Perspective: A grand challenge to academic medicine: speak out on gay rights.

Social responsibility, a dearly held value in the medical community, requires that medicine use its influence to end discrimination and to reduce barriers that affect access to care. Although the gay, lesbian, bisexual, and transgender (GLBT) population has been identified as suffering from health care disparities and oppression, the medical community and its affiliated organizations have done little to lobby in defense of the GLBT population. And with regard to the specific issue of gay marriage, medicine has yet to raise its voice in that debate, even if only to correct unscientific, capricious, and slanderous depictions of GLBT relationships. Closer to home, in medical schools and residencies, GLBT faculty and students are not provided with a safe and equal environment in which to work and learn. No credentialing provisions require residencies and their affiliate hospitals to include GLBT status in their nondiscrimination policies or to offer GLBT faculty and residents equal benefits. There is no assurance that those in power at peer-reviewed journals will use reviewers who are familiar with the research on sexual minorities to review manuscripts on GLBT topics, a situation that likely contributes to the community's status as an understudied population. Medicine cannot fulfill its obligation to GLBT patients, students, and faculty without a considerable and determined commitment to change. Some of the suggested remedies would require amending policy at the level of the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges.