By Michael Scarce
Harrington Park Press/Haworth Press, 1999
ISBN: 1560239263 (paperback)
Reviewed by Michael Walker, Oasis Science and Medical Editor
Before diving into this review, I should allow it to be admitted that I have something of a love-hate relationship with the discipline of medical sociology, an important fact given that the author of this book is a medical sociologist. The love part of the relationship comes from exciting work on medical and sociocultural issues I see medical sociologists addressing while other professions are ignoring such issues and the innovative approaches that medical sociology has contributed to the larger social sciences discourse. The hate part stems from the fact that I have found medical sociologists to be often overly (and unfairly) critical of the allopathic tradition in health care. True, the allopathic (modern Western medical) establishment has made some grave errors and has been slow to accept alternative forms of medical care, but it has also been responsible for the majority of the advances in quality-of-health that we enjoy in contemporary society and for the eradication of a variety of formerly deadly diseases. Many medical sociologists whom I know professionally have a broad understanding of the social sciences but lack a consummate understanding of the biomedical sciences and this lack of knowledge quite often seems to hamper their comprehension of how physicians and researchers make their decisions and how allopathic medical models work. Please keep all this in mind while weaving your way through this review, because this book both benefits and suffers from the predominant approach of medical sociology, and it shows.
Smearing the Queer is a timely book, a much-needed investigation of how contemporary biomedicine has approached the care of gay male patients and disease-states common or unique to such patients. Like many works of medical sociology, it examines the interactions between patients and health care providers through looking at use of language, allowance of social/professional agency, and conceptualization of the "sick role", or the ability of the patient to have his/her illness treated as a legitimate need for medical intervention. Scarce has performed comprehensive, broad-reaching research to provide a lucid (though sometimes lurid) depiction of how illnesses almost exclusive to gay males have been categorized and treated by doctors. AIDS, of course, is addressed, but a great deal of focus is given to gay bowel syndrome and to the approaches health professionals have taken to this so-called syndrome. Scarce's overarching theme throughout the book -as even his title suggests-is that most physicians have a strong bias towards gay men and have manifest that bias strongly and continually in the care provided to gay patients. Of course, he is supported by a long history of mostly straight male physicians allowing their ignorance and homophobia to creep into their research and patient care, right up to the early years of AIDS. But sometimes Scarce is unfair to doctors and researchers in his critique; at times he is very condescending to them and seems surprisingly removed from an appropriate historical perspective, failing to realize that homophobia was until the Stonewall era (1970s) endemic to all facets of society, medicine included. Scarce seemingly wants to criticize doctors for acting like gods while at the same time expecting them to be free of the failings of mere mortals. Strange.
Another criticism I have of the book is Scarce's rather coy and patronizing writing style. For a book that claims to be a serious critique of a serious sociomedical topic, the writing is annoyingly humorous and oddly personal. Scarce even includes poems he has written on such subjects as, well, gay bowel syndrome. These seem appropriate for sharing with his colleagues prior to journal club perhaps, but not for inclusion in a work such as this book. I write poetry myself-and have published a fair amount of it in Oasis and elsewhere-but I don't attempt to include my poems in my scientific publications. I am also surprised at Scarce's apparently slow acquisition of knowledge on gay bowel syndrome; at the beginning of his first chapter, he mentions that he first discovered the term "in 1994, buried in a medical journal article". Oh really? This, despite the fact that he was in San Francisco, immersed in gay culture, working on AIDS prevention, and studying both gay-related topics and medical sociology? I had heard of the term in 1992 and I was far removed from the type of immersion Scarce had. I point this out because Scarce treats gay bowel syndrome as some sort of obscure, antiquated, misbegotten terminology that has crept out of medical jargon to rear its ugly head at gay men. Standard medical publications report a very different genesis of the term, a more pragmatic and less demonized version of how the medical community adopted this term to refer to pathogenic conditions related to anal intercourse.
Scarce also approaches the use of alternatives to condoms in safer anal intercourse, spending a fair amount of his discourse on the use of female condoms for anal penetration. His coverage of this novel concept is illuminating and includes information that I have not found elsewhere, but there seem to be some gaps in his research here. Several previous studies regarding the use of female condoms for vaginal intercourse and the safety and reliability of these devices are not referenced, much less discussed. Perhaps most surprising was the omission of Lisa Jean Moore's work on the social and psychological aspects of the use of female condoms among sex workers in San Francisco-published research that could add an interesting perspective to those views covered by Scarce. Here's why this omission so surprised me: Lisa Jean Moore is a graduate of the same doctoral program in medical sociology at the University of California San Francisco as Scarce is currently a doctoral student in-with little doubt, not only is he aware of the research (which was in fact her doctoral dissertation) but knew Moore as a fellow grad. student and postdoctoral fellow! Furthermore, Lisa Moore was active in AIDS prevention research in San Francisco and in gay-oriented organizations and causes. Although her research concerned female use of the female condoms, it is a hallmark study in medical sociology as applied to social concerns affecting sexual relations and marginalized populations. (For those readers curious about Moore's work, you may read her study in the journal Science, Technology, and Human Values-Vol. 22; No. 4, 1997. If you-like Scarce-are at UCSF, you can trot across the road to the bottom floor of the Library and Center for Knowledge Management and pull her dissertation in full.)
My criticisms aside, Smearing the Queer is a much-needed work on a rather neglected subject. Like I said before, it came at an ideal time and will add to the discourse about gay health and the social treatment of gay males by the medical profession. I think it will also serve as a great impetus to further commentary on these issues and should challenge those who practice medicine and care for gay male patients to be more compassionate and to learn more about the culture of their patients. However, the book was overly coy and unfairly antagonistic to allopathic medicine. Biomedical research has at times faltered in its duty to provide the highest quality of care to various marginal populations due to fear, ignorance, and biases, but this situation is not limited to gay males nor is it limited to medicine and the life sciences as legal, political, and educational institutions have been just as guilty. Due to his writing style and attitude, I fear that the medical professionals who may most benefit from Scarce's book will put it down after reading the first few pages. This is a pity, because there is a lot that these doctors could learn from Scarce and this book deserves a place in their libraries. Scarce is a key figure in the advancement of gay-oriented causes and issues at one of the world's leading research institutions and, for that matter, at the university that has arguably done more than any other to combat the AIDS epidemic: UCSF. I would expect that in his ongoing research and writing that Scarce would treat medical professionals with more respect and would work to unify the efforts of social scientists with those of biomedical researchers because if such is done, we will all greatly benefit and the so-called smearing of the queer may become but a footnote for medical historians.
MICHAEL WALKER is the Science and Medical Editor of Oasis Magazine. He has also contributed original research and review articles to a number of diverse academic and popular publications, as well as fiction and poetry. He may be reached at: MCWalker@hotmail.com