The Health of Lesbian, Gay, Bisexual, and Transgender People:Building a Foundation for Better Understanding

Researchers need to proactively engage lesbian, gay, bisexual, and transgender people in health studies and collect data on these populations to identify and better understand health conditions that affect them, says a new report from the Institute of Medicine.  The scarcity of research yields an incomplete picture of LGBT health status and needs, which is further fragmented by the tendency to treat sexual and gender minorities as a single homogeneous group, said the committee that wrote the report. 

The report provides a thorough compilation of what is known about the health of each of these groups at different stages of life and outlines an agenda for the research and data collection necessary to form a fuller understanding.

"It's easy to assume that because we are all humans, gender, race, or other characteristics of study participants shouldn't matter in health research, but they certainly do," said committee chair Robert Graham, professor of family medicine and public health sciences and Robert and Myfanwy Smith Chair, department of family medicine, University of Cincinnati College of Medicine, Cincinnati.  "It was only when researchers made deliberate efforts to engage women and racial and ethnic minorities in studies that we discovered differences in how some diseases occur in and affect specific populations.  Routine collection of information on race and ethnicity has expanded our understanding of conditions that are more prevalent among various groups or that affect them differently.  We should strive for the same attention to and engagement of sexual and gender minorities in health research."

Because LGBT individuals make up a minority of the population, researchers face challenges in recruiting sufficient numbers of these individuals in general population surveys to yield meaningful data.  Stigma experienced by gender and sexual minorities can make them reluctant to disclose their orientation, worsening the problem.  Moreover, it is difficult to synthesize data about these groups when studies and surveys use a variety of ways to define them. 

Because demographic data provide the foundation for understanding any population's status and needs, federally funded surveys should proactively collect data on sexual orientation and gender identity, just as they routinely gather information on race and ethnicity, the report says.  Information on patients' sexual orientation and gender identity also should be collected in electronic health records, provided that privacy concerns can be satisfactorily addressed, the committee said.  The National Institutes of Health should support the development of standardized measures of sexual orientation and gender identity for use in federal surveys and other means of data collection.

In addition, NIH should provide training opportunities in conducting research with LGBT populations.  Training should engage researchers who are not specifically studying LGBT health issues as well as those who are.  The agency also should use its policy on the inclusion of women and racial and ethnic minorities in clinical research as a model to encourage grant applicants to address how their proposed studies will include or exclude sexual and gender minorities.

The study was sponsored by the National Institutes of Health.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  For more information, visit http://national-academies.org or http://iom.edu.  A committee roster follows.

Contacts: 
Christine Stencel, Senior Media Relations Officer
Luwam Yeibio, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

NAP.Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities; Board on the Health of Select Populations; Institute of Medicine.Gay & Lesbian Medical Association (GLMA) awarded The Health of Lesbian, Gay, Bisexual, and Transgender People their LGBT Health Achievement Award for 2011. Also in 2011, this book received a Callen-Lorde Community Health Award.

The Health of Lesbian, Gay, Bisexual, and Transgender People:Building a Foundation for Better Understandings

Review of the Scientific Approaches Used During the FBI's Investigation of the 2001 Anthrax Letters

A National Research Council committee asked to examine the scientific approaches used and conclusions reached by the Federal Bureau of Investigation during its investigation of the 2001 Bacillus anthracis mailings has determined that it is not possible to reach a definitive conclusion about the origins of the anthrax in letters mailed to New York City and Washington, D.C., based solely on the available scientific evidence.

Findings of the committee's study include:

The FBI correctly identified the dominant organism found in the letters as the Ames strain of B. anthracis.

Silicon was present in significant amounts in the anthrax used in the letters.  But the committee and FBI agree that there is no evidence that the silicon had been added as a dispersant to "weaponize" the anthrax.

Spores in the mailed letters and in RMR-1029, a flask found at the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID), share a number of genetic similarities consistent with the FBI finding that the spores in the letters were derived from RMR-1029.  However, the committee found that other possible explanations for the similarities -- such as independent, parallel evolution -- were not definitively explored during the investigation.

Flask RMR-1029, identified by the U.S. Department of Justice as the "parent material" for the anthrax in the attack letters, was not the immediate source of spores used in the letters.  As noted by the FBI, one or more derivative growth steps would have been required to produce the anthrax in the attack letters.  Furthermore, the contents of the New York and Washington letters had different physical properties.

Although the FBI's scientific data provided leads as to the origin of anthrax spores in the letters, the committee found that the data did not rule out other possible sources.  The committee recommended that realistic expectations and limitations regarding the use of forensic science need to be clearly communicated to the public.

Following a required FBI security review of the committee's draft report in October 2010, the bureau asked to provide the committee with additional materials and briefings about its investigation.  From these materials the committee learned more about the organization and oversight of the scientific investigation and about the collection and analysis of environmental samples.

Included in the new materials were results of analyses performed on environmental samples collected from an overseas site.  Those analyses yielded inconsistent evidence of the Ames strain of B. anthracis in some samples.  The committee recommends further review of the investigation of overseas environmental samples and of classified investigations carried out by the FBI and Department of Justice. 
  
"The committee commends the FBI for reaching out to the scientific community for assistance early in the anthrax letters investigation," said Alice P. Gast, chair of the committee and president of Lehigh University, Bethlehem, Pa.  "We believe this independent review -- done at the FBI's request -- will help strengthen the law enforcement and national security community's scientific and analytical capabilities in future investigations."

Immediately following the 2001 anthrax attacks, there was no clear organizational structure to assist the FBI in pursuing the scientific investigation.  Over the course of its inquiry, the FBI worked to develop one.  It found and engaged highly qualified scientists from both the government and private sector to give expert scientific advice on anthrax and the attacks.  The bureau appropriately decided to establish a repository of the Ames strain of B. anthracis gathered from laboratories around the world against which to compare the anthrax used in the 2001 mailings.  But problems with the repository, the committee found, limited the strength of conclusions that could be made using it.

During the last decade, new "molecular" scientific methods and insights relevant to this investigation also became available.  "Using tools such as high-throughput, 'next generation' DNA sequencing could have strengthened or weakened the association between spores found in the mailed letters and spores from RMR-1029," said David A. Relman, vice chair of the committee and Thomas C. and Joan M. Merigan Professor, Stanford University School of Medicine, Palo Alto, Calif.  "Such new technology will be important to similar investigations in the future."

The Research Council was asked to consider facts and data surrounding the scientific investigation based on documents and oral presentations provided by the FBI and others.  Judging the conduct of the law enforcement inquiry was beyond the scope of this study.  The committee was neither asked for nor offers findings on the possible guilt or innocence of individuals connected with the 2001 B. anthracis mailings.  Moreover, authors of this report did not review classified materials about the case.  Thus, they cannot comment on how classified information may have influenced the course of the FBI's inquiry, including the scientific investigation. 

The FBI asked the Research Council to conduct this independent review in September 2008, and the committee was appointed and began its work in 2009.  In early 2010, the Justice Department closed its investigation of the anthrax mailings, concluding that the attacks were carried out by Bruce Ivins, a scientist at USAMRIID who committed suicide in July 2008.
   
The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  They are independent, nonprofit institutions that provide science, technology, and health policy advice under an 1863 congressional charter.  Committee members, who serve pro bono as volunteers, are chosen by the Academies for each study based on their expertise and experience and must satisfy the Academies' conflict-of-interest standards.  The resulting consensus reports undergo external peer review before completion. 

For more information, visit http://national-academies.org/studycommitteprocess.pdf.  A committee roster follows.

Contacts: 
William Skane, Executive Director
Jennifer Walsh, Media Relations Officer
Luwam Yeibio, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

The Nacional Academies Press. Committee on Review of the Scientific Approaches Used During the FBI's Investigation of the 2001 Bacillus Anthracis Mailings; National Research Council

Review of the Scientific Approaches Used During the FBI's Investigation of the 2001 Anthrax Letters

Feasibility of Using Mycoherbicides for Controlling Illicit Drug Crops

New From NAP.The control of illicit-drug trafficking and drug use is a difficult and complex process that involves a variety of prevention, control, treatment, and law enforcement strategies. Eradication strategies for controlling illicit-drug crops are used to target the beginning of the drug-supply chain by preventing or reducing crop yields. Mycoherbicides have been proposed as an eradication tool to supplement the current methods of herbicide spraying, mechanical removal, and manual destruction of illicit-drug crops.

Some people regard them as preferable to chemical herbicides for controlling illicit-drug crops because of their purported specificity to only one plant species or a few closely related species. As living microorganisms, they have the potential to provide long-term control if they can persist in the environment and affect later plantings. Research on mycoherbicides against illicit-drug crops has focused on three pathogens: Fusarium oxysporum f.sp. cannabis for cannabis (Cannabis sativa), F. oxysporum f.sp. erythroxyli for coca (Erythroxylum coca and E. novogranatense), and Crivellia papaveracea or Brachycladium papaveris (formerly known as Pleospora papaveracea and Dendryphion penicillatum, respectively) for opium poppy (Papaver somniferum).

The Nacional Academies Press. Committee on Mycoherbicides for Eradicating Illicit Drug Crops; Board on Agriculture and Natural Resources; National Research Council

Feasibility of Using Mycoherbicides for Controlling Illicit Drug Cropsa