May 19, 2000 (Chicago) -- Embarrassed American Psychiatric Association (APA) officials say a lack of new scientific evidence is why they called off a debate over whether it can ever be ethical to try to change a person's sexual orientation. The debate had been scheduled here at the society's annual meeting.

The program this week was cited in full-page newspaper ads by anti-gay groups as proof that the APA was once again ready to denounce homosexuality as a mental illness. Ironically, the debate had been organized by Robert Spitzer, MD, the Columbia University psychiatrist who led the effort that culminated in the APA's 1973 removal of homosexuality from its list of mental disorders. Spitzer was scheduled to moderate the debate, which would have pitted proponents of so-called "reparative sexual reorientation therapy" against opponents who say the practice is unethical and unscientific.

Pedro Ruiz, MD, chair of scientific programs for the APA, tells WebMD that he at first rejected the proposal. "An opinion is not science, and in the 1970s the APA made a very clear scientific decision that it does not consider homosexuality to be a pathology," he says. "So I saw no point in presenting the topic."

Spitzer persuaded him to reconsider. "He submitted a proposal," Ruiz says. "I sat down and looked at it and saw no reference -- none whatsoever -- to any view of homosexuality as a pathology, and there was no politicizing of the subject." He says that what finally convinced him to change his mind was that Harvard Medical School psychiatrist Marshall Forstein, MD, agreed to participate as one of the debaters opposing sexual reorientation therapy.

Ruiz, professor and vice chair of psychiatry at the University of Texas Medical School at Houston, soon began to regret his decision. Two months after accepting Spitzer's proposal, APA members and others received letters from a nondenominational Christian organization that actively seeks to have gays change their sexual orientation. The letter claimed that the APA had changed its position and was prepared to reinstate homosexuality as a form of mental illness.

"I was upset and insulted," Ruiz says. "Marshall [Forstein] got a copy of this letter, and based on it felt that Spitzer had violated the agreement, so he withdrew from the symposium. Well, you have to have two sides if there is to be a discussion, and now there wasn't a second side. So we canceled the program. It was never supposed to be on whether homosexuality is an illness that might be cured."

One reason mainstream psychiatrists dropped out of the debate is a recent television newsmagazine appearance by Spitzer in which he gave credence to reparative therapy. "They felt there was a conflict of interest," says Jack Drescher, MD, president elect of the New York county district board of the APA and APA representative of the Caucus of Lesbian, Gay, and Bisexual Psychiatrists.

Drescher tells WebMD that a 1998 APA position statement obliges psychiatrists to speak out against religious and political groups that say homosexuality is a mental illness. The statement notes that as there are no scientifically valid studies on reparative therapy -- but anecdotal reports of harm -- ethical psychiatrists should refrain from the practice. It calls for further research either by the National Institute of Mental Health or by medical centers under the scrutiny of institutional review boards.

As recently as 1972, Drescher says, an APA presentation called "The Homosexual Psychiatrist" featured an APA member who spoke while wearing a hood that masked his face. Had he identified himself, he would have been forbidden to practice. Groups that would bring back those days, Drescher says, threaten to harm far more patients than they would help.

"I just finished a session with a patient who finished nine months with a reparative therapy group, and it was a very painful experience for that patient," he says. "Is it that it doesn't matter how many gay people you hurt if you can extract a couple of heterosexuals from the process? I don't think that is professional practice."

Neither Spitzer nor Forstein could be reached for comment. The APA does not plan to reschedule the debate, and has announced no intention of reconsidering its position on homosexuality.