R rating. I hope the ratings board changes their mind.

Positive Youth

Positive Youth is a one hour television documentary which follows four HIV+ positive youths in four different North American cities. Growing up in the 1980s and 90s we were hammered with terrifying statistics of HIV/AIDS. Thirty years in, we are still learning. What education do the youth receive now and why is the youth infection rate still the highest? We have seen retrospective documentaries on the AIDS crisis and interviews with survivors but what about the positive youth of today? We aim to feature accessible and inspirational individuals and the often-rocky road that they’ve traveled to get here. Each of the four subjects have been selected to create a dynamic perspective on the reality of living positive today. Medical and psychological experts will also weigh in to provide up-to-date facts and a historical context to the reality of living positively. In life we are inherently afraid of the unknown: of death. Our film will show this in action by exploring the social stigma these young people must rise above each day. The main conflict will lie with our audience. We intend to have our subjects, and our audience answer difficult questions about their own level of discrimination when it comes to HIV/AIDS. Ultimately we want the audience to feel educated with a new sense of empathy and understanding for positive people. Vancouver, Toronto, Phoenix, New York, Victoria – straight 18-year-old impoverished First Nations woman, gay 25-year-old white urbanite, 23-year-old wealthy jet-setter, straight black 22-year-old young man positive by birth. HIV does not discriminate. For the first time, young positive people open their homes and hearts to us – offering a no holds barred access into their lives.


Way to go Paula

Pour some sugar on me

“Way to go Paula,” is a line from the movie, Officer and a Gentleman. Remember that final scene where Richard Gere picks up Debra Winger and sweeps her off her feet? Her teary-eyed girlfriend, Lynette, shouts out, “Way to go Paula!” as she watches her best friend being carried out of the factory where they work. It’s a bittersweet ending for Lynette seeing her best friend reveling in the happy ending she will likely never experience for herself.

That’s how I felt when I heard Paula Deen was diagnosed with diabetes and is endorsing a new oral medication to treat  her disease. For years, I’ve watched along with the rest of the country as this larger than life Southern woman warmed our hearts and enticed our bellies with recipes that went against everything doctors and nutritionists have been preaching about for years. I remember once watching Paula Deen as she dropped whole sticks of butter into a bowl with the same disregard Joe Pesci’s character in Goodfellas unloaded bullets into mobsters. The cruel twist is that Deen knew she was a diabetic for years and still she relied heavily on fatty foods without once acknowledging her condition was directly related to her obesity and eating habits. This week she admitted to being a diabetic but her announcement came suspiciously once she  signed a lucrative endorsement deal for an oral diabetic medication.

I wonder if Paula Deen and the Food Network will alter her format and use Deen’s diagnosis as a cautionary tale that this can happen to you if you eat like glutton? Improving Deen’s ingredient profile could prove deleterious to the food star who typically doesn’t mince words or cut corners. Her food is rich, high in calories and loaded with fat. I guess you could say she lives life like her hair: big, brassy and dangerous. Will the public watch a streamed down Deen? We shall see.

One out of every 10 American women is living with diabetes, which causes more deaths each year than breast cancer and AIDS combined. Still, most Americans don’t see it as a serious disease, according to a recent survey. Here’s why women should worry…

Are you overweight and hate working out?

Were you diagnosed with gestational diabetes during a past pregnancy?

If you answered yes to either of these questions, you’re at risk for developing diabetes, a chronic, incurable disease that raises the risk of heart disease, kidney failure and more. And women with the disease are also more likely to die younger.

“If you see a 40-year-old woman with chest pain, she’s not likely to have a heart attack,” says Andrew Drexler, M.D., an endocrinologist and director of UCLA’s Gonda Diabetes Center. “But if she’s diabetic, that’s not true.”

The federal government spends billions each year conducting diabetes research, with scientists searching for more efficient ways to manage the disease.
What’s the difference between type 1 and type 2 diabetes?
Type 1 is an autoimmune disease that destroys islet cells [which produce insulin] in the pancreas. Insulin controls [blood sugar levels] in the body.

[With] type 2 diabetes, the insulin is there, but it doesn’t work – not because the insulin isn’t normal but because the body doesn’t respond to it well. The body compensates by producing more insulin.

What causes diabetes?
We really don’t know what causes type 1. There’s no way of avoiding it. There is a genetic component to it, but we don’t fully understand the trigger. That’s why even if we were to catch it early, we couldn’t prevent it.

Type 2 is [largely caused] by eating too much and not being active enough. The data are pretty strong that the problem is the calories – not the type of food.

Which type is more common?
Between 90%-95% of diabetics have type 2.

We’re seeing an increase in both types, but type 2 is being called an epidemic. That appears to be true worldwide. As obesity becomes an epidemic, so does type 2 diabetes. It’s that simple.

Are the symptoms the same for type 1 and 2?
Type 1 develops rather quickly, with dramatic symptoms occurring within a week to a month. Symptoms include frequent urination, weight loss, blurry vision and thirst.

[Symptoms are] the same with type 2, but it develops more slowly.

Can someone be diabetic and not know it?
The feeling used to be that 50% of type 2 cases were undiagnosed. It’s better now, but still grossly undiagnosed. [Being diagnosed with type 2 diabetes] is more likely to happen as you get older.

Actually, something like 25% of people in their 80s have diabetes.

What problems do women have in managing diabetes?
Women are thought to have a harder time with weight than men. Excess weight makes everything worse: It makes it harder for insulin to work. You can’t produce enough insulin for your body’s needs. The more overweight you are, the more you have to produce.

How does pregnancy affect a woman with diabetes?
When a woman’s pregnant, the placenta produces hormones that make women more insulin-resistant. That’s why they develop gestational diabetes and often end up on insulin when pregnant. Nature doesn’t care a lot about you: It cares about you having children. There are a number of hormones made by the placenta – most are designed to be good for the baby and the hell with you.

What role does diet play in preventing or managing diabetes in women?
A restricted diet isn’t the most important part of preventing diabetes; women have to eat the right things. The best diet  includes whole grains, fresh fruits and vegetables, low-fat cheeses and yogurt, and baked or broiled fish and meats.

How does menopause affect diabetes?
Menopause doesn’t have any direct impact on it. But women often find it hard to control their diabetes because menopause is stressful, and with any stress, diabetes is going to get worse. Stress hormones cause a number of actions that can counteract insulin’s effect. For example, stress causes the release of glucose by the liver, which raises blood sugar.

Can you manage diabetes without medication?
Most type 2 patients end up on medication. (The starting medication is metformin.)

Exercise is critical.

Most doctors would say that cardiovascular exercise [is important], but there’s some evidence that increasing muscle [through resistance training] may help as well by increasing the use of glucose. What about insulin?
Patients may want to stay off insulin, but most physicians feel we don’t start insulin soon enough.

At some point, in almost all cases, medications fail, and when they do, the only alternative is insulin.

The goal isn’t staying off insulin; the goal is keeping blood sugars under control.

Death of your therapist

Yesterday I received an angry message left on my voicemail from a patient who was furious that his therapist – someone I recommended – was a no-show at his last appointment. “Some emergency must have come up,” I assured this patient. “There had to be some emergency,” I repeated to myself after I hung up. That’s because it just wasn’t like Bob to miss an appointment, let alone not call to cancel. Then I began receiving other similar irate text messages and emails from other patients all referred to this therapist, who had similar experiences this past week. So I called Bob, but there was no answer. I left a message. Then I decided to check his Facebook page. There I learned the awful truth

Bob had died.

I was shocked.

I met Bob Bergeron nearly ten years ago when I began referring patients to him. He specialized in gay men’s health specifically HIV. I had been sending patients to Bob almost exclusively for a period because we became friends, but more so because patients adored him. It was uncanny how many said the same thing, “I love Bob. He’s so nice. Bob really understands me, and he’s not judgemental.”

Each morning for years, I worked out at David Barton Gym. I often saw Bob there and we chatted, not just about patients, but also about each other. I got to learn more about him, and eventually I began to reveal more about myself to him. He was an amazing listener, something I feel most doctors need to learn how to do.

It was a huge relief and comfort to have Bob in my arsenal of healthcare providers I referred to. He always made himself available to me and fit my patients in even when I’m sure he didn’t have the time. Bob even saw patients on a reduced fee schedule and sometimes even for free. But that was how Bob practiced. He loved taking care of gay men, and he especially loved helping them navigate through their lives when most of them didn’t know which way to turn next.

Last year Bob called to tell me he was working on a book focusing on life after 40. I told him I thought that was a great idea. The proposal was picked up by a publisher, and he’d begun working on it feverishly. Often he called to ask for advise, and I was so excited for him because this book was going to add another dimension to his life both professionally and personally. I only wish he would have seen that dream come to fruition.

If you were a patient of Bob Bergeron please contact Stanley Siegel at 917-991-5077. He is assisting Bob’s patients and can help you deal with the emotional impact of his death. He is also helping Bob’s patients transition their care. I am also available to help assist you. I can be reached at 212-929-2629.

I will always remember Bob as a warm, kind, friendly and compassionate man. My prayers go out to his family.

New Year’s Resolutions

Seriously, who was it that came up with the idea for New Year’s resolutions? I suspect the idea germinated from a marketing meeting after a pitch by some advertising agency as a way to get us to buy stuff we don’t need.  

Generally, the promise to give up smoking and drinking are the most common resolutions followed closely behind are losing weight, becoming more punctual, being honest and more self confident. Surveys suggest the success rate of adherence to resolutions is very low, but for some strange reason each January we make the same commitment year after year.

Who invented New Year’s Resolutions and where did they begin? Well, people have always associated new years with a fresh start. Even in the most ancient traditions, it was a custom to make improvements at such times. During the reign of the Babylonians, people made promises to do better starting March 23, their new year (spring equinox). One common resolution was to give back something one had borrowed in the past year.

InRome, Janus was the god of the New Year. The month of January was named after him. The New Year began on January 1st according to the Julian calendar invented by Caesar in 46 BC. Janus had two faces: one looked back on the past and the other into the future. The Romans worshipped him as a symbol of endings and new beginnings. During the holiday, they would do things that would hopefully kick off their year to a good start. They would make up with people they quarreled with and exchange gifts.

Judaism expects their followers to look back on one’s behavior during the past year. This was supposed to motivate the person to do better the following year.

I gave up on resolutions years ago, but for some reason I can’t help but make myself secret little promises right before the clock strikes twelve. Last year it was read Anna Karenina. P.S. she’s still sitting on my nightstand, but I am on page 325. This year it was exercise more, ban anything Kardashian from my life and learn a foreign language (preferably one the Kardashians’ don’t know). 

I agree with Judaism. We should reflect on the previous twelve months and think how we can improve ourselves in the new year. So if you fall off the resolution bandwagon, don’t be discouraged. Either start over again or wait for 2013.

Cronenberg’s Freudian Slip

For those of you who may not know me, I am a cinemaphile. That means I LOVE movies. Before I went to medical school, I hoped to become a film director. In my twenties, I directed several horror movies I shot on video tape (remember that?). In college I won a Best Actor Award for playing psychotic twin brothers.

I love many genres but psychological thrillers, especially Alfred Hitchcock’s movies, resonate with me on such a deeper level. I still hate all birds because of his film. Whenever I hear the music to Vertigo, I become entranced in a hypnotic state, and I defy you not to straighten out your spine at the slightest hint of a violin screech to the soundtrack of Psycho. It’s impossible. 

Let’s just say if there is a movie about girls in a sanitarium (Girl Interrupted) or crazy girls in a boarding school (Picnic at Hanging Rock, Cracks) then I’m there. 

Yet, only certain directors are able to navigate their way into your subconscious so that when you watch one of their movies you become completely and utterly transfixed, even when you have nothing in common with their characters. 

You can imagine by now how excited I was when David Cronenberg released, A Dangerous Method, a movie that depicts the relationship between the grandfather of modern psychiatry, Sigmund Freud and his contemporary, Carl Jung. The film explores their relationship and its subsequent deterioration as it relates to Jung’s patient, Sabina Spielrein, a hysterical Russian woman, who becomes involved in a sadomasochistic relationship with Jung while under his care. 

It had all the makings of a classic psychological thriller: great director, great cast, great story!

Unfortunately, I found the movie beautifully photographed, very well acted, particularly, Kiera Knightly and Viggo Mortensen, but painfully dull. 

This is Cronenberg  for Freud’s sake! Where were the sadistic director’s touches I grew to love in Dead Ringers with Jeremy Irons, probing female private parts with instruments designed for mutant women? Where were those intricately choreographed sex scenes that aroused me in Crash with Debra Kara Unger and James Spader?

 Has Cronenberg gone soft? 

That night I dreamt I was being attacked by the roots of a tree with veins and tendons branching out from every limb. Just as I was being pulled apart, I awoke and saw Freud himself, sleeping there next to me. He whispered, “Sometimes a tree is just a tree.”

Well, hopefully, next time, Cronenberg will bring his C@CK.

here! TV Debuts Documentary 30 Years From Here


Documentary special shares real-life accounts of the 30-year war against the AIDS pandemic
November 9, 2011 (NEW YORK) – here! TV (, the world’s leading premium gay television network, proudly presents the original documentary 30 Years From Here, featuring real-life accounts from the decades-long war against AIDS. The special premieres November 25, 2011, exclusively on here! TV and here! Online, here! TV’s premium online subscription video player found at
“When here! TV’s General Manager, Eric Feldman, and I began discussing plans to make a documentary looking back at the last the 30 years of the AIDS pandemic, the most difficult part was deciding on what part of this massive epic to tell. 30 Years From Here is just one story among millions. Focusing primarily on the epidemic and how it unfolded in New York City, we follow a timeline that shows where it began, what has been accomplished, and how we arrived here,” says Josh Rosenzweig, here! TV’s Senior Vice President of Original Programming & Development.
30 Years From Here examines the trials and tribulations the AIDS pandemic has created over the past 30 years. The documentary looks at how this nondiscriminatory disease has affected many lives over many years. Hear personal accounts from people who were there in the beginning and have seen both the sorrow over lives lost and the hope generated by advances in medical research. Activists, medical experts, and people who were on the ground describe their stories from the war on AIDS. Interviewees include playwright Terrence McNally; activist and ACT UP found Larry KramerMarjorie Hill, CEO of Gay Men’s Health Crisis; physician Frank Spinelli; director and choreographer Jerry Mitchell; and radio talk show host Larry Flick.
To obtain a screener of 30 Years From Here, please contact Mark Umbach at

Get exclusive here! TV updates on Facebook at and on Twitter at @heretelevision.

My Halloween Top Ten List

I have to say I love Autumn. I’m not made for summer. In fact, I have the opposite of seasonal affective disorder in which individuals become depressed during the winter when there is a limited amount of sunlight. I, like vampires, feel repelled by the sun. Yeah, okay, so I love the beach, but summer weather is for vacations. Living day to day during those hot summer months in Manhattan, walking to and from work, sweating like a pig is not fun. Keep your hot weather, short pants and long days where the sun sets after 8 pm. Give me cool crisp September mornings, orange and yellow leaves scattered on the ground and bowls full of hot creamy soup. I want to wear hats, scarves, and other clothes that conceal my body. Summer to me is nudity with sunscreen. By August I feel like a walking chicken cutlet.

What I love most about the fall is Halloween. Hands down it is my favorite holiday of the year. I always loved dressing up in costumes as a child. Then as a teenager and young adult I created my own characters and make up effects. At an early age I even learned how to use latex thanks to special effects pioneer Tom Savini. NO, he didn’t tutor me personally, but I watched his documentary repeatedly. In my twenties, I made my own horror movies, casting my friends and creating my own gory special effects. Boy, do I miss slitting Janice Anastasio’s throat against my parent’s oak tree or dismembering Karen Lassen with a garage door. We had so much fun back then.

I still dress up for Halloween. This year I’m going as silver Evil Knievel. Chad is going as the gold version.

But more than anything, I grew up loving and fearing horror movies. And so I have put together a list of my top ten and in no particular order. Let me know if you agree or disagree.

1. The Exorcist – Still to this day this movie is like no other. How they got a young Linda Blair to do those things, I’ll never know.

2.The Birds – Yes, I know you would have said Psycho, but watch it again. Hitchcock didn’t even use music, only the sound of those horrible birds.

3. The Changeling – (with George C. Scott not Angelina Jolie) Never before was a grown man terrorized by a little red ball.

4. The Shinning – Forget Jack Nicholson. It was all about those creepy twin girls.

5. Suspiria – Who could forget the trailer with the girl brushing her hair singing, “Roses are red. Violets are blue…” The first time I sat through it I nearly puked. Dario Argento is a master at creating elaborate death sequences that are gory and at the same time wonderfully artful, almost beautiful.

6. Halloween – The original is a classic. Jamie Lee Curtis screaming up at Tommy’s bedroom window to let her in still makes me writhe in my seat.

7. Texas Chainsaw Massacre -Two words – “meat hook”

8. Jaws – That little boy getting eaten on a raft nearly put me in a coma.

9. Alien – Space never felt so futuristic and frightening. Even at the very end, I swore that cat was not to be trusted.

10. Nosferatu – This classic vampire tale left me haunted. The visuals are stunning. Isabel Adjani walking the beach was like watching a Monet.

Honorable mentions go to ‘Salem’s Lot, The Others, Sixth Sense, Carrie, The Legacy, The Fury, The Omen, Rosemary’s Baby, and The Sentinel.

Bachmann’s Vaccine Debacle

Oh, those crazy politicians. First, they comment on medicine and when confronted about their remarks, they excuse themselves by saying they’re not doctors.

That’s what Michele Bachmann did when she referred to the vaccine to prevent cervical cancer as “dangerous.” I suppose she knows better than the FDA, who approved the vaccine as safe.

Gardasil is a vaccine that protects against the Human Papilloma Virus (HPV), a sexually transmitted infection that can lead to cervical cancer in women and anal cancer in both men and women. Indicated for adolescents and young adults, the vaccine initially had a slow start. Some parents feared the vaccine condoned having sex at an early age. The vaccine is recommended beginning at age 11 or 12. I seriously doubt a child would rationalize that a vaccine was their parents’ way of giving them the greenlight to have intercourse. Besides, 17 seems to be the magic number where most individuals engage in first intercourse. Of course, if you have a mother like the one Sissy Spacek had in Carrie, then I would agree that this vaccine was made by the devil to entice young children into acting on their lustful urges. Then again, if you have a mother like the one played by Piper Laurie or one like Michele Bachmann, who is married to someone who thinks you can cure homosexuality with therapy, then you probably shouldn’t get the vaccine because you’ll spend the rest of your life worrying that you’ll burn in hell for it.

Aside from all the guilt brought on by the religious right, the fact is that the rates of sexually transmitted diseases increase every year. HPV is extremely common with millions of new infections each year. That’s because any kind of intimate contact can transmit the virus. For some, the immune system fights off the infection. Unfortunately, for others, the virus persists and can lead to cancer. Gardasil was initially indicated to prevent cervical cancer, but it has been show that HPV causes cancer of the penis, anus, vagina, and even the throat.

Among gay men with HIV, anal cancer rates have increased. At a recent HIV conference, it was recommended that all HIV positive men undergo annual anal Pap smears followed by high resolution anoscopy for Paps confirming HPV. I routinely recommend Gardasil for my HIV positive male patients even though it is not covered by insurance.

Vaccines have been given a bum rap over the years with unproven ties to autism. Each year vaccine rates decline. The public’s growing concerns with vaccines ignore the statistical proof that they prevents certain diseases and death. It’s interesting to think a patient would refuse a flu vaccine despite the fact that thousands die from the flu each year.

The repercussions of Bachmann’s comment will linger in the minds of skeptical patients and parents when their doctors recommend vaccines for them and their children. It’s unfortunate when someone like Bachmann, who said she wasn’t a doctor, offered her medical opinion on a matter she obvious knows little about. Perhaps she had a mother like Carrie.

Penis ennui

The penis industry is huge, pardon the expression.

When I was a surgical residency doing my urological rotation back in the late 90’s, the clinic was packed with men complaining of erectile dysfunction. This was before Pfizer came out with Viagra. I vividly recall my Attending urging me to invest any money I had in Pfizer stock.

“What extra money?” I replied. “I’m an intern.”

From that day on I realized how big a deal men’s penile function was, and it has become a lucrative market for pharmaceutical companies to tap into. Just think how far we’ve come sinceViagra. Now we have Levitra, Cialis (which lasts 36 hours), and there are even sublingual versions produced by the makers of Levitra so that you don’t have to carry around that annoying little pill.

The surge in the penis market was also evident in men’s quest to enlarge their penis –  a problem pharmaceuticals, surgeons and technology have failed to conquer. There are penis elongation procedures but none are widely recommended and often they are disfiguring.

I can’t help but think back to my youth when I first saw what Barbie’s boyfriend Ken looked like under his pants. My best friend Diane was playing Barbie’s with her younger sister, Karen. Undressing them I found Ken did not have a penis but a lump where his penis ought to be. Recently, it got me thinking: Isn’t the penis a waste? I mean, honestly, what function does it serve?

Yes, the penis is important to excrete urine.

The penis also acts as the vehicle to expel semen with great velocity into the female vagina in order to procreate. But when you set aside the physiological functions, what is the penis other than a sign of male virility?

Imagine if all men were like Ken.

We had a lump that looks like the cup I wore during Little League. Of course it would still have to have an opening so that we could urinate and also propel semen (I suppose the velocity would have to increase). It could still orgasm and stimulate females to orgasm. Think about it: female orgasm is primarily clitoral. Of course, you could argue that nothing is more erotic than a man’s penis, but if we all looked the same then we wouldn’t have to waste so much time worrying about why it doesn’t get hard enough or why isn’t mine as big as Johnnie’s?

I’m not saying this is the answer to all our penile problems, but when you think about it, isn’t the penis really just obnoxious? It’s like six-pack abs. I mean it looks good and all, but really how long can you keep it up?

Forgetful or early Alzheimer’s?

I keep my iPhone plugged in next to my bed. At night while I watch television with my partner, I often write myself notes. Before I go to bed, I email them to myself. Chad is old fashion and prefers paper and pen. In the past I kept lists on random scraps of paper and accumulated them until my briefcase was full of reminders. I stopped using paper because if something came to mind, and I didn’t have anything to write it down on, I’d forget it. Chad sometimes forgets what he was about to write before he even makes it into the other room.

We’re both in our forties. Are we overscheduled, forgetful or experiencing early Alzheimer’s?

Millions of Americans suffer with mild cognitive impairment (MCI), which could manifest as lapses in word-finding or name recall. Other examples include forgetting appointments, losing your train of thought in mid conversation and difficulty paying bills.

Dr. Ronald Petersen, a neurologist with the Mayo Clinic described MCI as an intermediate state between the normal changes that occur with age and the severe deficits associated with dementia. Petersen wrote that MCI occurs in 10 to 20 percent of people older than 65. 

Differentiating MCI from normal aging can be difficult. Problems like depression, medication side effects, Vitamin B12 deficiency and underactive thyroid glands can mimic MCI. Patients with HIV experience an increase in cognitive impairment in the long-term. Antiretrovirals that penetrate the central nervous system are being used as first line treatments to prevent future cognitive impairment.

There are people like my best friend Eric who insists he has early Alzheimer’s disease. Eric complains he loses his keys, misplaces his cell phone and forgets appointments. People with MCI often experience prominent impairment, typically forgetting telephone conversations, recent events and important appointments. Being forgetful or what I refer to as pulling an Eric is often just a normal sign of aging.

So what can you do?

It is important to reduce your cardiovascular risk. Smoking, elevated cholesterol and high blood pressure can impair memory as does certain medications like, Demerol, certain antidepressants, Valium, and Benadryl (Tylenol PM).

So far there is no conclusive evidence that memory games help reduce  impairment. I do recommend them. For example, can you recall what MCI stands for?

The most promising study focused on regular exercise, which reduced amyloid accumulations in the brain. This study performed in Australia had patients walk for 150 minutes a week to improve cognitive function.

So next time you forget your doctor’s appointment, don’t pull an Eric and blame it on early Alzheimer’s. Chances are if you have a career and live in a city, you more than likely suffer from being just too busy.

Pharmacy phacts

The other day my receptionist left me a message. I was from a pharmacist who was having trouble reading my handwriting. I attended eight years of Catholic grammar school. My principal was a three hundred pound woman named Sister Catherine. I have impeccable penmanship.

I called the pharmacist who explained she was unable to read the name of the drug. I asked, “Who is the patient?”

“John B.,” she said, “The directions on the script read, 6mg SQ QD.”

I know John B. is HIV positive. “Is it for Serostim (a brand of growth hormone prescribed for HIV associated wasting)?”

“Uh, that could be it.”

“Where are you located?” I asked.


Chelsea happens to be one of the neighborhoods in Manhattan with the largest population of gay men. It was unfathomable that this pharmacist hadn’t filled a prescription for Serostim.

“How long have you been working there?”

“One month.”

A whole month and not one script for Serostim?” I said. Then I asked, “Which pharmacy do you work for?”

She mentioned one of the large chain drug stores. Enough said.

More and more insurance plans are dictating where patients can fill their prescriptions. This is alarming to me when you consider that these same insurance companies are allowing doctors fewer choices of prescription drugs. For instance, I wrote a patient for Micardis, an antihypertensive medication. His pharmacist informed him that his insurance company wouldn’t cover the cost. His insurance carrier then faxed me a list of meds they would cover.

It’s frightening to think an insurance company, not a healthcare provider, is choosing which medications their patients should take.

This year, more insurance companies are requiring patients to use mail order pharmacies. The rue is that it will be cheaper for the patient. This is true. Mail order pharmacies may be cost-effective. My patient, Billy J. gets his HIV meds via mail order. They send him a 3 month supply. The upside is that he only pays one copay. The down side is that his meds often arrive late. This is alarming for someone with a chronic disease like HIV, when missing a dose can have unwanted consequences like, resistance. I suggested he use a local privately owned pharmacy like, New London.

He said, “My insurance company won’t allow it.”

But this problem goes even further. Insurance carriers should not tell doctors which drugs to prescribe nor should they influence where patients get their prescriptions meds filled.

Case in point: Charlie M. travels around the world for work. He has HIV, Hep C and high blood pressure. His is on a laundry list of meds.

His father had a heart attack one Friday night. Charlie called and asked if I could get him an early refill on his meds because he left them in a hotel in Brazil.

I asked, “Which pharmacy do you use?” I’ll simply say it was a pharmacy attached to a popular drug store chain.

I called them. The pharmacist, of course, did not work there normally. Like most chains, pharmacist fill in and rotate routinely so that they are unfamiliar with their clients. I explained the situation. The pharmacist informed me that he was not authorized to over ride a premature request for medications as expensive as HIV meds. Frustrated, I hung up and called my patient.

“What do I do?” he asked.

“Pay for your medication yourself,” I suggested.

Incidentally, if Charlie was diabetic the pharmacist would not refuse him insulin.

Later that same day I went to New London to fill a prescription for my partner, Chad. I asked the owner if she was aware of this trend to use mail order and large chain pharmacies. She explained they were driving small pharmacies out of business.

It’s sad when you think about it. The glory days of visiting a local pharmacist who knew your name and probably your prescription medications by heart is a thing of the past, like visiting Sam the butcher for you meat or Gepetto, the cobbler for your shoes. Perhaps I’m most bothered by this growing trend because I see it shifting toward doctors. Oh wait, that’s already happening. Insurance carriers prefer you see in-network doctors particularly if you have an HMO.

Be smart, if you have to use mail order, stay on top of your deliveries, and complain to your insurance company if they’re late. If you can’t use a privately owned pharmacy then make sure you learn the name of one of the regular pharmacists and the name of the person you paid at the cash register.

Advocate report: William Fox

Plea Deal for N.Y. Cop Accused of Abusing Young Boys


By Julie Bolcer

Frank Spinelli
William Fox, a retired New York City police officer accused of sexually molesting three young boys, could spend the rest of his life in jail following a plea deal that resulted from an investigation launched with the help of Frank Spinelli, a gay Manhattan doctor.

The Staten Island Advance reports on the plea from Fox, a former Staten Island resident now living in Pennsylvania, where his trial began this week on sex charges involving the three youths from 1996 to 2009. The boys, now grown men, are among at least 10 children that Fox adopted in New York, Pennsylvania and Florida over the past few decades.

The Advocate reports that on Tuesday, the second day of his trial in Tioga County Court, “Fox, 66, pleaded ‘no contest’ to nine charges, including incest, corruption of minors, involuntary deviate sexual intercourse and indecent assault relating to three victims who lived with him, according to the Pennsylvania attorney general’s office.”

Fox could receive up to 69 years in prison and a fine as high as $125,000 when he is sentenced in the fall. Authorities will first evaluate him to assess whether he is a sexually violent predator.

Identified in police records as William Patrick Fox Sr., the retired NYPD officer won acclaim in 1981 for talking a teenager out of committing suicide and later becoming the legal guardian of the young man. He was named a National Father of the Year in 1982 and wrote a book about the experience.

Police arrested Fox at his home in Liberty, Pa. this past March after a two-year investigation launched at the urging of Frank Spinelli, a Manhattan internist with a practice focused on HIV-positive and gay men. Fox sexually abused him between 1978 and 1980 while leading a Boy Scout troop on Staten Island. Spinelli, an Advocate health contributor, tipped authorities about Fox two years ago and made wiretapped calls leading to his arrest.

Gay Men and Prostate Cancer

Gay men have a tougher time dealing with the aftermath of prostatectomy than heterosexual men do, says researchers at the American Urological Association. The physical as well as psychosocial quality of life of a gay man appears to suffer more from the side effects of the cancer treatment compared with the situation for straight men, said David Latini, PhD, Assistant Professor of Urology at Baylor College. “We find that men in our sample are significantly different in almost every domain of quality of life, and these differences are large enough to not just be statistically significant but are also clinically relevant,” Dr. Latini said at a news briefing.

Dr. Latini also noted that many gay men, especially the insertive partner, had severe sexual “quality-of-life disturbances,” mainly erectile dysfunction, because the aftermath of prostatectomy was not helped as much by phosphodiesterase-5 inhibitor medication that allows men with erectile dysfunction to function sexually.

“For gay men this is a particularly difficult area,” he explained. “The phosphodiesterase-5 inhibitors were created with an endpoint in the trials of vaginal penetration. We know that an erection has to be firmer to penetrate someone anally. So for sexual intercourse between two males, these medications are usually not sufficient.” I don’t agree but in my experience I know that men who undergo radical prostatectomy, the majority do not respond to phosphodiesterase-5-inhibitor unlike men who opt for radiation therapy. “Many of the guys in our sample are struggling with that, and are forced, if they want to remain the insertive partner to go to other more invasive treatments.”

The moderator of the news conference, Tomas Griebling, MD, MPH, Professor of Urology at the University of Kansas Medical Center, said, “From my perspective, one of the biggest things we learned from these results is that gay men and straight men experience prostate cancer and the effects of prostate cancer in different ways. For gay men the negative impact on their overall health-related quality of life is more severe. It’s more profound.”

Dr. Latini said that since gay men constitute about 3% to 5% of the total male population of the United States, that also means that about 3% to 5% of the 200,000 men diagnosed with prostate cancer are gay and that 3% to 5% of the men living with prostate cancer are gay men.

More data needs to be collected looking at gay men with prostate cancer and the aftermath of their treatment.


I remember the year Amy Winehouse’s CD, Back to Black came out: I was given the CD by a patient who said you must listen to this. I did and was pleasantly struck by the innovative way Mark Ronson fused that early Motown sound with contemporary beats under scoring Winehouse’s smoky voice. And those lyrics with nods to pop culture!

Anybody that can weave a James Bond reference in with Stella and fries had me at hello.

I recall singing, Rehab in my office after all the patients had gone. My then receptionist and I would sing along to the CD, dancing and creating our own choreography, waving our index finger at each other as we sang, “No, no, no!” That receptionist incidentally ended up in rehab.

As life often imitates art it was clear that Winehouse wasn’t just singing about her refusal to attend rehab. She wasn’t going. “No, no, no.”

I suppose if you believe in freedom and civil liberties then you have to agree that a person has the right to live as they see fit. Even if it isn’t how you would.

What bothers me most about Amy Winehouse’s death is that we won’t have any more music from her. “No, no, no.” And that unfortunately is the biggest tragedy.

But if you ever knew anyone who was addicted to drugs or alcohol it would be easy for you to understand that you CAN”T make someone go to rehab. They have to decide for themselves. The awful truth is that if you are dependant on either drugs or alcohol or both, your view on life is skewed. Your vision of how life really is can be described as myopic. I’ve been around many people in my career who were either addicted or used drugs recreationally. Most of the time they thought they were in complete control.

My worst memory is when I visited a friend in the hospital after she overdosed. I offered to go to her house to fetch some of her personal belongings. She pleasantly refused. Later she confessed that she didn’t want me to find her stash of drugs fearing I would dispose of them. Thankfully, she did go to rehab and has been sober for two years.

Yet, rehab is not for everyone. That much I know is true. Your choice of rehabilitation is a decision you should make with professionals like a therapist, doctor or a drug counselor.

Today I was watching television while listening to Amy Winehouse’s Love is a Losing Game. The announcer stated that Winehouse’s death at age 27 added her to an infamous group of artists who all died at 27 years old. This list includes Kurt Cobain, Jimmie Hendrix and Janis Joplin. I don’t know if that is an honor or a curse.

I suppose if you believe in immortality then it was for the best that Amy Winehouse check out now. I don’t agree. The tragedy is that she was an artist who let her own personal demons get in the way of living her life. It takes a strong person to admit they have a problem. It takes an even stronger person to get help and stick with it. The fact is that most people who enter rehab fall off the wagon. That still doesn’t mean you shouldn’t get right back up and try it again.

There is no glory in being included in a group of artists that died tragically at age 27. Instead we should celebrate the ones that choose to live. I hate when the media glamorizes this live hard, die young mentality.

When Alexander McQueen died tragically, I spoke with a friend who knew him. He told me that McQueen’s death wasn’t a tragedy. Tragedy would imply that we should be sad. McQueen’s death left him angry. When I attended the Metropolitan Museum’s exhibit, Savage Beauty, which showcased McQueen’s work, I understood why he was so angry. We’d lost a great art.

For me it all goes back to the root of the problem, which is we don’t see addiction as a disease. We see it as a choice, and that’s why many people who are dependant on drugs and alcohol don’t want to go to rehab. It reminds me of the Nancy Reagan years. Her solution to the problem was simply to say, “No, no, no.” Not much has changed.

Comedy or just plan hate?

30 Rock star Tracy Morgan found himself in the center of a heated debate after he went on an anti-gay rant during a show in Tennessee earlier this month. Reportedly, Morgan said he’d stab his son if he were gay. Homosexuality, he went on, was a choice because “God don’t make no mistakes.” Eye witnesses said his jokes were met by cheers from the audience.

Many comics rely on cruelty. Joan Rivers has made a career at poking fun at celebrities. She tormented Elizabeth Taylor for years, insulting her weight. During an interview, she was asked if there were any topics that were off limits. She replied no, but then added that when Elizabeth Taylor was admitted to the hospital, she stopped making jokes about her until she was better. Her rule was that she didn’t kick people when they’re down.

Recently Chelsea Handler went on a tirade about Angelina Jolie, calling her a “cunt.” When asked by Joy Behar if she thought she had gone too far, Handler responded that she was not going to apologize because then she would have to apologize to everyone she’d ever made fun of.

Tracy Morgan spent much of last week on the remorse circuit after his anti-gay rant. He was sorry, he told anyone who’d listen. He meant no harm. Later that week, Morgan met with New York youths who have been shunned by their families because of their sexuality. Joan Rivers  later commented that Morgan should not have apologized.

In light of the recent number of LGBTQ suicides, is it the right time for any comedian to jokingly say they would stab their child if they were gay? Tracy Morgan should have apologized. Why doesn’t Joan Rivers own rule of thumb apply in this instance as well. As far as I’m concerned comedians can provoke, insult and joke about each other all they want, but from some accounts it seemed Morgan’s rant went too far. It touched a nerve among anti-gay supporters who probably feel that gay marriage should never be allowed or that homosexuality is a choice. When Morgan offered his violent solution to dealing with one of his own children if they said they were gay, he was inciting hate and perpetuating violence among the LGBTQ community. Imagine the outrage if Jeff Foxworthy said at his next Redneck Roundup that if his daughter brought home a black man he’d shoot her in the head?

I will say that Morgan was smart to apologize immediately however, Tina Fey’s response that he is not a hateful person and is much too sleepy, is a lame excuse for his behavior. What really bothers me is Joan Rivers, who after watching her documentary clearly feels that no topic is sacred, but that is not true. Good comics provoke thought and make us laugh at ourselves, and yes, mean comedy can be funny when it’s pointed at ridiculous social norms or holds a mirror up to the way we live.

In late 2010, Tracy Morgan underwent a kidney transplant for chronic renal failure secondary to diabetes. You’d think he’d have a new outlook on life now that he’s been given a second chance. So stop the hate Tracy, it’s bad for your health, and you’re already working on borrowed time. Pay more attention to your sugar and less about your child’s sexuality.

Gay Marriage

My cousin Sal recently married his longtime girlfriend Lauren. It was the first time in my adult life I had been invited to an event where the host knew I would be accompanied by my male partner. It was a big deal for me being a first generation Italian American. Although I come from a loving family it is implied that what goes on behind closed doors, remain behind closed doors and not in plane sight. Most times I felt my own close family preferred I remained closeted for the sake of maintaining peace. Ruffling feathers and creating drama is something any Italian knows very well. As a people, we rarely shy away from confrontation and in fact we invite it, thriving on its energy as a source of inspiration to propel us through our otherwise mundane lives.

Arriving at the Venentian in Garfield, New Jersey just before 7:00 p.m last Friday night, the Spinelllis arrived in two cars. I drove my mother’s cream Jaguar accompanied by Chad and my sister, Maria, who flew up just for the wedding from Alabama with her 13 year old daughter Madeline. This weekend excerusion was a surprise gift to her granted by her father who gave her permission to attend the wedding because she was the flower girl to the groom’s sister nearly eight years ago. In the other car, jettisoning perillously like a slalom skier through the careening traffic was my brother-in-law, Joe driving my other’s sister, Josephine’s blue BMW325 with my overly sequined mother in the back seat. They were not without their own backstory. Josephine was once married to a man related to the groom and his entire extended family would be present.

It was a big night for all of us. Themes of betrayal, homosexuality, fury and alliances rang out long after the church bells. Ultimately, little happened. There was no table flipping, no glasses of wine thrown into faces or worse, actual pushing and shoving. The wedding was simply just that, a union of one young man to a beautiful young lady. Of course we had our own internal dialogue. I’m sure one of my disapproving cousins had something to say about Chad’s presence as likely my sister’s ex had something to say about my  her current husband. I know we had lots to say about his wife. The only spillage was when I knocked over a glass of wine at the table and the server had to set a new place setting next to Chad after removing the chards of glass. I suppose you could say that the body count was kept to a minimum as Italian weddings go.

It took decades for me to be invited to a wedding with a male partner. At the same time it made me consider when I might marry myself. As another Italian, Governor Cuomo is pushing through legislation to allow gay marriage, it made me proud to be part of a culture that was so passionate about issues whether they be pro or against it. If this should happen then maybe this time next year, cars will be jettisoning over bridges and tunnels from Queens, Staten Island and Brooklyn… and even Alabama to attend the union of this doctor to his own primary care physician.

Time will tell.

New HIV cases on the rise

Since January 1, 2011, I have diagnosed one new HV patient a week. They have all been men under 40, and more than half had no health insurance. What makes this most worrisome was that many were in the twenties.
In the current issue of the Journal, Levy et al. describes some of the issues associated with the emerging and evolving HIV epidemic in Israel. They not only documented that the absolute number of HIV infections has been increasing over the past decade, despite wide access to HAART, but that the preponderant number of those recently infected and newly diagnosed were MSM. Particularly concerning was the finding that 29% of the men were infected with HIV that was resistant to at least 1 of the antiretroviral classes, and coinfection with syphilis was common.
In my practice nearly half of the men diagnosed with HIV had a concomitant syphilis infection. Several contracted a strain of HIV with one or more major mutations. “These findings call to question some of the recent optimism about “treatment as prevention”, which presumed that if expanded efforts at increasing HIV testing and linkage to care could be undertaken, and individuals could be promptly treated, that the AIDS epidemic could be brought to a halt.”
That doesn’t seem to be true. The data suggests that a subset of these infected men may be engaging in unsafe sex. 
The current school of thought states there is a low risk for transmitting HIV to HIV negative partners if the patient is on medication which effectively suppresses the virus. One explanation for the increase in transmission is that a subset of HIV positive men are not compliant with their medications due to depression, drugs or forgetfulness. Also co-infection with a sexually transmitted disease can possess sufficient concentrations of resistant HIV in the genital tract secretions to transmit to uninfected sexual partners. “This study is not the first to document that some individuals are newly infected with resistant virus [27] and that syphilis is increasingly common in HIV-infected MSM [28, 29], but the combination of these factors and their association with an expansion of a national HIV epidemic heightens the acuity of the concern that a new generation of MSM could face an AIDS epidemic with constrained therapeutic choices.”

Why is this happening? 
Therapeutic optimism is only part of the explanation. Since the earliest days of the epidemic, affective disorders, like depression, as well as substance use, have been associated with unprotected sex and multiple partners [30, 31]. For some, early life experiences, ranging from sexual abuse to homophobic violence, may result in decreased self-efficacy and lowered self-esteem [32]. The use of disinhibiting drugs and unprotected sex may serve a depressed MSM as ways to “self-medicate” in an adverse environment [33, 34]. These conditions not only tend to co-occur, they synergistically interact to enhance the risk of engaging in unprotected sex and becoming HIV-infected [35]. Thus, attenuating the spread of HIV among MSM requires the scaling up of evidence-based programs that not only encourage HIV testing, linkage to care, and treatment, but also engage providers in the provision of culturally competent care to sexual and gender minority patients [36]. For example, drug treatment programs that are tailored to substance-using MSM have been shown to be more effective than those that do not acknowledge the participants’ sexuality [37]. Unfortunately, many MSM who engage in practices that put them at risk for HIV and other sexually transmitted infections (STIs) report that they are not always comfortable disclosing their behaviors to their medical providers [38, 39], creating multiple missed opportunities for slowing the epidemic every day around the world.
The last patient I diagnosed with HIV had been my patient for over five years. He was very distraught to learn he was HIV positive, and so I encouraged him to see a therapist. When the therapist called to confer with me, he asked if I knew the patient had a crystal meth addiction. I did not. Even after five years of treating this man, he denied ever using drugs whenever I asked.

“The Israeli study holds a mirror to the future of the epidemic in this population, suggesting that MSM should not assume that their partner is HIV-uninfected, and if he is infected, it is unwise to assume that his medication will make him noninfectious.

Talkin’ bout a revolution

When I hear revolution I’m reminded of songs from the Beatles or Tracy Chapman. I think of going against the establishment. There have been great revolutions in this country: the women’s movement, the civil right’s movement and even the Stonewall revolution, which marks the gay movement for equality.

That’s why it’s hard for me to digest the five-year study commissioned by the nation’s Roman Catholic bishops, which concluded that the church’s sexual abuse crisis had nothing to do with either the all-male celibate priesthood or homosexuality.

Oh no, the reason why there was a surge in the number of sexual abuse cases by priests against minors was because “priests were poorly prepared and monitored amid the social and sexual turmoil of the 1960s and ’70s.”

The “blame Woodstock” explanation has been floated by bishops since the church was engulfed by scandal in the United States in 2002 and by Pope Benedict XVI after it erupted in Europe in 2010. But this study, which to me is as ridiculous and carries as much wieght as South Park’s hysterical, Blame Canada Theory, is likely to be regarded as the most authoritative analysis of the scandal in the Catholic Church in America. The study, initiated in 2006, was conducted by a team of researchers at the John Jay College of Criminal Justice in New York City at a cost of $1.8 million. About half was provided by the bishops, with additional money contributed by Catholic organizations and foundations. The National Institute of Justice, the research agency of the United States Department of Justice, supplied about $280,000.

The researchers concluded that it was not possible for the church to identify abusive priests in advance. Priests who abused minors have no particular “psychological characteristics,” “developmental histories” or mood disorders that distinguished them from priests who had not abused, found researchers.

“Since the scandal broke, conservatives in the church have blamed gay priests for perpetrating the abuse, while liberals have argued that the all-male, celibate culture of the priesthood was the cause.” The report notes that homosexual men began entering the seminaries “in noticeable numbers” from the late 1970s through the 1980s. By the time this cohort entered the priesthood, in the mid-1980s, the reports of sexual abuse of minors by priests began to drop and then to level off. If anything, the report says, “the abuse decreased as more gay priests began serving the church. One of the more outrageous findings report that fewer than 5 percent of the abusive priests exhibited behavior consistent with pedophilia, which it defines as a “psychiatric disorder that is characterized by recurrent fantasies, urges and behaviors about prepubescent children.”

“Thus, it is inaccurate to refer to abusers as ‘pedophile priests,’ ” the report says.

That finding is likely to prove controversial because the report uses a definition of “prepubescent” children as those under the age of 10. Using this cutoff, the report found that only 22 percent of the priests’ victims were prepubescent. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders classifies a prepubescent child as generally age 13 or younger. If the John Jay researchers had used that cutoff, the majority of the abusers’ victims would have been considered prepubescent. It angers me to think that the distinction between pre and post-pubescent is used to discount those victims who were still very much minors. So a 13-year-old is up for the taking. Another reason why this distinction is ridiculous is because children in Catholic school enter at about age 5 or 6 and graduate at age 13 before they enter high school Priests would have access to these children for many years. The process of grooming in order to develop trust could occur from age 11 until graduation. Excluding these children is yet another way of protecting the perpetrators.

The report, “The Causes and Context of Sexual Abuse of Minors by Catholic Priests in the United States, 1950-2002,” is the second produced by researchers at John Jay College. The first, on the “nature and scope” of the problem, was released in 2004.

Cell Phones, Brain Tumors and mothers

My iPhone makes my ear burn whenever I speak on it for more than ten minutes. The reality is that I’m not a phone person. Of course, I use my cell phone with the same obsessive compulsive behavior I reserve for checking my Facebook messages, but the truth is that I really don’t like to talk on my phone for more than ten minutes at a time. Unless of course I’m on the phone with my mother, and in that case, my ear is probably burning because she’s been yelling in it for over a half an hour. I basically use my iPhone for texting and Internet access.

In a recent article in the New York Times, Siddhartha Mukherjee, an assistant professor of medicine in the division of medical oncology at Columbia University, gave a timeline of certain carcinogens and their relationship with certain cancers. For example, smoking and lung cancer. Researchers identified smoking as a cause of cancer through careful clinical studies in the 1950s and 1960s.

“To ask whether cellphones increase the risk of brain cancer, then, we might begin by turning to this question: Has the age-adjusted incidence of brain cancer increased in the recent past?

The answer is no. Brain cancer is rare: only about 7 cases are diagnosed per 100,000 men and women in America per year, and a striking increase, following the introduction of a potent carcinogen, should be evident. From 1990 to 2002 — the 12-year period during which cellphone users grew to 135 million from 4 million — the age-adjusted incidence rate for overall brain cancer remained nearly flat. If anything, it decreased slightly, from 7 cases for every 100,000 persons to 6.5 cases (the reasons for the decrease are unknown).

In 2010, a larger study updated these results, examining trends between 1992 and 2006. Once again, there was no increase in overall incidence in brain cancer. But if you subdivided the population into groups, an unusual pattern emerged: in females ages 20 to 29 (but not in males) the age-adjusted risk of cancer in the front of the brain grew slightly, from 2.5 cases per 100,000 to 2.6. These cancers appear in the frontal lobe — a knuckle-shaped area immediately behind the forehead and the eye. It is difficult to imagine that cellphones caused these frontal-lobe tumors: how, or why, would a phone’s toxicity have skipped over the area nearest to it and caused a tumor in a distant site?”

Most epidemiologists and biologists agree that tissue-skipping is not plausible, and most do not believe that frontal lobe tumors are the result of cellular phones.

Like most people, I often worry that I have a brain tumor especially since my maternal grandmother died of a brain tumor in the 1960’s. Of course she did not own a cell phone. Every common symptom that could be attributable to stress like, headaches, fatigue, blurry vision or even indigestion, leads me to a definitive diagnosis of brain tumor but only in myself. Of course when any patient comes into my office, I reassure vehemently that the likelihood of having a brain tumor is very low. So why can’t I talk myself out of it? I suppose I’m like everyone else. We assume the worst and expect the inevitable.

This mother’s day my sister and I are taking my mother out to dinner. No cell phones allowed. Researchers say that the lag time for the development of brain tumors from cell phones is estimated to take between 50 and 70 years. I should only hope I have my mother around for that much time.

William Fox Timeline

1978: William Fox is alleged to have sexually abused Frank Spinelli, an 11-year-old boy Boy Scout at the time.

1981: Fox, then a 36-year-old New York Police Department officer, convinces Michael Buchanan, a 17-year-old boy, not to jump from a Manhattan building. He then becomes the boy’s legal guardian.

1982: Fox co-authors a book called “The Cop and the Kid” about the Buchanan experience.

1990: Fox moves to Palm Bay. He has four adopted boys living with him, according to a neighbor.

Mid-1990s: Fox leaves Florida to go live in Pennsylvania.

2008: Three decades after the alleged abuse, Spinelli talks to NYPD, leading to an investigation by Pennsylvania State Police.

March 21, 2011: Fox is arrested in Liberty, Pa., and charged with sex crimes against his adopted children. Bail is set at $100,000.

April 25, 2011: Fox is arraigned and enters a plea of not guilty. His request to have his bail lowered is denied by the judge.


The month of April is very significant to me.

On a personal note, my birthday is on April 28th. Although I don’t really care to celebrate the day, I do recognize the significance it holds in that it brings me one year closer to the end of my life. At this point in time I cherish the years I have left to live because of the man I love and the many things I have yet to accomplish.

The Center for Disease Control recognizes April as Sexually Transmitted Disease Awareness Month. I encourage everyone to discuss sexual health with their healthcare provider to ensure the safety of you and your partners. It is imperative that if you are not in a monogamous relationship (and maybe even if you are); you should get checked at least annually for HIV, syphilis, gonorrhea and Chlamydia. Women should get annual Pap smear and men who have sex with men should get annual anal Pap smear.

At this point in my career I diagnose at least one person a week with HIV and many more with other STD’s. Please practice safe sex and use condoms correctly.

April is also the National Sexual Assault Awareness Month. Sexual violence, including child sexual abuse, crosses all ages, genders, races, ethnicities, and economic backgrounds. According to research published in the journal Violence and Victims in 2007, in the United States, an estimated 2.7 million women and 978,000 men are victims of sexual violence each year. In recognition of the widespread prevalence of sexual assault in this country, the National Sexual Violence Resource Center has designated the month of April as National Sexual Assault Awareness month.

Although the amount of sexual violence is alarming, there is hope for survivors. As Esther Deblinger, PhD, co-director of the CARES Institute, an expert in the field of child sexual abuse, and an NCTSN member, says, “There is increasing evidence that, with support from a caring adult and high-quality treatment, many children and parents effectively recover and may feel stronger and closer as a family in the aftermath of a traumatic experience.”

The NCTSN is proud to observe National Sexual Assault Awareness Month, and offers the resources to help educate parents, professionals, policy makers, and communities about the profound impact that sexual violence has on men, women, and children.

If you or someone you know is being abused sexually or was sexually abused as a child, please notify the authorities and get help. 

It is not your fault.

William Fox preliminary hearing

MANSFIELD – William P. Fox Sr., 65, of 39 Liberty Lane, Liberty, charged with several counts of rape, corruption of minors, involuntary deviate sexual intercourse and sexual assault, will face those charges before District Judge James Carlson April 6.

State police charged Fox following a two-year investigation into the alleged sexual assaults against three minor males at Fox’s residence between February 1996 and February 2009, which was heard by the 30th statewide investigative grand jury.

According to documents filed at Carlson’s office, Fox sexually assaulted the juvenile males repeatedly during the 10 years in question.

According to documents, Fox’s original preliminary hearing was set for today. He remains in the Tioga County Prison in lieu of $100,000 bail.

NY 1 Interview

Click below to watch the video

Thank you to Mara Montalbano for allowing me to tell my story last night on NY1. Currently, my former molester is currently in jail. A hearing is set for early April. I will keep you posted on any further developments.

Oscars 2013

Every year I look forward to the Oscars as though it were Christmas and yet, this year, I find myself not so excited. Usually, I would be creating ballots for all of us to fill in so that on Oscar night, when we’re all at my friends’ Eric and  Scott’s apartment, we can cheer for our picks. Except this year, I’ll be on a plane coming home from Arizona. 

How did that happen you ask?

I don’t know, and for some reason, I don’t really mind. 

Of course, I want to see how Seth MacFarlane does. I’m sure he’ll be hilarious. It’s just that over the years, I feel like the Oscars are fixed somehow. Movies I thought were amazing seem to have been neglected all together, like Perks of Being a Wallflower. I understand it’s hard for small movies to compete with big blockbusters with producers who campaign heavily, but after reading some of the nominees, I sat there scratching my head in confusion.

To keep up the tradition, I will list my Oscar picks including who will win and who I feel should win. As an extra bonus, I’ve included those who should have been nominated.

Best Picture

Winner will be Argo. Should win, Life of Pi

Best Actor

Winner will be Daniel Day-Lewis. Joaquin Phoenix should win.

Best Actress

Winner will be Jennifer Lawrence. In my opinion she was really a supporting character. Should win, Naomi Watts. What went wrong with the promotion of The Impossible? It seems like no one is talking about it. And don’t even get me started on that little girl from Beasts of the Southern Wild. As a rule, children should not be nominated. The Oscars should bring back the young adult or rising star Oscar. Quvenzhané Wallis was good but it was all reactions shots. Was she better than Nicole Kidman in The Paperboy or better than Marion Cotillard in Rust and Bone? I think not. If I were them, I’d be pissed. 

Best Director

Winner will be Steven Spielberg. If he gets it he should give it to Ben Affleck even though I don’t agree with all the bru ha ha about Argo. If anyone made a movie that was pure cinema – a film that had great characters, had visually stunning effects and showed you something you’ve never seen before – it was Ang Lee

Best Supportive Actress

Winner will be Anne Hathaway. Should win Anne Hathaway. What will be exciting is to watch Anne Hathaway carry on as though she’s surprised and then act as if she’s won Best Actress. I would kill for an upset in this category. Give it to Amy Adams or even Sally Field.

Best Supporting Actor

Winner will be Robert Deniro. I’m going out on a limb because out of everyone in Silver Linings Playbook, I though Deniro was the most touching of all. 

So there you have it. 

I wish I could say that I’m getting more excited as the Oscars approach but I’m not. Good luck to all, and I’m sorry Frankenweenie. You’re going to lose to Brave