Point By Point: A Look At Paul Cameron’s Medical Consequences of What Homosexuals Do
Part 4: “Fecal Sex”
Where Dr. Cameron Ignores His Own Sources — Twice!
January 31, 2006; revised October 15, 2006
We’ve just completed a very uncomfortable description of what Dr. Cameron calls “rectal sex” Now that he has our attention, he’s is ready to crank up the volume with something he calls “fecal sex,” which is guaranteed to disgust his audience even further:
About 80% of gays (see Table) admit to licking and/or inserting their tongues into the anus of partners and thus ingesting medically significant amounts of feces. Those who eat or wallow in it are probably at even greater risk. In the diary study,5 70% of the gays had engaged in this activity — half regularly over 6 months. Result? — the “annual incidence of hepatitis A in… homosexual men was 22 percent, whereas no heterosexual men acquired hepatitis A.” In 1992,26 it was noted that the proportion of London gays engaging in oral/anal sex had not declined since 1984.
…Ingestion of human waste is the major route of contracting hepatitis A and the enteric parasites collectively known as the Gay Bowel Syndrome. Consumption of feces has also been implicated in the transmission of typhoid fever,9 herpes, and cancer.27 About 10% of gays have eaten or played with [e.g., enemas, wallowing in feces]. The San Francisco Department of Public Health saw 75,000 patients per year, of whom 70 to 80 per cent are homosexual men… An average of 10 per cent of all patients and asymptomatic contacts reported… because of positive fecal samples or cultures for amoeba, giardia, and shigella infections were employed as food handlers in public establishments; almost 5 per cent of those with hepatitis A were similarly employed.10 In 1976, a rare airborne scarlet fever broke out among gays and just missed sweeping through San Francisco.10 The U.S. Centers for Disease Control reported that 29% of the hepatitis A cases in Denver, 66% in New York, 50% in San Francisco, 56% in Toronto, 42% in Montreal and 26% in Melbourne in the first six months of 1991 were among gays.11 A 1982 study “suggested that some transmission from the homosexual group to the general population may have occurred.”12
5. Corey Lawrence; Holmes, King K. “Sexual transmission of hepatitis A in homosexual men.” New England Journal of Medicine 302, no. 8 (February 21, 1980): 435-438.
9. Dritz, Selma K.; Braff. Erwin H. Letter to the Editor: “Sexually transmitted typhoid fever.” New England Journal of Medicine 296, no. 23 (June 9, 1977): 1359-1360.
10. Dritz, Selma K. Editorial: “Medical aspects of homosexuality.” New England Journal of Medicine 302, no. 8 (February 21, 1980): 463-464.
11. Centers for Disease Control and Prevention. “Hepatitis A among homosexual men — United States, Canada, and Australia.” Morbidity And Mortality Weekly Report (MMWR) 41, no. 9 (March 6, 1992): 155, 161-164. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/00016243.htm
12. Christenson B.; Broström, C.; Böttiger, M.; Hermanson, J.; Weiland, O; Ryd, G.; Berg, J.V.R.; Sjöblom, R. “An epidemic outbreak of Hepatitis A among homosexual men in Stockholm.” American Journal of Epidemiology 116, no. 4 (October 1982): 599-607.
26. Elford, Jonathan; Tindall, Brett; Sharkey, Terry. Letter to the Editor: “Kaposi’s sarcoma and insertive rimming.” Lancet 339, no. 8798 (April 11, 1992): 938.
27. Beral, Valerie; Bull, Diana; Darby, Sarah; Weller, Ian; Carne, Chris; Beecham, Mary; Jaffe, Harold. “Risk of Kaposi’s sarcoma and sexual practices associated with faecal contact in homosexual or bisexual men with AIDS.” Lancet 339, no. 8793 (March 14, 1992): 632-35.
The middle of the second paragraph is difficult to understand. The incomplete sentence terminated by bracketed information and the sentences interrupted with ellipses (…) are original to the pamphlet. As before, this section continues to ignore lesbians, referring only to gay men.
Dr. Cameron’s abuse of legitimate research is now accompanied by a more alarmist tone. For example, the studies that he cites talk about anal-oral contact (sometimes referred to as analingus or “rimming”), but none of the studies mention “eating or wallowing in” feces. That phrasing is completely of Dr. Cameron’s creation.
Let’s go through each allegation one by one.
“About 80% of gays (see Table) admit to licking and/or inserting their tongues into the anus of partners… For this claim, he appears to refer to columns 2, 3 and 7 of the table of “Homosexual Activities” in the first section, which we’ve already covered:
The details of Paul Cameron’s ISIS Survey were first discussed here.
The details of the Beral, et al. study were first discussed here.
- Column 2: Jay & Young (#13) is the casual survey in which at least 98% declined to participate. The authors warn that their results are not representative.
- Column 3: is based on Dr. Cameron’s deeply flawed survey.
- Column 7: Beral, et al. (#27) studied a convenience sample of only 65 gay men from an STD clinic, all of whom were specially selected for their particularly risky behavior. The authors stated emphatically that these men did not represent the general gay male population.
The details of the Corey & Holmes study were first discussed here.
“Those who eat or wallow in it are probably at even greater risk. In the diary study, 70% of the gays had engaged in this activity…” Cory & Holmes (#5) simply does not support that charge. The authors discuss 41 out of 102 STD patients (only 40%) who reported “frequent oral-anal contact.” This is by no means the same as “eating or wallowing” in feces, nor does the figure for oral-anal contact come close to 70%. Dr. Cameron’s charge here is completely without foundation.
“Ingestion of human waste is the major route of contracting hepatitis A and the enteric parasites collectively known as the Gay Bowel Syndrome.” In 1976, an article appeared in the Annals of Clinical and Laboratory Science entitled, “The Gay Bowel Syndrome: Clinico-Pathologic Correlation in 260 Cases”.AAA This article, the first to use the term “gay bowel syndrome,” gave a two-part definition for the syndrome: 1) the patient suffers from at least one of 22 intestinal ailments and 2) the patient is gay. Some fifteen articles appeared in professional journals over the next decade, expanding the list of medical conditions to more than fifty items, but holding the second criteria the same: the patient is gay.
Using “gay bowel syndrome” as a medical diagnosis presents several problems. First, none of the conditions described in the literature were unique to gay men. This often placed researchers in the awkward position of warning that “these diseases are not unique to this patient population,”BBB or that “the term [gay bowel syndrome] is a misnomer, since it covers a variety of etiologically unrelated diseases…”CCC
Second, if a straight man were diagnosed with benign polyps or hepatitis (which are among the more than fifty conditions supposedly part of this “syndrome”) he automatically escapes the diagnosis of “gay bowel syndrome.” A straight woman with hemorrhoids who participates in anal sex with her husband also escapes this diagnosis. Yet a gay man with exactly the same medical condition would supposedly be given the diagnosis of “gay bowel syndrome”.
According to the Centers for Disease Control, two-year-olds constituted the age group with the highest incidence of shigellosis in 1982 when the term “gay bowel syndrome” was still being discussed in the literature.DDD But how would the condition, symptoms or treatment of a two-year-old be any different from a patient in a nursing home (30% of all cases that year were from resident care centers) or a gay man?
But now let’s imagine a doctor who is handed a patient’s chart with a diagnosis of “gay bowel syndrome.” Would he even begin to know how to treat the patient? Obviously not. After all, the best treatment for colon cancer is very different than that for benign polyps. And this is not a mere hypothetical exercise — there was one reported case of a gay man who had colon cancer, but was diagnosed with “gay bowel syndrome,” despite his family’s history of early colon cancer. This caused a huge delay before he received proper treatment — his cancer wasn’t discovered until he was admitted to the hospital.EEE His diagnosis of “gay bowel syndrome” didn’t even offer a hint as to what was wrong or what the proper course of treatment should be.
Conversely, if the patient were a straight man or woman, would the prescribed treatment be any different than that for a gay man with exactly the same medical condition, but diagnosed with “gay bowel syndrome?” Of course not. A straight woman with hepatitis A would undergo exactly the same course of treatment as a gay man with the same disease. A diagnosis of “gay bowel syndrome” is clinically useless.
But that’s not all. “Gay bowel syndrome” doesn’t even fit the clinical definition of a syndrome: “A set of signs or a series of events occurring together that often point to a single disease or condition as the cause [emphasis mine].”FFF The multitude of medical conditions which fall under the umbrella of “gay bowel syndrome” all have unrelated viral, bacterial or parasitic origins. They have nothing in common — no underlying medical cause ties them together, and there is no similar remedy for their cure or treatment. “Gay bowel syndrome” simply doesn’t meet the definition of “syndrome.”
This leaves us with the conclusion that the “gay bowel syndrome” is neither a gay condition nor a syndrome, nor does it have any useful clinical meaning. One medical professor outlined all of these weaknesses and more, clear clear back in 1985:
The “gay bowel syndrome” was first used to describe not a syndrome, but a list of conditions. The term hides the problems facing the gastroenterologist. Firstly, the sexual orientation of a patient may not be easily ascertainable in the setting of a general outpatient clinic. Secondly, many infections of the gay bowel are asymptomatic and are missed without full microbiological screening. Thirdly, coinfection is common and the organism isolated may not be causing the symptoms and signs. Finally, the bowel has limited and non-specific clinical and histopathological responses to many infections.GGG
The medical community (except for a few conservatives) has abandoned this term. Its mention in the medical literature died out by the early 1990’s, and it is now regarded as being without merit, a relic of bigotry and stigmatization. It lives on only in anti-gay literature, where it is sometimes used to justify discrimination against gay men (and oddly, lesbians, who are never mentioned in the literature describing this “syndrome”) in employment and the military.HHH
“The proportion of London gays engaging in oral/anal sex had not declined since 1984.” Elford, et al. (#26), a four paragraph letter to the editor, is not subject to peer review. The letter presents data from a study in Sydney, Australia, not London. They don’t describe how the study participants were selected or the methods used in the analysis, which makes the results unverifiable. They also don’t claim that their study consisted of a representative sample of gay men.
But before we leave this statistic, let’s look at Schechter, et al. (#25), another reference that Paul Cameron uses in Medical Consequences.III This is a letter to the editor entitled “Changes in Sexual Behaviour and Fear of AIDS”. By the title, you can guess what that letter is about — changes in behavior. The authors note a substantial decrease in the practice of rimming between 1982 and 1984, and say that other studies note similar decreases.
We know Dr. Cameron saw this letter — he uses it elsewhere in the same pamphlet and included it in his footnotes. But when it comes to examining the main thesis of the letter, he ignores it and uses another one that paints a picture more to his liking. But keep the Elford et al. letter in mind, because we will see him ignore it too when he decides that it is convenient to do so.
“Consumption of feces has also been implicated in the transmission of typhoid fever.” Dritz & Branff (#9) is not a study, and was never represented as such by the authors. Again, Dr. Cameron neglects to note that it is another letter to the editor. This letter describes only two cases of gay men who contracted typhoid over a two-year period. The letter doesn’t describe the type of sexual contact for either case, and it certainly does not describe these cases as being the result of “consumption of feces”.
It is true that the slightest contact with feces or urine from someone who is infected can result in the transmission of typhoid fever. This contact can be as simple as shaking hands or eating food prepared by someone who didn’t wash their hands after using the restroom. This is why signs are posted in restaurant washrooms reminding employees to wash their hands thoroughly before returning to work. It is also why many developing countries spend vast sums to educate their populations to wash their hands after using the restroom.
The authors note that both cases involve contact with foreign nationals (one man’s sexual partner was Mexican; the other’s, Portuguese). Because typhoid fever can be transmitted with minimal contact, travel to foreign countries is the single greatest risk factor for contracting the disease.JJJ
“Consumption of feces has also been implicated in the transmission of… cancer.” Beral, et al. (#27) did not study cancer in general. Instead, it was a very early study (published in 1992, based on populations recruited in 1982 and interviewed between 1984 and 1985) that investigated the transmission of Kaposi’s sarcoma, the extremely rare skin cancer that afflicted many people with AIDS. The authors erroneously concluded that fecal contact was a transmitting agent for Kaposi’s sarcoma, despite noting that Kaposi’s sarcoma was common in Africa and the Caribbean where AIDS is mainly a heterosexual disease. They also noted that hemophiliacs and intravenous drug users also came down with Kaposi’s sarcoma as well, which couldn’t be explained by fecal contact.
As soon as the article was published, it was immediately obvious that there were problems with Beral’s conclusions. Elford, et al. (#26) — the very same letter Dr. Cameron misused just a moment earlier, was one of four letters to the editor which disputed that study’s conclusions.KKK Two of the Beral, et al. authors (Valerie Beral herself, and Harold Jaffe) even contributed to a letter which partly refuted their own study’s conclusion. Amazingly Dr. Cameron ignores all of this, including the Elford et al. letter, which he had just cited in the previous paragraph. It’s as if he simply cannot let the evidence get in the way.
We now know that the human herpesvirus 8, a virus related to herpes and mononucleosis that is easily suppressed in a healthy immune system, can cause Kaposi’s sarcoma in weakened immune systems.LLL It has nothing to do with “consumption of feces.”
“About 10% of gays have eaten or played with [e.g., enemas, wallowing in feces].” (sic.) Dr, Cameron cites no source for this charge. Neither the Dritz letter to the editor (#9), nor Beral, et al. (#27), nor the Dritz editorial (#10) mentions any of this. His table of homosexual activities cites Jay & Young (#13) for claiming that 11% engage in “fecal sex – eating,” but not only did that survey suffer from a response rate of less than 5%, but there is no statistic offered anywhere for “fecal sex – eating” as Dr. Cameron claims in his table. (Jay & Young say that 11% of their adventurous men have had an enema at least once in their lifetime, but this isn’t equivalent to eating or any other fecal contact.MMM)
“An average of 10 per cent of all patients and asymptomatic contacts reported...” Dritz (#10) is an editorial, not a study. Dr. Dritz stated that her figures were from the Venereal Disease Clinic only, not the entire Department of Public Health as Dr. Cameron claims. Because the figures were only anecdotal estimates from among STD patients, they exaggerate the extent of problems among the healthy gay population as a whole.
“…a rare airborne scarlet fever broke out among gays and just missed sweeping through San Francisco.” The Dritz (#10) editorial mentions a rare incidence of scarlet fever among a few gay men in 1978. She is able to offer little information about the incident, saying that the reasons a wider outbreak didn’t occur are unknown.
Since scarlet fever is not sexually transmitted, its appearance in the gay community is considered coincidental. Appearances of unusual diseases emerge and disappear quite often in many communities, whether it’s Legionnaires disease, hepatitis, ebola, or the common cold. According to the CDC, scarlet fever is caused by the same bacteria that causes strep throat, and it is easily treatable with penicillin. Even without medical treatment, most patients fully recover within two weeks.NNN
Dr. Dritz’s editorial emphasizes the need for physicians to put aside their personal biases when treating gay men and women. She noted that due to social stigmas, gay men and women may not be comfortable sharing their health problems with their physicians, and this “may result in failure of therapy for a patient in need of skilled medical assistance.” She mentioned the scarlet fever incident in passing as an example of a disease that could have gone unnoticed in the community if gay men had not contacted their physicians. Unfortunately, Dr. Cameron uses Dr. Dritz’s call to set aside anti-gay bigotry to reinforce anti-gay bigotry.
“29% of the hepatitis A cases in Denver, 66% in New York, 50% in San Francisco, 56% in Toronto, 42% in Montreal and 26% in Melbourne in the first six months of 1991 were among gays.” Dr. Cameron runs a bit roughshod over the CDC (#11) report:
- The 29% statistic for Denver included bisexuals, and was a sample of only 24 men.
- The 66% statistic for New York does not appear anywhere in the CDC’s report.
- The San Francisco statistics in the report were cases reported from January through November 1991, not the first six months. It’s not clear how Dr. Cameron derived the 50% statistic. It doesn’t appear in the report. There were 350 hepatitis A cases reported to the city’s Department of Public Health during the period, 293 whom were men. But of only 237 men interviewed, 186 identified themselves as homosexual or bisexual.
- The 56% figure for Toronto was only from among a smaller sample of men aged 20-49 years old, and does not represent a comprehensive statistic for that city.
- The 42% figure for Montreal was only for 45 men who engaged in homosexual activities.
- The 26% figure for Melbourne was actually for the entire state of Victoria, and consisted of only 35 men who engaged in homosexual activities.
The CDC report began by noting that “the frequency with which homosexual activity was reported by persons with hepatitis A was less than 10% during 1982-1989.” But by 1991, the CDC noted an increase in reports from several cities of hepatitis A among homosexual and bisexual men. Because hepatitis A outbreaks typically occur in waves over relatively short periods of time in close-knit communities, this report was intended to serve as an early warning to ward off a wider outbreak. This same CDC report noted an ongoing outbreak in an un-named traditional ethnic/religious community in Brooklyn. But look at the numbers again: 24 homosexual men in Denver, 186 in San Francisco, 45 in Montreal, 35 in Melbourne. This is hardly the stuff of widespread epidemics. Meanwhile, some European studies failed to note any difference in infection rates between gay and straight men.OOO
The CDC report does conclude that gay men are at a higher risk of acquiring hepatitis A in the U.S., but according to the CDC hepatitis A is easily preventable. Not only is a vaccine available, but once a person has acquired hepatitis A, that person then becomes immune to it, much like chicken pox. The CDC notes that about one-third of all Americans are immune due to past infections.
Between 1987 and 1997, hepatitis A was a general population disease most commonly found among children, especially those living throughout the American west, southwest, the southern plains and Alaska.PPP Hepatitis A peaked at 35,822 cases in 1989. But when a vaccine became routinely administered in the 1990’s, the number of cases dropped significantly. Only 7,653 cases were reported in 2003.QQQ
“Some transmission (of hepatitis A) from the homosexual group to the general population may have occurred.” Dr. Cameron truncated that statement from Christenson, et al. (#12). The following sentence said they found no evidence to support that assumption.
You should be — you’d probably be crazy not to be. And it appears that is exactly Paul Cameron’s intention. You can read more about it in “Paul Cameron and the Authority of Science.”
Yes, you read that right — it’s not a typo. Dr. Cameron finds it convenient to ignore evidence of identical heterosexual activity in his own survey.
His report (“Effect of Homosexuality upon Public Health and Social Order”, #6) showed that 355 heterosexual men and 670 heterosexual women participated in oral-anal contact verses 38 gay men and 13 gay women.RRR. If his survey were correct, then far more straight people are engaging in oral-anal contact (what he calls “feces-eating” in this pamphlet) than gays — by a factor of more than 20:1.
Of course, there are too many problems with his survey to conclude that these statistics are representative of the heterosexual population, although it does indicate that analingus is not exclusive to gay people. But this doesn’t stop Dr. Cameron from depicting gays as being depraved disease-laden “fecal-eaters”. The provocative and shockingly lurid descriptions he uses in this section was specifically designed to shock and disgust the reader, and he does this by not only misrepresenting the evidence in front of him, but ignoring counter evidence that is also right in front of him. With his treatment of the Schechter and Elford letters in particular, it appears that he has no regard for the truth. Passing this off as “science” is simply absurd.
Please continue with:
Part 5: “Urine Sex”. Because Dr. Cameron isn’t finished with talking about bodily wastes.
AAA. Kazal, Henry L.; Sohn, Norman; Carrasco, Jose I.; Robilotti, James G., Jr.; Delaney, William. “The gay bowel syndrome: Clinico-pathologic correlation in 260 cases.” Annals of Clinical and Laboratory Science 6, no. 2 (March 1976): 184-192.
BBB. Kazal, Henry L.; Sohn, Norman; Carrasco, Jose I.; Robilotti, James G., Jr.; Delaney, William. “The gay bowel syndrome: Clinico-pathologic correlation in 260 cases.” Annals of Clinical and Laboratory Science 6, no. 2 (March 1976): 184-192.
DDD. Centers for Disease Control and Prevention. “Shigellosis — United States, 1982.” Morbidity and Mortality Weekly Report 32, no. 34 (September 2, 1983): 449-450. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/00000132.htm.
FFF. Dept. of Medical Oncology, University of Newcastle upon Tyne. Online Medical Dictionary Web page (October 1997): http://medical-dictionary.com; accessed December 15, 2004.
III. Schechter, M.T.; Jeffries, E.; Constance, P.; Douglas, B.; Fay, S.; Maynard, M.; Nitz, R. Willoughby, B.; Boyko, W.J.; MacLeod, A. Letter to the Editor: “Changes in sexual behavior and fear of AIDS.” Lancet no. 8389, vol 1 (June 9, 1984): 1293.
Peterman, Thomas A.; Friedman-Klein, Alvin E.; Jaffe, Harold W.; Beral, Valerie. Letter to the editor: “Kaposi’s sarcoma and exposure to faeces.” Lancet 339, no. 8794 (March 14, 1992): 685-686.
Page-Boykin, Kimberly; Tappero, Jordan; Samuel, Michael; Winkelstein, Warren. Letter to the editor: “Kaposi’s sarcoma and faecal-oral exposure.” Lancet 339, no. 8807 (June 13, 1992): 1490.
Matondo, Patrick. Letter to the editor: “Kaposi’s sarcoma and faecal-oral exposure.” Lancet 339, no. 8807 (June 13, 1992): 1490.
LLL. American Cancer Society Kaposi’s Sarcoma web page (October 7, 2005): http://documents.cancer.org/159.00/159.00.pdf.
NNN. Centers for Disease Control and Prevention. Scarlet Fever – General Information web page (October 13, 2005): http://www.cdc.gov/ncidod/dbmd/diseaseinfo/scarletfever_g.htm.
“Streptococcal Infections.” The Merck Manual of Medical Information. Home Edition. Robert Berkow, ed. (New York: Simon & Schuster, 1997): 875-877.
OOO. Ballesteros, J.; Dal-Ré, R.; Gonzáles, A.; del Romero, J. “Are homosexual males a risk group for hepatitis A infection in intermediate endemicity areas?” Epidemiology and Infection 117, no. 1 (August 1996):145-148.
Corona, R.; Stroffolini, T.; Giglio, A.; Cotichini, R.; Tosti, M.E.; Prignano, G.; Di Carlo, A.; Maini, A.; Mele, A. “Lack of evidence for increased risk of hepatitis A infection in homosexual men” Epidemiology and Infection 123, no. 1 (August 1999): 89-93.
Nandwani, R.; Caswell, S.; Boag, F.; Lawrence, A.G.; Coleman, J.C. “Hepatitis A seroprevalence in homosexual and heterosexual men.” Genitourinary Medicine 70, no. 5 (October 1994): 325-328.
PPP. Centers for Disease Control and Prevention. Hepatitis A Fact Sheet web page (August 16, 2005): http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm.
QQQ. Centers for Disease Control and Prevention. Disease Burden from Hepatitis A, B, and C in the United States web pages (August 16, 2005): http://www.cdc.gov/ncidod/diseases/hepatitis/resource/dz_burden02.htm.