How anti-gay bias is spoiling medical trials

A new report finds gays and lesbians excluded from clinical studies -- a move that's both unethical and dangerous

By Nancy Walton

How anti-gay bias is spoiling medical trials

Topics:LGBT

This post originally appeared on The Research Ethics Blog, on Open Salon (and researchethicsblog.com).

A recent story from CBC news has uncovered that in the US, clinical trials are being done from which potential participants who identify as gay or lesbian are being excluded. This trend was uncovered by a biostatistician who was gathering data on enrollment into cancer studies and found that, in a couple of studies he came across, sexual orientation was used as a screening tool and, ultimately, an exclusion criteria. After reviewing exclusion and inclusion criteria on more than 80,000 studies on ClinicalTrials.gov, a registry of clinical trials in the USA, he and his colleagues found that it wasn’t just a fluke he had uncovered in one or two studies, but a noticeable trend in a percentage of clinical trials.

Here’s the story: Gays, lesbians excluded from U.S. trials: MDs

The letter in Thursday’s New England Journal of Medicine includes examples of 37 studies out of 243 searched or 15 per cent that had explicit exclusionary language, such as requiring participants to be “in a reciprocal relationship with a person of the opposite sex.” Some trials are restricted to heterosexual patients because of the nature of the study, such as how HIV spreads between heterosexual partners. But the researchers also found trials where there is no clear need to exclude lesbians and gay men, including a clinical trial of attention deficit-hyperactivity disorder.

While some might say, well, that isn’t a huge number of studies in which this discriminatory and seemingly irrational practice has been employed, so why is this so worrisome? Here’s why. Clinical research has a long history of trying to do one thing: prove that a hypothesis is correct. Best case scenario? Proving, through a randomized controlled trial — still considered the gold standard of scientific evidence — that x does in fact directly cause y. And the one thing that scientists don’t like when trying to clearly demonstrate a correlation or cause? Confounding factors, i.e. things other than x, that might be causing y. So for many years in many studies, care was taken only to include participants who made up a relatively homogeneous group in order to minimize confounding factors. The result? We learned a lot about older, white males because they were the most dominant and powerful group. We learned about how heart disease affects older, white males. What a heart attack looks like in an older white male. How medications to treat chronic hypertension work in older, white males. You get the idea. Meanwhile a whole bunch of black men were dying from hypertension. Little to nothing was known about the disease, how to prevent it or treat it, in black men.

If we look back at clinical research, we see that many already-marginalized groups and those felt to be more vulnerable have been purposefully excluded from research. Non-whites, children, women, pregnant women, persons with mental illnesses, Aboriginal persons, the elderly, etc. While sometimes these exclusions have been for well-intentioned reasons, they often aren’t scientifically justified. What happens is that, as a clinical community, we end up knowing very little about the health, illnesses and medication tolerances of these excluded groups — and like the case of hypertension in older men, there may be some significantly different effect or tolerance that clinicians should and must know about.

Sometimes it makes sense to exclude particular groups. If you’re conducting a study on the effect of certain hormonal medications on peri-menopausal women, then it makes sense to exclude men. But does it make sense to exclude non-white women, gay or bisexual women? Since menopause is a reality for all women, it really doesn’t make sense. If you’re conducting a clinical trial to find the ideal dose of a medication to treat SARS, it doesn’t make much sense to conduct trials that might exclude women or children. SARS certainly isn’t selective about who to infect. Knowing little to nothing about what is considered a safe dosage or medication for a pregnant woman or a child presenting in an emergency room with SARS can directly result in serious negative outcomes, and even death.

The exclusion of gays and lesbians, without one good scientifically sound reason, shouldn’t be tolerated by the clinical community for two reasons. First, it’s blatant discrimination, and without clear scientific rationale, seems simply like someone’s political agenda making its way into scientific exclusionary criteria. Second, it seems clear that allowing this on any level implies we might well look the other way when faced with discriminatory clinical or research practices like this which have already been clearly shown, through history, to be far from beneficial.

Here’s the letter that the biostatistician along with other colleagues, wrote to the New England Journal of Medicine, uncovering their findings on this practice: Clinical Trials That Explicitly Exclude Gay and Lesbian Patients.

: More Nancy Walton

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An offensive advocate for LGBT rights

By choosing Goldman CEO Blankfein as a spokesman, HRC signals that corporate malfeasance is perfectly acceptable

By David Sirota

Lloyd Blankfein (Credit: AP/Alessandro della Valle)

Topics:Wall Street, LGBT

Last week, the Human Rights Campaign, the organization that advocates for equal rights for gay, lesbian, bisexual and transgender people, announced that Goldman Sachs CEO Lloyd Blankfein will be its first “national corporate spokesman for same-sex marriage.” HRC’s move was almost universally portrayed in the media as a laudable one for the cause of equality: a supposed Nixon-goes-to-China-esque coup that aligned a politically conservative icon with a liberal cause. As one HRC executive told the New York Times: “Lloyd Blankfein is not someone average Americans would think is going to support marriage equality.”

In all the ovation and self-congratulation, however, two big problems were left unmentioned.

First and foremost is the simple fact that this is not some brilliant P.R. move in the Nixon-to-China vein. On the contrary, many (though certainly not all) Wall Street financiers have long professed their support for gay rights, culminating in their pivotal role helping legalize gay marriage in New York state. That’s, in part, because it’s an effective strategy to divert attention from their economic agenda.

Taking a page out of corporate greenwashing strategies, many of the most offensively greedy, right-wing thieves in the business world have long touted their personally progressive position on select social issues like gay rights as a means of publicly presenting themselves as Good and Decent People. Not surprisingly, the particular progressive causes they choose tend to be those that do not impact their businesses or personal economic situations. In some cases, in fact, these thugs seem as if they are leveraging their stands on such progressive issues as a quid pro quo bargaining chip for their personal financial interests. As just one example of where that kind of dynamic may have played out, recall that almost immediately after Wall Streeters underwrote Democratic Gov. Andrew Cuomo’s campaign to legalize gay marriage, Cuomo launched a public (though ultimately unsuccessful) campaign to halt the extension of a so-called millionaires tax on those same Wall Streeters.

This isn’t to say that Wall Streeters’ support for marriage equality isn’t a good thing; it most certainly is. (As a strong supporter of marriage equality, for instance, I’m glad those Wall Streeters helped New York State legalize gay marriage.) It’s only to say that Blankfein’s support of gay marriage isn’t some hard-to-believe coup; it’s probably exactly what many “average Americans” would expect from a Manhattan investment banker.

That gets to the second, even bigger problem: What, then, is the movement for equal rights really saying to “average Americans” when that movement promotes someone like Blankfein as its chief public spokesman? And what is the muted reaction to the HRC announcement saying about what is acceptable in America?

To answer that question, consider who Blankfein is — and recall specifically that he is not some quiet, buttoned-up executive in a staid manufacturing industry, nor is he known as a new Lee Iacoca or Steve Jobs — aka a person widely revered (rightly or wrongly) for how his innovation and business savvy (supposedly) helped the world. On the contrary, Blankfein is the singular — and rightly detested — poster boy for the lies, crimes and avaricious schemes that destroyed the economy, impoverished millions of Americans and ripped off taxpayers.

This is a man who refused to tell Congress the truth about the basic facts of how the firm he led bet against — and profited off — the destruction of the American economy. As Rolling Stone’s Matt Taibbi documented, in 2010 Blankfein “went to Washington and testified under oath that Goldman Sachs didn’t make a massive short bet and didn’t bet against its clients” — even though the Senate’s “Levin report proves that Goldman spent the whole summer of 2007 riding a ‘big short’ and took a multibillion-dollar bet against its clients, a bet that incidentally made them enormous profits.” Blankfein’s lying was so egregious, the Senate Subcommittee on Investigations has recommended that the Justice Department consider perjury charges against him.

Blankfein is also the CEO who oversaw Goldman at the very moment that the firm engineered the infamous Abacus deal, a deal that was so insidious, that it ultimately drew a record $550 million fine from the Securities and Exchange Commission. Lately, he’s made headlines personally lawyering himself up in preparation for possible criminal prosecution, which is probably a smart move because he’s already being formally deposed in a civil lawsuit related to the SEC settlement. And, of course, this says nothing about Blankfein and Goldman’s central role in the deceptive mortgage securitization schemes that, ya know, cratered the entire global economy.

Considering all of this through the prism of HRC’s decision to promote him and the political/media world’s supportive reaction to that decision, we see a disturbing message: namely, that in America, if you commit the most odious economic crimes against humanity, you can not only get taxpayers to bail you out, you can not only keep your job atop the most powerful corporations, but you get to keep your social status as well. In this case, you get to be promoted as the cheery spokesman of a progressive social cause.

This elucidates a troubling double standard between how we see civil rights/equality and how we see economic justice. Most mainstream organizations (and certainly all progressive organizations) would never willfully brand themselves to opponents of the former — that is, they would never make their spokespeople open proponents of bigotry, prejudice and homophobia, and they would never do so in the name of reaching “average Americans” (yes, there are of course still groups like Focus on the Family and the Family Research Council that align themselves with that kind of hate, but at least as they do so it’s considered controversial and cause for widespread criticism). Yet, when a group pushing the progressive cause of civil rights and social equality promotes one of the avatars of economic injustice as a spokesman, there’s either no criticism at all — or widespread applause.

To be sure, when it comes to divisive political issues, there are no perfect high-profile spokespeople for public awareness campaigns. Everyone has a flaw, nobody is pure, and almost nobody is universally liked. But there’s a clear and obvious difference between imperfect and villainous. When a progressive group refuses to find the former and instead willfully aligns itself with the latter, it may help the specific and worthy cause at hand in the short term (in this case, marriage equality). But over the long haul, it sanitizes that villain and, worse, helps legitimize all he represents — including all the terrible things he represents.

That’s why Blankfein probably jumped at the chance to be HRC’s spokesperson — it’s a great deal for him, even as it gives the big middle finger to the millions of Americans he harmed in this recession.

: David Sirota is a best-selling author of the new book "Back to Our Future: How the 1980s Explain the World We Live In Now." He hosts the morning show on AM760 in Colorado. E-mail him at ds@davidsirota.com, follow him on Twitter @davidsirota or visit his website at www.davidsirota.com. More David Sirota

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Is gay literature over?

In an era of same-sex marriage and "Modern Family," the role of gay writers is changing. An expert explains how

By Thomas Rogers

Gore Vidal, Tony Kushner and James Baldwin (Credit: Library of Congress/Carl Van Vechten/Reuters/Phil McCarten/Miami Dade College)

Topics:LGBT, Writers and Writing, Editor's Picks

Gay life in America has utterly transformed itself since World War II. In the 1950s, homosexuality was a crime. Now, openly gay people are everywhere in popular culture, gay kids are coming out as early as elementary school and we can get even get married in a half-dozen states (including, soon, Washington). One of the most crucial, but least-talked about, reasons for this change is gay literature. Starting in the 1940s, a coterie of bold writers — Gore Vidal, James Baldwin, Armistead Maupin and Tony Kushner, among many others — played a central role in creating what we now think of as gay life. Their words gave voice to a segment of the American population that, for much of its history, was hidden away.

In his new book, “Eminent Outlaws,” novelist Christopher Bram uses a series of complex portraits of America’s most influential gay literary lions to argue for their position in the pantheon of American culture. The book covers expansive territory, charting the tumultuous relationship between Gore Vidal and Truman Capote, whose passionate hatred for one another lasted until the latter’s death (Vidal called it a “good career move”). It describes Tennessee Williams’ tortured relationship with his sexuality and gradual descent into alcoholic misery, James Baldwin’s struggles against racism and Edmund White’s eloquent reactions to the terror of AIDS. For anybody interested in gay culture, “Eminent Outlaws” offers a crucial and fascinating overview of decades of American literary history. It also raises the question: In an era when being gay is considered mainstream, does gay writing still matter?

Salon spoke to Bram (who is also the author of “The Father of Frankenstein,” which was later turned into the film “Gods and Monsters”) over the phone about Gore Vidal’s importance, the death of the gay bookstore and the problem with gay men today.

As you point out in the book, literature has had an outsize role in the evolution of gay culture. Why do you think that is?

For the longest time, there were no gay characters or story lines in television or in the movies, so people had nowhere else to go but books for stories of gay life. After WWII there was suddenly a slew of them. It was surprising how many came so quickly. People could and wanted to write about it and the publishers would publish it. In my book I emphasize Capote’s “Other Voices, Other Rooms” and Gore Vidal’s “The City and the Pillar,” but there were others. The mainstream houses backed away from gay material in the ’50s but it was picked up by smaller presses, like Greenberg and Guild. Once it started it couldn’t stop.

Why do you think the gay literary explosion happened right after World War II?

It was partly WWII itself. Gay boys who had grown up in the middle of nowhere entered the service, and found out they weren’t alone. Alan Berube, in his book “Coming Out Under Fire,” does a great job of painting this sudden awareness and huge change. Gay people also wanted to read about each other, and after WWII censorship for books loosened. Before, cities would ban any book with sexual content, and after WWII people could write about sex, even gay sex.

Gore Vidal is the major thread connecting the book. Do you think he’s the most important figure in gay literature of the last 50 years?

Yes, but almost by accident. It’s not a role he wanted. “The City and the Pillar” is a very gay book published early on in 1948. It sold very well but he got kicked in the teeth for writing it, and after that he played a little more coy. He adopted the strategy that there’s no such thing as a homosexual, there’s only a homosexual act; homosexual is an adjective and not a noun. He wrote “Myra Breckinridge” in the ’60s, which is this wonderfully polymorphously perverse novel about a transsexual who rapes a straight man at one point. It’s over the top and out there and was a huge bestseller. Then he started writing historical novels, which hardly dealt with homosexuality. But one of the most amazing things he wrote from a gay political point of view is the essay “Pink Triangle, Yellow Star,” which was sparked by a very foolish bizarre essay by Midge Decter about gay men and their identity. He tore her essay to shreds, but he also argued that Jews and homosexuals had a lot in common, that they were both minorities that are in the same boat.

In the last few years we’ve seen the disappearance of a lot of gay bookstores around the country. What do you think this says about the state of gay literature?

That is a major change and it’s an important and worrisome one. There are a couple of factors causing it. Independent bookstores have been in trouble for a while, struggling to compete first with super-chains and then Amazon and the Internet. Now the whole book business is going to transition, and even the super-chains are in trouble. Gay bookstores were always just keeping their heads above water. But I don’t think it says so much about gay books in particular as it does about the book business.

Edmund White once wrote that “‘Will & Grace’ killed gay literature.” Do you think he’s right — that the rise of gay TV and movies has made gay writing less appealing?

I think it’s reduced the gay readership by 10 or 15 percent — not a huge amount. And those were the people who didn’t really enjoy reading anyway. For them, it was their only way to get gay stories. Now they don’t have to. Independent film has dried up the same way indie bookstores have, so there’s not as much gay film as there used to be just 4-5 years ago, but the change in TV is phenomenal. These shows matter-of-factly include gay story lines and characters and do really good jobs with them. They’re not just here as comic relief, they’re really fully fleshed out, well-drawn characters. These TV shows are following in the footsteps of Armistead Maupin’s “Tales of the City” by including gay characters in this larger world.

Larry Kramer has very forcefully argued that young gay people these days don’t respect their elders or their history. Do you get the sense that young gay men today are less interested in gay culture and literature than they were in the past?

Not really. I don’t think the current younger generation is different from mine or even Larry’s. In my generation, we hated our elders. We might like Christopher Isherwood, but there was a dislike of the older generation: “They got it all wrong, we’re going to get it right.” I think that’s a natural generational dynamic; as time goes on you learn to keep what was good from the older generations and drop what was bad. I like the generations being different. Every generation wants to carve out their own space and to some extent it’s going to mean rejecting the older generation.

But Larry Kramer isn’t alone in feeling hurt by this. What do you think spurs this particular kind of anger among older gay men?

You’re getting older and you know you’re going to die, and you’re not happy about that, so you take out your anger on the generation coming behind you. I teach at NYU, so I work with people in their early 20s and I expect us to have nothing in common but I’m always surprised by the books they like, the movies they like, the things we do have in common.

I also think older gay men are pissed off that young gay men seem entitled and don’t seem to know what gay life was like in the ’50s, ’60s, ’70s, and especially the ’80s, during the first wave of the AIDS crisis.

Why should they know it? When they are aware of it, I’m pleased but I don’t expect them to. They’re lucky they didn’t grow up with the hardships Larry’s generation grew up with. My generation didn’t have it as harsh as Larry’s did, but I had it a little harsher than yours. It’s only natural. You just kind of have to accept that.

In his famous essay in the Atlantic, Andrew Sullivan argued that we’re witnessing the “end of gay culture,” that it’s splintering and dissolving as a result of mainstream acceptance.

Old gay culture wasn’t that solid to begin with, and [literary gay men] were always a minority within a minority. Even when gay books were the only game in town, there were plenty of gay people who didn’t read. For them being gay was about sex and going to bars and dancing. There’s still gay culture around and it takes different shapes and forms. Gay bars don’t play the same role in gay life they once did 10-15 years ago. The Internet has changed that too. I miss the gay bookstores, but I like the difference and the variety.

Do you think there’s such a thing as a gay sensibility in literature?

When Jeff Weinstein, the New York culture critic, was asked if there was a gay sensibility and if it affected culture, he said, “No, there’s no such thing as a gay sensibility and yes, it does affect culture.” I feel that way. The only thing holding these men together is that these were men who were sexually attracted to men who would write about it and about how that mixed with the rest of their lives. For some writers, [their gayness] was just one more ingredient in the stew, like Armistead Maupin. For some, sex and love with other men was everything, like Edmund White. But even he mixed things up. His new book is about the friendship between a gay man and a straight man (though I think his best writing is his sexual writing).

Speaking of Edmund White, he has very strong feelings about writers, like Susan Sontag, who were famous but did not come out of the closet.

I think if she had actually written as a lesbian about lesbian life it would have given a whole other dimension to her work and she would have been a much more interesting and exciting writer than she was. But I just think of her as a writer [not a gay writer]. The other writer he talks about is Harold Brodky. Being unable to write directly about gay life made his prose weird and baroque and really blocked him as a writer. For me, their being in the closet becomes its own punishment.

A friend of mine recently told me that he thought we just don’t have the kinds of great gay literary writers that we used to. I think we do, they’re just not known as primarily gay writers. Do you think that’s true?

There’s good stuff being done by younger writers than the old war horses. It just hasn’t gotten the attention it deserves. Paul Russell just did an amazing book last year called “The Unreal life of Sergei Nabokov,” following Vladimir Nabokov’s gay brother from pre-revolutionary Russia to Paris in the time of Cocteau to Nazi Germany. Peter Cameron’s last book, “Someday This Pain Will Be Useful to You,” was very smart and beautifully written. Bob Smith, a comedian, did a wonderful novel called “Remembrance of Things I Forgot,” about a gay man who travels through time to help his family and discovers he’s been pursued by that arch-villain Dick Cheney. And then there’s Rakesh Satyal, and the novel he published two years ago, “Blue Boy,” about a gay 12-year-old boy in an Indian family in Cincinnati.

What gay books would you recommend as must-reads to a gay kid coming of age right now.

You could do far worse than Armistead’s Maupin’s “Tales of the City”; the entire series would be a great education in itself. Maupin imagines and records this world in San Francisco where gay people are just one more piece of the puzzle and accepted as such. And there’s “Giovanni’s Room” by James Baldwin. It’s set in Paris in the 1950s, about a gay man who almost comes out but doesn’t. It’s very painful, beautifully written and it would show him what we’ve come away from. I’ll be selfish and recommend one of mine, “Surprising Myself.” It was my first novel, published in like 1987, and it’s set in New York in the ’70s — the sexual golden age.

: Thomas Rogers is Salon's deputy arts editor. More Thomas Rogers

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Ellen stands up to One Million Moms

A conservative group calls for her removal from a JC Penney campaign, but the host responds with humor and heart

VIDEO

By Mary Elizabeth Williams

Ellen DeGeneres

Topics:LGBT, Ellen Degeneres, Consumerism

The conservative Christian group One Million Moms is angry. Angry like just-missed-an-awesome-sale angry. Sure, the down-home-sounding offshoot of the reliably right-wing American Family Association exists in a perpetual state of twisted knickers. It’s whipped itself into a frenzy of indignation at the not-quite-exclusionary-enough tactics of Macy’s, Levi’s, Jenny Craig and Oreos in just the past few months. But its outrage at JC Penney, the jeans supplier to at least 800,000 of those million moms, is especially intense of late.

At issue is the group’s contention that by hiring Ellen DeGeneres for a new campaign, the department store is “jumping on the pro-gay bandwagon” and turning away from “traditional families.” The organization warns darkly that “Unless JC Penney decides to be neutral in the culture war then their brand transformation will be unsuccessful.” There is so much to love in that sentence alone. Culture war! Brand transformation! Fearless disregard for the rules of comma usage after a subordinate clause! “The majority of JC Penney shoppers will be offended,” they continue, “and choose to no longer shop there.”

JC Penney, however, which recently declared that “We share the same fundamental values as Ellen,” has remained unmoved from its perch on a “pro-gay bandwagon” in the midst of a “culture war.” (I hope that bandwagon is reinforced.) Also unmoved: the woman at the center of the controversy.

On her daytime talk show Wednesday, DeGeneres cheerfully opened by talking about Proposition 8 being overturned in California, then segued into a riff about her partnership with Penney’s. “Normally I try not to pay attention to my haters,” she said, “but this time I’d like to talk about it.”

After announcing she was “proud and happy” that JC Penney was sticking by her side, she explained to America that “Being gay or pro-gay is not a bandwagon. You don’t get a free ride anywhere. There’s no music, and occasionally we’ll sing, ‘We Are Family,’ but that’s about it.” And she noted that “For a group that calls itself the Million Moms, they have only 40,000 members on their [Facebook] page. They’re rounding to the nearest million.” It was a witty retort to a campaign of hate, though frankly, not nearly as hilarious as the Million Moms’ depiction of DeGeneres as an “open homosexual spokesperson.”

On her show, DeGeneres read some of the hundreds of supportive messages that have been posted on the Million Moms’ own Facebook page since their campaign against her launched. DeGeneres has also received public support from, of all people, Bill O’Reilly, who said on his program Tuesday that the protest was “a witch hunt and shouldn’t happen.” When you’re too loathsome for Bill O’Reilly, you’ve really outdone yourself, loathsomeness-wise.

One Million Moms describes itself as an organization for people who are “fed up” and “tired,” one that devotes itself, seemingly exclusively, to complaining “on behalf of our children.” On her program Wednesday, DeGeneres said, “I stand for honesty, equality, kindness, compassion, treating people the way you want to be treated, and helping those in need. To me, those are traditional values.” Even the most die-hard shopper knows that values aren’t just reasonably priced furnishings from the Cindy Crawford collection. They’re how you live. And if you’re going to be on a bandwagon, who wouldn’t choose the one without all those angry people on it?

: Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams

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Praying to be skinny and straight

An expert explains what evangelical weight-loss and ex-gay movements say about America -- and us

By Hannah Tepper

Interview with the author of Skinny and Straight

(Credit: iStockphoto LincolnRogers)

Topics:LGBT, Religion, Editor's Picks

Fatness and gayness have a few things in common: They are both highly charged social issues that can anger people in ways few other things can. To many people, they both represent a sinful inability to control urges – in the case of fat folks, to eat food, and in the case of gay people, to have sex. In evangelical circles, however, fatness and gayness are not just stigmatized, they are actively fought.

In her eloquent new book, “Seeking the Straight and Narrow: Weight Loss and Sexual Reorientation in Evangelical America,” Lynne Gerber examines the ways these two separate issues interact in that most morally stringent segment of American culture. A University of California, Berkeley, scholar in residence whose work emphasizes intersections of sexuality, bodies and health in contemporary Christianity, Gerber spent more than three years documenting evangelical weight loss and ex-gay culture, primarily in two evangelical ministries, First Place, a weight loss group, and Exodus, an ex-gay ministry with aims to train gays into straightness. Along the way, Gerber unpacks the historical influence of evangelicalism on American society, while providing a thoughtful look at real people struggling to change.

Salon spoke with Gerber over the phone about her new book, out this week from University of Chicago Press. She was kind enough to share her opinion on everything from how fatness and gayness are valuable points of comparison, the often heartbreaking measures “ex-gays” take to curb same-sex urges, and how evangelicalism is a little bit queer sometimes.

In the book, you focus on two specific evangelical ministries: Exodus, a moderate ex-gay group organized around helping members overcome homosexuality, and First Place, a weight-loss ministry. Why were these important groups to compare and contrast?

I have often been interested in the intersection of fatness and homosexuality. They are both places where there is a lot of social energy, and social hatred toward people who represent fatness and gayness. If you think about what fatness and gayness represent, they are similar. One is a sort of excess; the idea that fat people have this excessive desire for food, and gay people are depicted as having this excessive sexual tendency. Excess is directly linked to social efforts to control those excesses, to get fat people down to size and gay people into the “correct” sexual orientation.

In ex-gay ministries, they have a somewhat psychoanalytic explanation for how homosexuality develops in childhood. What is their theory exactly?

They draw on some pretty psychoanalytic ideas to explain their theory. Basically the theory is that homosexuality is not a problem of sexual attraction to people of the same sex, it’s a problem of gender identification. So if I am a homosexual man, the issue is not so much that I want to sleep with other men, it’s that I don’t see myself as adequately masculine enough. The idea is that people are attracted to what they feel that they are not. So if I am a hypothetical gay man, that means that I think of myself as more female (because they frame it with only two genders). Their idea is that to shift sexual orientation one needs to shift one’s gender identity. A hypothetical gay male needs to start feeling more grounded in his masculinity in order to find his attraction toward women. They say that a homosexual person’s “gender deficiency” is the result of a breakage in the relationship between the same-sex parent during childhood. It’s interesting because this can be anything from abuse to perceived abuse to perceived neglect. It can be anything from the most intentional egregious violation on the part of the same-sex parent to the most unintentional slight that the child experienced.

In the book you explain that Exodus has to maintain this delicate balance; to make gay people feel accepted while at the same time attempting to fundamentally change who they are. How do they manage this?

What they want to do with these “strugglers” is give them a place. They really don’t want people with same-sex desire to leave the church, because their thinking is that once they leave the church, they go into the gay culture and they’re lost forever. They want to give them a place that feels like a home within the church. On the other hand, they believe that homosexuality is a sin, and they have to emphasize that homosexuality is a sin if they want their institutional allies. Ex-gay ministries have this paradoxical effect where people who are struggling with same-sex desires can be out about those desires, there is a place where they can talk about it without getting kicked out, there’s a place where they can acknowledge it, but they have to acknowledge it as “ex-gay.” So that’s the price.

There’s a chapter in the book that I found really compelling about the differences between change in theory and change in practice within the ministries.

In the book I argue that in evangelical culture there is a deep impulse to make a conscious initial choice about one’s faith. To choose God, recognize oneself as a sinner, and make a choice to become a disciple of Christ is a very strong value in evangelical culture. The notion is that this decision becomes a real place where all kinds of transformations can happen: The sinner becomes saved, the drunk becomes sober, and the gay becomes straight. Then the choice has to keep being made over and over again. In First Choice, the initial choice to lose weight brings this endless opportunity for choice where every time I eat I ask myself, is my eating in alignment with God’s will? Once you have been in either ministry for a long time and don’t become straight or lose weight, it shifts to this notion that change is a process. There is this balance between the initial, simple choice and this ongoing pathos to get further and closer to the goal. I think that is also a common polarity in therapeutic culture. There is a similar back and forth between making the first decision, and making a lifestyle change that is going to take a very long time.

In the beginning of the book, you talk about how evangelical Christianity is defined by paradox: the desire to identify with but also to distinguish itself from American culture.

There is a famous argument in academic circles that evangelical culture is a subculture. A subculture works by trying to distinguish itself from the mainstream culture. It does a lot of symbolic and discursive work in order to make that difference. What is interesting in evangelical culture is where they choose to accentuate difference. Clearly homosexuality is a place where they have really chosen that point of distinction.

And they are really proud of that.

They see it as a bold line in the sand that can’t be crossed. The extent to which evangelicalism has been willing to make their identity almost conterminous with their opposition to homosexuality is remarkable.

How does the weight loss ministry, First Place, differ?

Evangelicalism is very much part and parcel with the mainstream weight loss culture. I don’t know that they would consider it an intentional effort, but I think it’s a real reflection of how very deep the overlaps are. For example, Dr. Oz, the weight loss guru, just started working with Rick Warren, a pastor from one of the biggest evangelical churches in the country. They have a new weight loss plan called the Daniel Plan. Evangelicals have a proprietary sense — this deep identification with American culture. There is a notion that they do things just like the rest of Americans, just with more piety. First Place is like secular weight loss programs except the Bible is involved. It gives opportunities for Christians to explore a range of American culture within a Christian context.

Are both fatness and gayness considered sins?

Exodus, as part of its definition, believes homosexual sex, defined as genital acts between people of the same sex, is a sin. First Place is more vague about sin. They call weight a “fleshly problem with a spiritual solution.” They want to fall short of calling it a sin. In First Place, they are also not exactly sure what the sin even is. Is it being fat? Is it in excessive eating? In Exodus, they really limit the sin and say that only genital acts are sins because they want to make a breathable space for people who have same sex attraction to feel welcome.

And in the book you have some heartbreaking accounts about the extents to which some of these people would go in order to fight their urges and try to have this God-oriented agency.

The one that really sticks in my mind is this man I interviewed, an ex-gay man from a very cold state in New England. He wanted to stop fantasizing about men before he went to bed at night, so he would lie in bed and if he found himself veering into this realm of fantasy, he would get out of bed without a blanket and lie on the cold floor of his apartment and read the Bible until he fell asleep. That was his choice to do. That’s not a practice that Exodus necessarily endorses, but it definitely goes to show the extreme choices that people made in order to curb their desires.

What happens when people in these groups end up failing, either with weight loss or with their “struggle” to become heterosexual?

The goal post for success can be very porous. There’s a lot that counts for success. For example, at First Place, members have nine commitments that include things like following a certain eating plan, getting exercise, doing Bible study, showing up at meetings, encouraging others in between sessions, etc. If people aren’t necessarily losing weight, it becomes easy to call upon one of these other standards as success. In the case of the ex-gay ministry, they overtly say that the opposite of homosexuality isn’t heterosexuality, it’s holiness. Well, holiness may in fact be easier to achieve than heterosexuality for a lot of people in the ministry. When people actually fail, when they actually transgress, when a man goes and has sex with another man, for example, there is the opportunity to repent through confession. They tell the group what they did, they are adequately remorseful, and they return to the group’s good graces and submit themselves to the group’s discipline once again.

In the conclusion you note something really fascinating, which is that in American culture we tend to construct an opposing duality around the secular and the religious.

I have a good example of this. In terms of this secular/religious question, there is a common-sense understanding that American culture has become increasingly secular. Well, I would argue that certain forms of religious sensibilities have become secularized. They’ve become so common-sense that they are unmarked in American culture, or their underlying religious concerns have become obfuscated. The image that kept coming back to me is one that I saw at First Place. The first thing that folks do in the meetings is a weigh in, and at First Place, before you get on the scale you have to recite your Bible verse for the week. You go in, step on the scale, recite your Bible verse, and the group leader records whether or not you lost weight and whether or not you got your Bible verse right. It’s like the idea of putting your flag on the moon. Is it religion giving its deference to what is actually the moral authority in this culture, weight, or is it just making clear the compatibility between Christian ideals and the weight loss dogma?

Which do you think it is?

I tend to go back and forth, but I do think practices like that reveal the deep religious sensibilities underneath programs like weight loss and things that are addressed in scientific and health-related language. In some ways I think First Place just returns the explicit religious marks to something that seems to be secular, but actually has very deep moral concerns undergirding it.

At the end of the book, you make a really nice observation that evangelicalism can actually be really progressive and queer in certain unexpected ways.

One of the interesting things about the ex-gay ministries is, in a certain sense, how queer they are. I went to Exodus International’s 30th anniversary conference. Jerry Falwell was there to address Exodus, and he is quite controversial because of what he’s said in the past about gay people. The act that preceded Jerry Falwell was a skit from a Christian theater troupe about a former drag queen trying to join a church Bible study. At one point in the skit, the former drag queen talks about how he used to fantasize about a handsome hero taking him away. Eventually he realizes that Jesus is his real hero, and another character says, “That makes it sound like Jesus is your lover! That’s biblical!” So in front of Jerry Falwell, an ex-gay ministry said that it’s biblical for a man to call Jesus his lover! There is a certain kind of playfulness and queerness that is possible in their world to a degree that’s really surprising to me. And Jerry Falwell didn’t get up and leave.

: More Hannah Tepper

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Sundance: A great gay film, or just a great film?

Ira Sachs' "Keep the Lights On" offers a fearless portrait of the realities of gay love in 21st-century New York

By Andrew O'Hehir

(Credit: Sundance)

Topics:Sundance Film Festival, LGBT, Movies

PARK CITY, Utah — When we first meet Erik (Danish actor Thure Lindhardt), the New York documentary filmmaker who is the protagonist of Ira Sachs’ film “Keep the Lights On,” he’s got his hand down his pants and is describing himself to a stranger on a phone-sex line. (It’s 1998, so yes, such things still exist.) What he says is pretty accurate — 5-foot-11, blond and handsome, “masculine” — although we never get to confirm the “six-and-a-half inches, uncut” part. “Keep the Lights On” has plenty of explicit gay sex, but no NC-17 material.

That’s quite an introduction to a character, especially considering that Erik is evidently based on Sachs himself, an indie-film stalwart best known for the 2005 Sundance prizewinner “Forty Shades of Blue.” Sachs has made no secret of the fact that “Keep the Lights On,” the story of a long-running and tormented relationship, is drawn from his own life. (His ex-boyfriend is well known in the New York publishing world.) But this isn’t an excuse to issue apologias or vent personal grudges; it’s a loving but entirely fearless portrait of gay urban life at the turn of the millennium, seen through the prism of one dysfunctional love affair. In fact, this movie may test how far the gay community has come on issues of self-representation. While it seems unlikely that bigots and homophobes would actively seek this film out (except, you know, on the sly and stuff), any who do see it could certainly cherry-pick details to support the thesis that Erik’s entire cadre of humanity are degenerates.

As seen over the course of an on-and-off decade together, Erik and his boyfriend Paul (Zachary Booth) — a lawyer who is at first closeted, with a girlfriend — drift in and out of substance abuse, compulsive promiscuity and at least the outer margins of mental illness. Paul has a habit of disappearing for days or weeks on crack benders; on one such occasion, Erik tracks him down in a midtown Manhattan hotel room and holds Paul’s hand while he has sex with a male prostitute. (As I said earlier, there’s no full-frontal nudity in this film, but Sachs is frank about the messy realities of man-on-man sex in a way rarely or never seen on-screen before.)

I should save a full review of Sachs’ magnum opus (and that’s what it is) for a later occasion. But let me assure you that whatever else “Keep the Lights On” may be — scathing self-portrait, old-school NYC independent film (shot on super 16, not HD video!), showcase for two marvelously liberated performances — it’s absolutely not a freak show. Erik and Paul are complicated, confidently realized creations, and there’s plenty of human commonality to be found in their relationship, no matter what gender you are or whom you go to bed with. But Sachs has clearly decided that there’s no point in pretending that gay society and sexuality aren’t distinctive in many ways. (I’m a great admirer of Lisa Cholodenko and “The Kids Are All Right,” for instance, but that’s a movie predicated on the idea that gay marriage is fundamentally not different from the heterosexual variety.)

Like Andrew Haigh’s “Weekend,” another recent film that feels like a step forward or a step away from the “queer cinema” of the ’90s, this isn’t a movie about identity or coming out or facing oppression. It’s an unstinting relationship drama — perhaps consciously modeled on Bergman’s “Scenes From a Marriage” — about two guys who fall in love in the most tolerant and diverse metropolis in America, surrounded by supportive gay and straight friends, and manage to screw it all up with drugs and craziness and horndoggery. You could choose to interpret the movie as being about how people like Paul and Erik are ghettoized by an uncaring, heterocentric society or whatever, but frankly there’s nothing like that in the film. (One way to understand the title, as Sachs explained after the screening I attended here, is as a commitment to revealing everything and hiding nothing.)

Beautifully shot by Thimios Bakatakis, with songs by underground New York musical legend Arthur Russell (who died of AIDS in 1992), “Keep the Lights On” is an instant landmark in gay cinema, and easily the finest dramatic film I saw at Sundance this year. (Possibly that’s damning with faint praise — but it’s still good!) Not only does this film gloriously fulfill the potential that Ira Sachs has tantalized movie-lovers with for years, it also help explains what took him so long. Out of lost love comes a terrific work of art; it’s the oldest story in the world, but it always feels new when it’s done right.