UK Medical Students Turning to Sex Work, BMJ Articles Claim

Janis C. Kelly

February 28, 2012

February 28, 2012 — The lurid press release headline "Worrying Rise in Number of Medical Students in Prostitution Over Last Ten Years" touted 2 articles published this week in the student edition of the British Medical Journal, but close examination of the reports suggests that there may be far less there than meets the eye.

The first article, by Anonymous, is titled "Confessions of Student Prostitute." According to the author, a young man — "D" — moved to the United Kingdom for medical school but could not afford to pay tuition at international rates and starting working as an escort, booking clients via the Internet, to support his studies. D claims to have worked up a client list of "13 wealthy women" he sees regularly, some of whom "started to have strong feelings for him, and believed they were in some sort of relationship."

According to the anonymous author, "D currently lives in a rent free flat, has his own car, and is comfortable financially — as a direct result of funds provided by these women."

Despite the fact that this story bears more resemblance to romantic fiction than to real life in the world of sex workers, where the majority of male prostitutes cater to other men, not to "a middle age businesswoman seeking a pleasant 'no strings attached' evening with a young attractive man," the author takes it at face value.

Anonymous concludes, "Many students, including myself, believe that if studies are not grossly affected by how they are funded (loans and bursaries are rarely enough), and what we do to make money is within legal and moral boundaries, then it doesn't matter how we make a living." (Prostitution is legal in the United Kingdom.)

An accompanying article by Jodi Dixon, final-year medical student at the University of Birmingham, United Kingdom, suggests that a tuition fee increase set for September 2013 might "lead to an increase in [medical] students turning to prostitution."

Despite finding that the General Medical Council, the British Medical Association (BMA), the Medical Students Committee, and the University of Birmingham medical school have never taken up the issue of medical students in prostitution, that "[t]he BMA does not consider the prevalence of medical students partaking in prostitution to be widespread," and that the head of undergraduate medical education at the University of Manchester denied awareness "of any cases for fitness to practise involving such circumstances," Dixon implies that there has been a rise in the number of medical students engaging in prostitution.

The main supports for this contention are 2 studies in undergraduate student populations and claims by Estelle Hart, National Women's Officer for the National Union of Students (NUS), and Sarah Walker, spokesperson for the English Collective of Prostitutes (ECP).

The first study, an article published in 2007 in the Journal of Further and Higher Education, was based on a questionnaire survey of 130 undergraduates from a London university. The second study, by the same research group, was based on a questionnaire given in 2010 to 315 undergraduates at a single university.

Dixon writes, "Compared with similarly obtained data from 2000 and 2010, the proportion of students who knew of students using prostitution to support themselves financially increased from 3.99% in 2000 to 6.3% in 2006 and 9.8% in 2010, correlating with a rise in tuition fees.... These trends suggest a direct association between increasing debt and the prevalence of prostitution among students."

Neither study included medical students, the researchers did not validate the accuracy of the claims, and neither the researchers nor Dixon considered potential confounders, such as the possibility that student sex workers might have been just as prevalent in 2000, but more discreet.

ECP spokesperson Walker said, "Ever since grants were done away with and loans introduced, [the ECP has] been contacted by increasing numbers of students considering or involved in prostitution." Hart of the NUS is also quoted as claiming, "[W]here student support has been massively cut, people are taking more work in the informal economy, such as sex work." In neither case was information specific to medical students, who, as Dixon points out, have reason to worry that a known history as a prostitute might be seen as breeching "fitness to practice" standards.

That concern would be even more acute in the United States, according to Eric Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minnesota, who reviewed the BMJ articles for Medscape Medical News, "Prostitution is illegal in most of the US. Engaging in illegal acts and convictions do compromise this process [of obtaining medical credentials]."

Dr. Matteson also said that he knew of no medical students who had turned to prostitution to pay for their education.

The American Medical Student Association did not respond to a request for comment.

Dixon notes that British medical schools do not believe that prostitution among students is widespread and have no specific rule beyond the guidance that medical students act within the General Medical Council's guidance for medical practice, "Duties of a Doctor."

The authors and Dr. Matteson have disclosed no relevant financial relationships.

BMJ. Published online February 28, 2012. Anonymous article, Dixon article

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