Brink, M

Rosenthal, J

Suttle, K

Warton, C

Wewege, A

South African Medical Journal (SAMJ)

November 2005, Vol. 95, No. 11  SAMJBRIEWE816opportunity to access these powerful resources, which enablethe concentration of clinical, molecular, and computerapproaches, should be seized in order to obtain a deeperunderstanding of the various genetic diseases that collectivelyafflict so many South Africans.Eric R LemmerDivision of GastroenterologyMount Sinai School of MedicineNew York 1. Young SG, Fielding CJ. The ABCs of cholesterol efflux. Nat Genet 1999; 22: 316-318.2. Fredrickson DS, Altrocchi PH, Avioli LV, Goodman DS, Goodman HC. Tangier disease. AnnIntern Med 1961; 55: 1016-1031.3. Oram JF. Molecular basis of cholesterol homeostasis: lessons from Tangier disease andABCA1. Trends Mol Med 2002; 8: 168-173.4. Meissner, PN, Dailey TA, Hift RJ, et al. A R59W mutation in human protoporphyrinogenoxidase results in decreased enzyme activity and is prevalent in South Africans withvariegate porphyria. Nat Genet 1996; 13: 95 -97.SAMA and sexuality – breakingthe silenceTo the Editor: Jon Larsen’s letter entitled ‘Doctors andsexuality’1 is commendable for its clear, forthright approach. Itadds an important dimension to the politically correct viewoffered by the SAMJ’s Deputy Editor on the subject.2Yes, SAMA is silent on these issues, but it should speak outagainst all practices that affect the mental, physical, emotionaland spiritual health of the population. Jon Larsen’s commentsare particularly pertinent. It is indeed amazing that despiteevery major religion denouncing premarital and extramaritalsex, the medical profession remains silent on the issue. To bepractical these goals may not be attainable for the majority inour present culture, but do we give up promoting abstinencebefore marriage and faithfulness within it? Do we simply cutour losses and promote safe sex for all irrespective of anymoral considerations, even those that may impact on health?We are inextricably linked to our consciences and if oursexual practices do not fall in line with the fundamentalteachings of our churches, mosques and synagogues thensurely internal tension and in some cases even turmoil mayresult. That this must impact on individual health is logical. Wetherefore have the choice of either trying to modify ourconsciences to stay in line with society’s changes, or attemptingto halt that change by speaking out against the practices webelieve will affect us and our patients at some level at somepoint in time. The morality of modern day society movescontinuously in small increments in the direction it pleases, butnever without consequences. Individually and collectively themedical profession has the choice to stand firm or follow. If wechoose the latter then what we believe to be unacceptabletoday we may find acceptable tomorrow, and our practice ofmedicine will become progressively more devoid of absolutes.(It is worth recalling that in this country the legal abortion ofhealthy babies on request was once regarded as morallybeyond consideration). In the past medical practitioners were viewed as more thanphysical healers. We were held in high esteem for ourprofessionalism, our ethics and our adherence to high moralstandards highlighted by our Hippocratic oath.Our silence on these aspects of sexuality may be interpretedby many as condoning the practices outlined by Jon Larsenwhile showing no regard for the health consequences of suchbehaviour. It is quite likely that this will lead to our furtherdiminishment in the eyes of those we care for. Yes, SAMA should not be silent, but perhaps it is time to stopand think about how to break that silence. If we only adhere towhat seems politically correct then the medical profession,which has the ability to set a precedent, may lose theopportunity to take the lead on those moral issues that impacton the physical, mental, emotional and spiritual health of ourpeople.M Brink K SuttleA WewegeJ RosenthalC WartonSouthern Suburbs Cape Town1. Larsen J. Doctors and sexuality. S Afr Med J 2005; 95: 284-286.2. Van Niekerk JP. Sexuality and SAMA. S Afr Med J 2005; 95: 131. Legal, but is it right?To the Editor: Specialists in private practice have the legal rightto charge whatever fees they wish, but sometimes they leavebehind frustrated people.A 59-year-old widow developed a breast lump. The surgeontold her that she would need ‘an operation and areconstruction’ and that ‘medical aid will take care of thepayment’. Medical aid paid the hospital fees. The surgeon’s fees werethree times higher than the medical rate. The medical aidrefused to pay the reconstructive surgeon, demanding anadequate motivation as to why she needed reconstruction. Thewidow had no extra finances. A relative paid R4 000 to theprimary surgeon over the medical aid rate and R8 000 to thesecond surgeon.When the patient tried to obtain a motivation for thereconstructive surgery to send to the medical aid, the primarysurgeon’s practice refused to provide one. ‘This is a super-specialist practice and not a discount supermarket. The patientwas fully informed about our fee structure,’ she was told. Thiswas not true! She was also told that ‘the reconstructive surgeonmust write the motivation’.The old medico-legal adage applies. If it was not writtendown, it was not done. 

SAMA and sexuality - breaking the silence

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SAMA and sexuality - breaking the silence

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