Marriage as a Public Health Measure


Ronald Reagan had a very prompt response to a reporter asking about what he thought about the AIDS epidemic: “ Oh, they shouldn’t worry; all they have to do is wait until they get married.”


I knew that this response was not pertinent for most of my public.  I am grateful to President Reagan for a new question, now part of my interview with most new patients: “Are you medically married?”  One way or another we soon agree that the bugs don’t care about the paper work.  And I make points as a modern physician striving mightily to have a role in fighting the AIDS epidemic.  Obviously a committed relationship between sexual partners is a good start on preventing the spread of AIDS—for everyone, not just heterosexuals. 


This commitment for gays must be at least as great as for heterosexual households, or the gays would not be more successful in raising problem orphans—a fact consistently documented by adoption agencies both public and private.  Is this merely because of no unplanned pregnancies?  I doubt it.  It is also documented that no more of these children grow up to be homosexual adults than children raised by heterosexual parents.


Mammalian females, who invest much more effort than males in rearing our young, are more careful than males about having sex only with the best available mates.  Here lies a biological problem with monogamy--maximum reproductive participation of the most fit males improves all genetic inheritance of the species.  For most of our history, fitness for male offspring meant, among other things, success in tribal territorial warfare. The consequent chronic testosterone intoxication that has afflicted so many of our leaders is losing its allure.


In monogamous birds 10 to 20% of the nestlings are not sired by the hen’s mate.  This is a trade-off between maximum genetic fitness of her offspring and keeping the old man happy so that he helps in rearing her brood.  Human geneticists find a similar percentage of non-paternity when they do a family genetic analysis for inherited diseases.  The most charitable interpretation is that the same biological imperative present in the case of the birds is at work in us.


At the AAAS (American Association for the Advancement of Science) last February, I learned that in some of our larger cities the lesbian households who want families have organized sperm banks. (I did not learn this from the official program--I crashed a reception for gay and lesbian scientists, where among other impersonations, I impersonated a hidden microphone.) Predictably there will be some human genetic improvement as a result, certainly a reduction in the major inherited diseases like cystic fibrosis of the pancreas and Huntington’s disease.  Maybe it will lead to a permanent Lysistrata, the ancient Greek play in which the women abolished war by agreeing among themselves to withhold sex from the men who fought.  All it would take would be some specifications about a lack of aggressiveness in the personalities of the sperm donors. After a few generations will politicians from such families have a leg up on “normal” politicians when this modern beneficial selection becomes widely known?


Public recognition of committed relationships does have public health value.  We wouldn’t even have to call it marriage in all cases to get most of the benefit.


John A. Frantz, MD

August 25, 2006