HOMOSEXUALITY REMAINS CONTROVERSIAL IN THIS COUNTRY. LAST YEAR'S brutal murder of Wyoming college student Matthew Shepard brought forth recognition that despite much greater acceptance of gay and lesbian people than in recent history, antihomosexual discrimination marked by occasional violence remains a divisive fixture in the American social landscape. 1 Certainly conditions for gay and lesbian people have improved, especially within the medical profession. A moderate number of gay and lesbian medical students and physicians are now formally protected by antidiscrimination clauses in their academic and working lives. Many gay and lesbian physicians achieve high degrees of professional success, even after having disclosed their orientation to select colleagues and employers.In this issue, Jason Schneider and Saul Levin, MD, trace the American Medical Association's growing acceptance of gay and lesbian visibility within its own ranks over the past 2 decades. Kate O'Hanlan, MD, follows with a discussion of her experiences over the past 10 years in successfully advocating for domestic partner benefits at Albert Einstein College of Medicine and Stanford University.Yet despite successes in professional representation and employment status, surveys have documented that many admissions officers and residency directors are less enthusiastic about gay and lesbian candidates than heterosexual candidates, and that physicians who disclose a nonheterosexual orientation to colleagues face the potential loss of referrals and privileges. 2,3 A nationwide survey of women physicians by researchers at Emory University provides new evidence that lesbian physicians do in fact experience harassment at a greater prevalence than their heterosexual counterparts.From the patient's perspective, sexual orientation may expose one to specific health risks. Gary Remafedi, MD, provides a sobering view of the most catastrophic result of antihomosexual discrimination in his review of studies linking adolescent suicide to gay or lesbian sexual orientation. Suicide is among the most dangerous health risks of all to gay and lesbian teenagers and the most unrelentingly tragic.Finally, this month's MSJAMA online features an interview with and new poetry by Rafael Campo, MD, who has made a point of addressing gay issues and the patient-physician relationship in his writing. Campo inspires readers with his injunctions to remain human as a first priority-and thereby to experience empathy with others. One may hope, as Campo's writing and these articles suggest, that these special insights of the medical profession have the potential to better a society still struggling with its prejudices.

Skin with busulfan hyperpigmentation was studied using light and electron microscopy. There were both toxic effects on the melanocytes and stimulatory effects on the production of melanin. The mitochondria appeared damaged, and reduced in number. Cytoplasmic vacuoles, myelin figures and conglomerate masses of melanosomes were present. The melanosomes were normal in size but appeared increased. 'Ghost melanocytes' were found in the dermis. The basal lamina was damaged with evidence of duplication. Incontinence of melanin was seen. This hyperpigmentation may be similar to that in fixed drug eruption.

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A newborn infant had sporadic congenital goiter which caused airway obstruction and death. The case is of special interest as a right-sided pleural effusion was also present. The occurrence of these two rare congenital anomalies in the same infant suggests a causal relationship.Pleural effusion, rare in neo¬ nates, was associated with spo¬ radic congenital goiter and death due to airway obstruction in a newborn infant.