Abstinence study: it works!

I've been reading about the Jemmotts' work with inner city kids for a while. There's an article in this month's Archives of Pediatrics and Adolescent Medicine - one of the American Medical Association journals - about a randomized trial of abstinence-only vs. "safer sex" with encouragement to use a condom. The results were a significant difference in first intercourse and intercourse in the previous 3 months, during the 24 months of follow up. There was no difference in condom use between the two groups, when the kids did have sex. A repeat intervention decreased the likelihood of multiple sexual partners.


Here's the abstract:

Objective To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.

Design Randomized controlled trial.

Setting Urban public schools.

Participants A total of 662 African American students in grades 6 and 7.

Interventions An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex–only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

Outcome Measures The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

Results The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

Conclusion Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

Trial Registration clinicaltrials.gov Identifier: NCT00640653

Sudden Infant Death Syndrome associated with lower serotonin levels

Nature News has an article on a study published in the Journal of the American Medical Association that ties lower levels of serotonin to an increased risk of sudden infant death syndrome (also called "cot deaths," "crib deaths, or "SIDS"). The authors are not sure what causes the low levels or whether the low serotonin levels are the cause or an effect of the deaths and don't make any sort of recommendations for treatment or changes in care of children.

I'm still surprised at the decrease in crib deaths that happened when we all started telling moms to lay their babies on their backs in the crib. All of my life (and when my kids were babies) we had been taught to lay them on their tummies or sides. However, the more I thought about it, babies are on their backs when nursing from the breast, and so putting them in bed this way probably brings about some protective effect of mimicks one.

Don't forget: Back to Bed!

Tebow Super Bowl Ad Controversy Proves "Pro-abortion," not "Pro-choice"

Sarah Palin has written a note on her Facebook page on the move to oppose an ad that's scheduled to be run during the Super Bowl. The active opposition to the ad by the National Organization for Women (incorrectly named, btw) and other groups, shows just how pro-abortion, rather than pro-choice, they are.

The 30 second segment is sponsored by - and paid for by - Focus on the Family. It tells the story of Pam Tebow, mother of Heisman Trophy winner, Tim Tebow. Tebow's mother was encouraged to abort him due to medical problems.

Colorado Springs, Colo (Friday, Jan. 15, 2010) – Focus on the Family will broadcast the first Super Bowl ad in its history February 7 during CBS Sports' coverage of the game at Dolphin Stadium in South Florida.

The 30-second spot from the international family-help organization will feature college football star Tim Tebow and his mother, Pam. They will share a personal story centered on the theme of "Celebrate Family, Celebrate Life."

Jim Daly, president and CEO of Focus on the Family, said the chance to partner with the Tebows and lift up a meaningful message about family and life comes at the right moment in the culture, because "families need to be inspired."

"Tim and Pam share our respect for life and our passion for helping families thrive," Daly said. "They live what we see every day – that the desire for family closeness is written on the hearts of every generation. Focus on the Family is about nurturing that desire and strengthening families by empowering them with the tools they need to live lives rooted in morals and values."

Daly added that all the funds to air the ad came from a handful of "very generous and committed friends" who donated specifically to support the project. No money from the ministry's general fund was used.

The Tebows said they agreed to appear in the commercial because the issue of life is one they feel very strongly about.

The Washington Post reports that there has been opposition to the airing of the ad:

After learning of the ad late Monday, Women's Media Center (speaking on behalf of the National Organization for Women, the Feminist Majority Foundation and other organizations) asked CBS to pull the ad. It also questioned how and why the network, which used to forbid "advocacy" advertising, agreed to air Focus on the Family's spot, which is valued at $2.5 million to $3 million.

"An ad that uses sports to divide rather than to unite has no place in the biggest national sports event of the year -- an event designed to bring Americans together," Jehmu Greene, president of the Women's Media Center, said in a statement.

The pressure on CBS proves my earlier assertion that as a society, we in the US have moved from the 1960's slogan "Our Bodies, Our Choice," to "Our Bodies, Our Choice, and You Don’t Have Choice."

Qualify for government subsidy: become a(n involuntary) unionized government employee

 Next up: doctors, section 8 housing owners, ????? Grocery stores, drug stores???

A year ago in December, Ms. Berry and more than 40,000 other home-based day care providers statewide were suddenly informed they were members of Child Care Providers Together Michigan—a union created in 2006 by the United Auto Workers and the American Federation of State, County and Municipal Employees. The union had won a certification election conducted by mail under the auspices of the Michigan Employment Relations Commission. In that election only 6,000 day-care providers voted. The pro-labor vote turned out.

Many of the state's other 34,000 day-care providers never even realized what was going on. Ms. Berry tells us she was "shocked" to find out she was suddenly in a union. The real dirty work, however, had been done when the state created an "employer" for the union to "organize" against.
Of course, Michigan's independent day-care providers don't work for anybody except the parents who were their customers. Nevertheless, because some of these parents qualified for public subsidies, the Child Care Providers "union" claimed the providers were "public employees."
Michigan's Department of Human Services then teamed with Flint-based Mott Community College to sign an "interlocal agreement" in 2006 establishing a separate government agency called the Michigan Home Based Child Care Council. This council was directed to recommend good child-care practices—and not coincidentally, to serve as a "public employer." Although the council had almost no staff, no control over the state subsidies and no supervision of the providers' daily activities, it became the shell corporation against which the union could organize.
Thus the state created an ersatz employer and an ersatz "bargaining unit" against which what was essentially an ersatz union could organize.
Today the Department of Human Services siphons about $3.7 million in annual dues to the union—from the child-care subsidies. The money should be going to home-based day-care providers—themselves not on the high end of the income scale. Ms. Berry now sees money once paid to her go to a union that does little for her. She says she is "self employed and wants nothing to do with the union."

Open Letter to AMA: I quit

Emailed to the AMA Board:
I paid my Texas Medical Association dues for 2010 but will not renew my American Medical Association membership. I do not want to be counted as an AMA member.

I dropped my membership once before due to political moves by the leadership of the AMA. I rejoined hoping to work within the House of Medicine to influence policies of the AMA. I became more active in my TMA, the Texas Academy of Family Physicians, national meetings of the AMA and the American Academy of Family Physicians and accepted the Chairmanship of the Family Medicine Section of the Christian Medical Association.

This weekend, AMA President-Elect Wilson announced support for the Reid substitute and manager’s amendment, which dropped the effort to correct the “Sustainable Growth Rate” and does not even mention (much less achieve) tort reform. Instead, current language provides billions of dollars in special deals for Democrat Senators, support for payment for elective interventional abortion in healthy mothers and on healthy babies, and an expansion of Medicaid that threatens to bankrupt my State of Texas.

The AMA leadership have told us that they hoped to protect our patients and the practice of medicine in the final legislation, just as I had hoped to influence AMA policies by lending my name and paying my dues to them. I will no longer give the AMA my name or my money, since neither of us has achieved our goal.

Beverly B. Nuckols, MD
New Braunfels, Texas

Open Letter to AMA

No Connection - Hasting Center Essays Miss the Mark

The Hasting Center has published an online collection of essays called"The Values and Health Care Reform Connection" allowing the public to comment on health care and "American Values." You have to admire the awareness of the academics - not only have they noticed that the conservative, pro-life, religious “American” is concerned with values, but they are trying very, very hard to appeal to those of us with a Judeo-Christian background. I’ve only skimmed a couple of the essays so farm but I have found a glaring inability to stay on task or a basic lack of understanding of the world view of the intended target, uh, audience.

For example, in “Stewardship: What Kind of Society Do We Want?,” Len M. Nichols misses the mark in spite of peppering the essay with terms like “stewardship,” “abundant life” and “covenant” and appeals to the writings of John Locke and Thomas Jefferson.

 (Skip over the use of a faulty, biased 2009 Institute of Medicine report on the consequences of lack of universal health care insurance in the U.S., already thoroughly debunked by Steven Malloy’s “Junk Science” blog.)

In his appeal to “American Values,” Nichols attempts to define “stewardship” to include a “covenant” as a duty of property owners to ensure that the poor have food to eat. He refers to the book of Leviticus and Jewish Law that land owners leave “the corners” of their fields for the poor to glean, rather than going back to harvest all that is there.  While noting that the rule was propagated the “other books that Moses wrote,” Nichols explains that only adult males could own land "in ancient Palestine." He would have been better off referring to the “Torah” or “the Law,” which was given by G_d, not Moses, and to the Nation of Israel, since there was no “Palestine” at that time.

Nichols almost persuades me that he “gets it” in his discussion of the basis for rights: the belief that humans are created in the image of G_d. However, he asks what good is the right to life or the pursuit of happiness without access to essential health care and quotes Jefferson’s comparison of liberty with health. He does not seem to understand that both Locke and Jefferson described these as negative rights: the right not to be killed, and the right not to be enslaved or have ‘the fruit of one’s labor” forcibly taken. In other words, no one has the right to cause another to be sick, but there is no right to medicine or medical care.

Nichols does not resort to the usual call for Christians to remember the Good Samaritan. In fact, he turns to an argument that might be more appealing to Libertarians, whom he calls “a tiny group of argumentative people.” His discussion of rights and stewardship by is converted to support for the rationing of health care, noting that Leviticus does not require the landowner to bring the poor person home and cook him a meal. In this, too, he demonstrates his lack of understanding of the Judeo-Christian world view. The covenant to care for the sick and poor is between individual believers and G_d. Government hasn’t proven itself to be trustworthy enough for me to assign my duty to G_d over to its stewardship.

LifeEthics quoted about Doctors for America posts

I've been a little distracted, getting my house ready for the New Braunfels Republican Women's Christmas Tour of Homes, but I should be blogging more in the future.

Found a post at "RBO," (RealBarackObama) that quoted my reports (here and here) on the conference call with "Doctors for America," back in September. I like being known as someone capable of "serious sleuthing."

?No self breast exams?

The recommendation *not* to teach exams throws the whole report into question for me. If we are changing the frequency of mammograms, should we also change the recommendation to do self exams? Won't the first change the effectiveness of the second?


In the news, the report by the Agency for Health Care Research and Quality. The "conventional wisdom" about breast cancer screening was turned on its head - or, at least tweaked, this week.

I think we might have been over doing the mammograms ("MMG"), but the old recommendation to do a "baseline" MMG between 35 and 40, with self exams each month and MMG each 2 years from 40 to 55 and then one a year or each 2 years according to risk, made sense to me.

What I absolutely don't get is the recommendation to stop teaching self exams. Teaching self breast exams received a "Grade D" recommendation - meaning there's no empirical evidence that the procedure is "effective." In other words, it has "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." The practice would be "discouraged" -- considered bad medicine, and actually put the doctor at risk for criticism. It most certainly won't be paid for.

There's a reason to find masses: it will change what we do, we have treatment that we can and should do for positive changes. Any mass that's fast growing and lasts over a month is highly suspicious and any mass we can feel should be biopsied. Even though the sensitivity may be low (compared to MMG), patients who do regular exams have been proven to be more likely to find masses earlier and smaller than the doc would at an annual exam, and it's non-invasive, cheap, and accessible. Teaching the self exam gives me something to talk about while I'm doing my own exam of the patient and is an opportunity to explain what I've written, above.

It looks like the fuss over the recommendation will be the first test of the realities of "Comparative Effectiveness Panels" which was funded by $1 Billion allocated in the 2009 "Stimulus Package."  Emotions and reactions are high, with Health and Human Services Secretary Sebelius,  Medicare and most insurance companies already reporting that their policies (paying for annual MMG and recommending teaching at doctors' exams) won't change. The Mayo Clinic has absolutely renounced the recommendations.

For more information on the policies of other nations, see this article.

AMA opposes marriage and "Don't Ask, Don't Tell"

November 10, 2009, delegates to the AMA interim session approved resolutions recommending that the AMA oppose same sex marriage bans, urge redefinition of marriage under federal and state laws. They also recommend the ending of the "Don't Ask, Don't Tell" policy in the military.

"Report 1" - "REPORT 1 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (I-09), Health Care Disparities in Same-Sex Households," is only published in the "members only" access, in advance of publication in a "peer reviewed journal." There is a specific request *not* to publish the report. However, for those of you who would like to review the report, let me know and I'll forward the pdf.

Report 1 tells us that, according to census data, approximately one third of people living in same sex relationships are uninsured, while also noting that slightly less than 1% of the US population lives in same sex households. The Reference Committee report states that "Adoption of this report further strengthens AMA policy in support of issues impacting same-sex households."

The AMA currently recommends that members be aware of and work to prevent possible health care disparities among men and women who live in same sex partnerships. However, by adopting this report, the delegates have now apparently voted to encourage a wide-spread untried and potentially unhealthy social experimentation by calling for the redefinition of marriage on behalf of 0.33% of our population in order to "support measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite-sex households."

Surely, the same goal can be achieved without demanding that all States and the Federal Government change their definition of marriage.  It appears that even the State of Washington, which just voted to afford the same rights of marriage to same-sex couples, did not go far enough to make the radicals happy.



The resolution concerning "Don't Ask, Don't Tell" originally asked that the AMA oppose using any disclosure to a health care professional for dismissal. However, the reference committee recommended and the HOD approved, a substitute resolution that goes far beyond support for patient confidentiality in health care:
"HOD ACTION: Substitute Resolution 917 adopted.
"REPEAL OF “DON’T ASK, DON’T TELL”
"RESOLVED, That our American Medical Association advocate for repeal of “Don't Ask, Don't Tell,” the common term for the policy regarding gay and lesbian individuals serving openly in the U.S. military as mandated by federal law Pub.L. 103-160 and codified at 10 U.S.C. § 654, the title of which is "Policy concerning homosexuality in the armed forces.""

It's getting harder and harder to tell myself that I must continue my AMA membership in order to make a difference with in the organization. I'm beginning to be afraid that by adding to their numbers, I'm part of the problem, rather than a help.

Judge denies lawsuit to stop embryo destruction

Citing other legal rulings that embryos aren't "persons" under the law, a Federal judge (report, here ) denied the right of others to sue on their behalf or to sue to save them from being destroyed under new rules at the National Institutes of Health.

I've said it before: "law" does not a person make. "Person" is an artificial designation, made up by people who want to decrease the numbers of humans who have the right to live and by lawyers who want to control which entities (such as corporations) have "rights" bequeathed by law. Females are not "persons" in Arab nations like Saudi Arabia.

HPV vaccine adverse reports (prep for further posts)

Hwang convicted of fraud in cloning ruse

A South Korean court has convicted the perpetrator of the 2005 cloning fraud. Information here. 

Doctors pressured by scheduled Medicare pay cut

Here's confirmation from The Hill.com that planned cuts in Medicare payments to doctors are being used by Senate and White House leaders to secure support for the current health care reform bills, without tort reform.

The White House and Democratic leaders are offering doctors a deal: They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.
At a meeting on Capitol Hill last week with nearly a dozen doctors groups, Senate Majority Leader Harry Reid (D-Nev.) said the Senate would take up separate legislation to halt scheduled Medicare cuts in doctor payments over the next 10 years. In return, Reid made it clear that he expected their support for the broader healthcare bill, according to four sources in the meeting.

and,

Reid also asked that doctors ease up on demands for medical malpractice reform during the upcoming healthcare debate. Democrats have traditionally resisted calls for tort reform, which trial attorneys — a reliable base group — staunchly oppose.

The problem with fines (mandatory health insurance)

 The Washington Post notes that manufacturers of medical devices are being accused - they haven't offered "to give something back" to pay for health care insurance for all. Because they won't play the game that President Obama's been playing with the pharmaceutical industry and hospitals, their devices will be taxed like luxuries -- and the Administration will be able to say they've saved $40 Billion dollars.

Again, how much can they save by allowing Medicare docs' 21% cut to go through at the beginning of the year? (and they'll blame the Republicans for writing the original law in 1997)

Sarah Palin writes on the problem with mandatory health insurance at her Facebook page, here.

Americans want health care reform because we want affordable health care. We don’t need subsidies or a public option. We don’t need a nationalized health care industry. We need to reduce health care costs. But the Senate Finance plan will dramatically increase those costs, all the while ignoring common sense cost-saving measures like tort reform. Though a Congressional Budget Office report confirmed that reforming medical malpractice and liability laws could save as much as $54 billion over the next ten years, tort reform is nowhere to be found in the Senate Finance bill. [17]

Here’s a novel idea. Instead of working contrary to the free market, let’s embrace the free market. Instead of going to war with certain private sector companies, let’s embrace real private-sector competition and allow consumers to purchase plans across state lines. Instead of taxing the so-called “Cadillac” plans that people get through their employers, let’s give individuals who purchase their own health care the same tax benefits we currently give employer-provided health care recipients. Instead of crippling Medicare, let’s reform it by providing recipients with vouchers so that they can purchase their own coverage. 

Aristotle ethics, RFK, and health care reform

The Wall Street Journal's daily newsletter by James Taranto, The Best of the Web Today, debunks a quote floating around the Internet to support the "right" to health care paid for by government. The blurb has been attributed to a translation from the writings of Aristotle, a translation from the original Greek by Robert F. Kennedy.

Unfortunately, the first reference to the quote is from 10 years after Senator Kennedy died, is credited to someone else, and the original cannot be found in the existing works of Aristotle.

From an article by Edmond Pellegrino, the last chairman of President Bush's President's Bioethics Council, written in 2008:

In attempts to establish the provenance of the text in question we have conducted an extensive search for its source and original wording. We have not been able to locate it. Our initial curiosity was aroused by several things, including that rights language did not seem to have the Aristotelian context, and health care, as such, was not included in Aristotle's works. We searched Nicomachean Ethics and Eudemian Ethics, and the Magna Moralia without successfully locating the quote. Nor could we find it in other of works of Aristotle: On Length and Shortness of Life, De Anima, Economics or the Fragments. "Rights" language certainly would stick out in Aristotle's virtue-based ethics.

That article by Dr. Pellegrino is available in pdf, here, thanks to the WSJ and Georgetown Bioethics.