August 7, 2007
Internationally known sexual-medicine expert Dr. Irwin Goldstein has landed in San Diego, where his medical practice and research will place the city at the center of an effort to establish sexual medicine as a formally recognized medical discipline.
PEGGY PEATTIE / Union-Tribune
After spending three decades in Boston, sexual-medicine expert Dr. Irwin Goldstein has landed in San Diego, where he is creating a center to treat and study sexual problems at Alvarado Hospital.
It’s been about two years since the 57-year-old urologist left Boston University, where he spent three decades pioneering research on impotency and female sexual dysfunction.
Working out of Alvarado Hospital and as a volunteer instructor at the University of California San Diego School of Medicine, Goldstein wants to make the city a destination for people seeking treatment for sexual problems and for those who want to do research in the field.
In addition to naming Goldstein director of sexual medicine at Alvarado, the hospital’s owners have promised to fulfill the doctor’s long-standing dream of creating what could be the first department of sexual medicine in the country.
Goldstein on Monday will open his private practice on the campus of the College Area hospital with a modest staff that includes a certified sex therapist, a nurse practitioner and a medical assistant.
OVERVIEW
Background: Internationally renowned sexual-medicine physician Irwin Goldstein has relocated to San Diego, opened a private practice and been named head of sexual medicine at Alvarado Hospital.
What’s changing: Goldstein hopes to make San Diego a center for treating and studying sexual dysfunction as well as for training other physicians in the field.
The future: Establishment of a sexual-medicine department at Alvarado – possibly the first in the country – could help lead to the recognition of sexual medicine as a formal medical specialty.
He says he hopes the business will grow into a center for treatment, research and training, not unlike the 5,000-patient Institute for Sexual Medicine that he created and oversaw at the Boston University School of Medicine until May 2005.
“What he is going to be doing here is transforming our understanding of sexual medicine,” said Dr. Pedram Salimpour, one of Alvarado Hospital’s owners.
With some research suggesting that nearly half of all women and more than a third of all men experience sexual dysfunction at some point in their lives, the need for physicians with special training in the field is increasingly coming into focus, said Dr. Ira Sharlip, a clinical professor of urology at the University of California San Francisco who counts Goldstein among his friends.
“What we hope will occur is that sexual medicine will become a well-recognized and respected specialty in the panoply of medical specialties,” Sharlip said. “It is a serious medical specialty with its own vocabulary, set of clinical conditions, treatments and biochemistry.”
Some critics, however, say that much of the push to medicalize sexual problems is coming from drug companies seeking new markets, particularly among women.
PEGGY PEATTIE / Union-Tribune
Irwin Goldstein’s new ID notes that his practice is sexual medicine.
“Female sexual dysfunction is a concocted term,” said Dr. Leonore Tiefer, an associate professor of psychiatry at the New York University School of Medicine. “It’s all been sort of the cart leading the horse.
For sexual medicine to gain legitimacy, she said, it must expand beyond the narrow focus of treating people who have difficulty having sex and include other related matters, such as sexually transmitted diseases, gender identity problems, fertility issues, and rape and sexual-abuse issues.
“I don’t think that creation of this thing as sexual medicine is the right thing at the right time for the public,” Tiefer said.
For now, sexual medicine remains outside the 130 specialties recognized by the American Medical Association. Doctors who practice in the field must specialize instead in a related recognized area, such as urology, obstetrics and gynecology, neurology or endocrinology.
That can lead to practical problems, Goldstein said.
At Boston University, he encountered obstacles that made it difficult for him to work with physicians outside the Department of Urology, which oversaw his sexual-medicine institute. “I had handcuffs everywhere I went,” he said.
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While there is nothing unusual about bureaucratic walls between medical specialties, the divisions at Boston University became untenable for Goldstein.
He was operating in a world in which a growing body of research was linking sexual dysfunction to cardiovascular disease, neurological problems, hormone deficiencies and other physiological conditions. He believed that the evolution of sexual medicine demanded more cross-specialty collaboration than was possible in traditional academic medicine.
Differences over those strictures eventually led to his departure from Boston University.
“Dr. Goldstein made a number of requests to the medical center regarding department organization,” Boston University School of Medicine spokeswoman Ellen Berlin wrote at the time of the doctor’s departure. “The medical center was unable to reach an acceptable agreement with Dr. Goldstein and therefore decided not to continue his contract.”
Goldstein said the parting of ways was mutual. “You have to look in the mirror and say, ‘I could spend the rest of my life in the Department of Urology’ . . . or I could say, ‘I’m not willing to do that anymore.’ I chose to pursue my dream,” he said.
Goldstein said a search for a new home in the academic world took a year and a half, and included discussions with Cedars-Sinai Medical Center in Los Angeles and the University of California Irvine Medical Center. Those talks came up empty because most teaching hospitals were unwilling to give him the level of independence he sought.
Then in late 2006 he received a call from Salimpour, a Los Angeles pediatrician who had worked as Goldstein’s research assistant in the late 1990s.
An investor group headed by Salimpour and his older brother, Pejman Salimpour, also a Los Angeles pediatrician, was preparing to purchase Alvarado Hospital for $22.5 million. The hospital had been forced into a sale by federal authorities after several years of legal and financial difficulties.
Goldstein was scheduled to visit San Diego on behalf of Pfizer, the maker of Viagra, for a grand round – a meeting with other doctors to discuss his latest clinical work. The gathering was set for mid-January, a few weeks after the Salimpours were to close the hospital deal.
Hoping to garner positive attention for Alvarado within the medical community, Pedram Salimpour asked his friend and mentor to conduct the grand round at the College Area hospital. During the dinner that followed, the Salimpours proposed that Goldstein consider moving to San Diego and opening a new practice at Alvarado.
By the end of the next day, Goldstein and the Salimpours had hammered out a deal that promised the sexual-medicine expert the freedom and flexibility he desired.
Goldstein and the Salimpours would not say whether any financial arrangement exists between the doctor and the hospital. Under California law, hospitals are generally barred from directly employing physicians.
Having Goldstein on Alvarado’s medical staff will undoubtedly increase the hospital’s visibility and could boost its reputation, which suffered under previous owner Tenet Healthcare.
Goldstein is often quoted in articles about sexual medicine that appear in publications around the world, and he is editor-in-chief of The Journal of Sexual Medicine, the most influential publication in the field. Both San Diego and Alvarado are listed under the doctor’s name on the credits page of the journal.
“This shows everyone that we are pioneers and innovators,” Pedram Salimpour said.
Goldstein’s arrival also could have a more practical effect on the 306-bed hospital. Surgical procedures performed by the doctor, such as penile implants, and his research activity will help bring in patients. And many of his patients might be referred to other specialists who practice at Alvarado, Goldstein said.
On a recent afternoon in an Alvarado meeting room, Goldstein fiddled with an identification card hanging from the breast pocket of his sport coat. Made an hour earlier, the tag showed his photograph, his name and the words “sexual medicine” printed along the bottom. In Boston, his ID had read “urology.”
Goldstein smiled broadly as he cradled the new tag.
“This card doesn’t exist anywhere,” he said. “I went into the bathroom and stared at it in the mirror.
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