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

Elections have consequences (abortion, contraceptives, committees)

ABC's This Week with George Stephanopolis ran an interview with Speaker of the House Nancy Pelosi on Sunday, January 25, 2009. The transcript is here.

Stephanopolis allowed the Speaker to gloss over her policy that does not allow debate or amendments from the House floor, or that no Republicans were allowed to see or vote in Committee on last week's SCHIP Bill ("H.R. 2 is rushed legislation by the Democrat Majority that did not hold a single committee hearing or allow amendments to be offered on the bill."), and were only given a summary at 5:30 AM on the day of the vote.

STEPHANOPOULOS: The president has made it pretty clear he wants this to be a real bipartisan effort. Yet House Republicans have said they have been shut out of this process. There were no Republican votes in the appropriations Committee, no Republican votes in the Ways and Means Committee.
PELOSI: Well, because the Republicans don't vote for it doesn't mean they didn't have an opportunity to.

While I believe that true contraception, as in prevention of the union of sperm and oocyte, is ethical, I had planned to move strait to the Speaker's comments about Family Planning funds. However, it appears that the President was listening to the voters, even if the Speaker hadn't.

Posted: Tuesday, January 27, 2009 11:41 AM by Domenico Montanaro
Filed Under: White House, Congress

From NBC’s Mike Viqueira
The provision within the stimulus that would allocate money for contraceptive programs through Medicaid will be pulled out of the package.

NBC News confirms that the president called Henry Waxman, the chairman of the committee that inserted the contraception provision into the stimulus during the mark up last week, to ask him to remove the measure from the bill, according to a Democratic leadership source.

In short, the idea has simply become too controversial. Speaker Nancy Pelosi's defense of the program over the weekend, where she indicated that it would be a money saver, was not well received.

So that provision is out.

Complicating matters, both Minority Leader John Boehner and No. 2 Eric Cantor have told House Republicans that "all Republicans should vote against the stimulus" if it remains "in its current form," according to a GOP leadership aide.

They spoke inside their weekly conference meeting, behind closed doors. Afterward, both men came to the on camera stake out. The House will begin debate on the stimulus package late today, with no votes expected until tomorrow. Debate is expected to begin somewhere close to 5 p.m. ET.

The way your U.S. House works is that anyone who wants to offer an amendment to be considered on the floor has to go to a committee, the Rules Committee, beforehand.

The Rules Committee is a complete and utter tool of the majority leadership. (Emphasis mine, BBN.) It decides which amendments will be allowed on the floor for consideration. The minority is habitually unhappy with the result, as their measures, especially the ones that have a chance of passage or contain some political mischief or "poison pill" language, are barred. The Rules committee meets this afternoon to make its decisions.

So, besides politics, what's all the fuss about?

Part of the problem is the $50 million for the National Endowment for the Arts, ACORN, $200 million for sod for Washington, DC parks, $20 Billion for electronic medical records, and the emphasis on global warming research (with its increased costs for housing, transportation, food production and all aspects of our daily life).

One day after the 36th Anniversary of Roe vs. Wade and as the number of electively aborted children in the United States alone (non-medically necessary, not associated with "rape, incest, or the life of the mother") approaches 50 Million, President Obama overturned the so-called "Mexico City Policy" or "global gag rule." US tax dollars will once again be allocated to organizations that advocate abortion as birth control, and even those that lobby to change the laws of other nations to allow abortion where it is not currently legal. Every news article I've seen conflates the gag rule with limiting non-abortifacient contraception. However, the only restriction is that on abortion.

Another Bill now in the House and Senate, would wipe out abstinence-based sex ed and mandate emergency contraception according to the Rochester, NY newspaper:

* House member Louise Slaughter submitted the Prevention First Act of 2009 (H.R. 463/S.21). In the Senate it was introduced by Democratic Senate Majority Leader Harry Reid.

The legislation focuses on reproductive and sexual health issues, and in some cases reverses Bush administration policies. It provides funding for comprehensive sex education programs, and none for abstinence-only sex ed. Other provisions include mandatory access to emergency contraception for rape survivors, and a requirement that hospital staff provide factual, science-based information on EC, including instructions that it doesn't cause abortions.

The bill would also force health insurers to offer equitable coverage for prescription contraceptives.

And then, finally (from the first link above), Speaker Pelosi on Federally funded contraception for the poor:

STEPHANOPOULOS: Hundreds of millions of dollars to expand family planning services. How is that stimulus?

PELOSI: Well, the family planning services reduce cost. They reduce cost. The states are in terrible fiscal budget crises now and part of what we do for children's health, education and some of those elements are to help the states meet their financial needs. One of those - one of the initiatives you mentioned, the contraception, will reduce costs to the states and to the federal government.

Texas teens form pro-life club

And, it seems that the kids in Coppell, Texas (near Dallas) are only "anti-abortion" because of the undue influence of their families and churches. From the Dallas Morning News:

Abortion rights advocates say it's even harder for them to organize high school students because of the focus on abstinence.

"We're up against a movement that has federal dollars going into public schools," said Kierra Johnson, director of Choice USA. "You compound that with what they could be learning in church, and it sets us back in terms of outreach to young people under 18."

Of course, the Dallas Morning News calls the club "anti-abortion," not "pro-life." In spite of the fact that the kids call themselves "The Pro-Life Club." The author calls for tolerance on the part of the "anti-abortion crowd but can't even bring herself to use the term the teens would prefer.

I guess the DMN doesn't keep up with the latest research. Otherwise, they'd know that the study on abstinence that was in the news earlier this month informed us that teens - whether they sign a pledge or not - who come from religious, conservative backgrounds are more likely to delay their first intercourse for about 3 years longer than their peers. I nominate the author of the article,Katherine Leal Unruth, her editor, and Ms. Johnson for Twits of the Year and definitely award them my own Yellow Brick Road award. ("Do Not Look Behind the Curtain, Ignore That Little Man." Or small woman.)

Bravo Coppell teens, their parents, and their churches!

New study on virginity pledges and behavior

The article in question can be downloaded from Pediatrics, here.


The final "wave 3" data came from the group that the author calls "adolescents" -- who were 22 years old. Data from those who had married was treated as "missing."

We don't know anything about the actual sex ed courses that the students took, who paid for the course, or whether they actually took a course or just made a pledge.

From the article: “Virginity pledges are also now used to measure AOSE program effectiveness, which the US government considers successful if they produce many virginity pledgers, irrespective of participants’ sexual behavior.”

(Is it true that the pledge is considered a marker for the success of abstinence-only sex ed? I know that I’ve read several articles showing short term increase in the intention to remain abstinent, so that would not surprise me. However, I haven’t seen this “marker.”)

As far as I can tell, it appears that the author took data from a series of national questionnaires , matched kids for background and family, and found that they have similar outcomes after 5 years.

Oddly, a huge number - 80% - of the pledgers denied having pledged in follow up. The other number that seems to stick out is that the non-pledgers did pay for sex and/or get paid for sex more often.

Nevertheless, the only study that I’ve seen that measured pregnancy rates after a course that included teaching proper condom use did not show prevention of pregnancy, either. I posted a review of the pay-for-view article in the British Medical Journal.

Abstinence vs "plus"

The Texas Legislature is about to reconvene and the sex ed debate in our State is already in the news. (Free subscription required.)

Unfortunately, the news article blurs the line between sex ed for all children in our schools and the problem that some of our girls have multiple pregnancies as teenagers. What little evidence we have about "abstinence-plus" vs "abstinence-only" sex ed (some of which is reviewed here and here) is never mentioned, while the fact that our State teen pregnancy rate has dropped is seen as a failure or completely ignored.

Along with many of our local physicians, I teach the doctor's portion of "Worth the Wait." The program is taught in all our county's schools. The classes begin in the 6th grader (the students are 11 and 12 years old) and continue into High School health classes (through grade 12, or 17 to 18 years old). The course consists of 16 or 17 classes, including one on STD's that is taught by local doctors and one on the legal consequences, taught by local lawyers.

The main contrast between "Worth the Wait" and "Big Decisions," the program mentioned in the article ( available for download, free, here), is that in each of the 10 to 12 lessons, the latter emphasizes condom use for those who do choose to have sex. There's even a supplemental lesson that teaches how to correctly use a male condom.

Many point out that since some teens will have sex before marriage, and that many will do so much earlier than expected, the earlier these lessons are taught, the better. However, in my experience, the kids who are having sex before 17 or 18 are the ones who are also engaged in other risky behavior, including drinking alcohol and smoking, or who are being abused. (See the story about the 18 year old young man, here.)

I'm uncomfortable with early discussions about "taking action" to buy condoms and how to use them because it seems to actually endorse the idea that there is a healthy way to have sex outside of a committed, monogamous relationship - one that 14, 15 and most 16 and 17 year-olds are not able to establish.

I believe that the best decision is the one that parents, teachers and our schools should teach. We do not talk about the safest way to drive a car before they are 16 and have passed several tests or that seat belts will protect them if they drive recklessly, we don't teach them which alcohol to drink when they are under the legal age limit, and we never tell them that if they are going to smoke, here's the way to do it.

In my "How to live a healthy life" talk that I give adolescents and teens (and sometimes adults) I talk about the physiological and medical reasons we encourage helmets for skaters, seat belts in cars, and why we discourage certain other behavior. I mention the job of the liver, the differences in the body as it matures, the risk of addiction, injury, and infections. Then, I talk about the psychological and social risks and consequences.

For instance, can you really trust someone selling an illegal drug to be honest about what he's selling you? If someone pressures you to have sex without a condom, knowing the risk of even deadly infections (yes, I talk about condoms in my office) does he even love himself, much less you?

It astonishes me how varied the apparent ages of these children are - even through the High School classes (up to age 18). Some still appear to be prepubescent and some look to be fully developed physical adults. While discussing sexual abuse, I remind the 11, 12, and 13 year-olds that in the State of Texas, that it is absolutely illegal to have sex under the age of 14.

And in every class of 6th graders, there's at least one girl who raises her hand and asks if she could go to jail.

I'm quoted in Texas Monthly

Over the weekend, at the annual convention of the Texas Medical Association, a friend said that she'd read my quote in "Texas Monthly." I assumed she meant an old article in Texas Medicine, the journal of the Texas Medical Association. I was wrong. (And, maybe now I know why I can't get appointed to any of the TMA Councils or Committees!)

In an article titled, "Faith, Hope and Chastity," in the very liberal Texas Monthly the author (without contacting me at all, by the way) used a statement that I made at a 2004 Texas School Board hearing on the content of high school textbooks on sex education.

The board met to consider these textbooks in July and September of 2004. More than one hundred people testified or submitted written testimony. Those who testified in person were given three minutes each to make their case. According to Gordon Crofoot, a specialist in HIV and STD treatment and research, many of the board members appeared totally uninterested in his testimony. Crofoot cares for about one thousand patients in his practice in Houston and is currently seeing more young patients with HIV than he has in his 31 years of practice.

“These textbooks do not meet the criteria and are factually and scientifically incorrect in what they say,” he told the board, “but their major fault is in what they don’t say and the resulting consequences. . . . If we do nothing [about STDs], the direct cost over the next ten years would be $10.6 billion. Comprehensive sex education programs might reduce this cost by fifty percent. Can Texas afford this cost?”

Crofoot was cut off when his three minutes were up. He offered to answer any questions. The board had none. Later in the day, he watched as Beverly Nuckols, a family doctor in New Braunfels opposed to comprehensive sex ed, was asked about the implications of human papillomavirus for men. She answered that HPV affected women differently than men before stating her position that condom instruction, in her experience as a family doctor, would do little good. “Yesterday I saw a boy who had had three partners in the last month,” she said. “He’s had twenty-two partners. He’s eighteen. He uses condoms every time. Unfortunately, a lot of the times he’s drunk and so they break or they don’t work. I mean, condoms are not a solution for teenagers outside of monogamous relationships. They don’t use them right even if we teach them.”

I'm not quite sure why I was chosen as the representative of those who "opposed comprehensive sex ed." I can't quite remember telling the story, but I probably did -- however, I don't think I would say, "I mean . . ." In order to read it in the journal, you'd have to turn to the "continued on page 200-something." However, I believe that the story was to refute testimony that high school boys and girls should be taught that condoms are the answer to all risk from the consequences of sex. My more common story is to note that condoms are more likely to be used correctly by couples in a monogamous relationship, that couples get better as time goes on, and that if a hundred couples use condoms to prevent pregnancy, 11 of them will get pregnant within a year.

The part that I remember addressing was a comment from a nurse practitioner who stated that there was no risk of contracting the Human Papilloma Virus for a girl, if the male wore a condom. The concern, according to her, is the infection of the girl's cervix. This was about the time that the public was becoming aware that cervical cancer is caused by HPV 99% of the time. According to the nurse, the tip of the penis when covered by the condom wouldn't actually touch the cervix. I felt compelled to delicately explain that the most common human sexual activity involves ins and outs, and that there is much more contact and potential for spread of the virus to all of the male and female genitalia -- except for the parts actually covered by the condom.

Let me correct one thing: I'm not against comprehensive sex education. I disagree with some people about the definition of "comprehensive," and believe that anything beyond the basics of very boring biology - the medical and legal responsibilities of human sexual activity - ought to be vetted by the parents in the local school districts. The school is not the place to teach methods and techniques and condoms are not the panacea they're far too often made out to be.

I do believe that the State (schools) should encourage sex within monogamous marriage, since that is the healthiest for individuals, families and their children, and for the taxpayer. While some people do very well in different arrangements, it takes a lot more work and the risks are far greater.

"Modest" Increase in Sexually Transmitted Diseases

After a decline in STD's in the late '80's and '90's that is believed to have been driven by "safer sex" strategies brought on by the spread of HIV, numbers of infections have increased for the second year in a row.

The increase may actually be the result of increased efforts at screening and more sensitive tests, according to the CDC.

The report notes that the greatest risk is found in men having sex with men and girls 15-19. These numbers may simply reflect the fact that these populations are more likely to be screened for diseases and that there's been a push to increase screening, particularly in the former demographic.

There's a physiological explanation about why younger girls are more likely to catch diseases like chlamydia and HPV, the virus that causes abnormal pap smears and can lead to cervical cancer. There's also a behavioral explanation: younger girls are more likely to engage in riskier behavior, have higher-risk partners and have more partners.

The cells of the cervix of the young girl are more susceptible to injury and to invection. As the girl matures, the columnar epithelium is replaced by squamous cell epithelium. (At the risk of grossing people out being indelicate - think of it as the difference between the tissues of the inside of your cheeks and the tissue on the outside of the lips.)

(Similar risk factors probably apply to the men having sex with men category, too, although I didn't see any specific discussion about these risks for girls or men in the mainstream press articles here, here, and here. This this article in a gay publication does review the girl's tissue changes and the difficulty of notifying the partner of an infected patient who is more likely to have anonymous sex partners. )


It is alarming, however, that the two vulnerable groups are also the people who are most likely to have life-long consequences of STD's. The girls risk early pregnancy and infertility and the men having sex with men risk truly deadly diseases like drug resistant strains of HIV/AIDS, syphilis, and gonorrhea.

I'm afraid that this report will fuel criticism of abstinence education. But let's face it, teaching condom use and oral contraceptives are not the answer for either of these populations.

We know a little about what works and a lot about what doesn't.

Edit, 11/27/07, grammar typos.

Two sex ed reviews, still no conclusions

We're finding that nothing changes the rates of pregnancies and STD's in teens except parental and peer pressure and concerns ("costs") of pregnancy.

I'm afraid that two published reviews of the literature on studies on sex education for adolescents and teens done by Kristen Underhill, Don Operario, and Paul Montgomery at the Centre for Evidence-Based Intervention at the University of Oxford ( here)and (here ) don't tell us much more than we knew before.

Although the authors report that there are few if any reports that give biological data or actual pregnancy and STD (including HIV) infection rates, the first study found no significance in behavior in "abstinence only" sex education compared with "usual care" in the community. (We're not sure what the "usual care" at those schools is, however.)

In the second study, authors did a review focusing on reports on sex education in "high income" societies, comparing "abstinence only" (which are defined as not promoting condom use) and "abstinence plus" (those which emphasize abstinence but promote condom use if you're going to have sex). report that there is a significant difference in decrease of "HIV risk behavior," but no evidence that teens have sex later, actually contract STD's less often, or have fewer pregnancies.

Neither of these studies tell us that abstinence based sex education does not work. I'm afraid that the only thing they do tell us is that there are factors we are not measuring and that our young people are engaging in risky behavior.

Hat Tip to "Pure Pedantry."

Med Associations Announce Position Statements on HPV Vaccine

Washington State is planning to offer the Human Papilloma Virus vaccine free to girls. New Hampshire has made the vaccine available on an "opt in" basis. Florida's Legislators are considering following Texas Governor Rick Perry in making the vaccine mandatory, with an "opt out" option, similar to the way that Hepatitis B and other mandated vaccines are regulated. (The vaccine would also have been mandatory under the bills that had been introduced in the Texas Legislature before the Governor's Executive Order.)

Two letters (via email) concerning the HPV arrived since yesterday, one from the Christian Medical and Dental Association and the other from the American Academy of Family Physicians. There is also a newspaper article that covers the Statement of the Texas Medical Association. (I'm a member of each.) Another group forwarded the statement from the Catholic Medical Association.

All encourage the voluntary use of the HPV, because of the safety and efficacy of the vaccine and the ethical practice of preventing disease. And all discourage making the vaccine mandatory.

The Catholic Medical Association (CMA) statement is available online, but in "Macromedia FlashPaper" form, which I've never seen before. The statement is well thought out, with excellent ethics and medical basis. The short statement explained by the 5 page document is:

Does the CMA Support Use of the HPV Vaccine?
The CMA supports widespread use of Gardasil for girls and women in the age range for which the vaccine has been recommended by the ACIP, because it is effective, safe and ethical to use, provided certain conditions are met.

Those conditions include continued teaching concerning abstinence outside of marriage and allowing parents to give informed consent.


The Christian Medical and Dental Association gives the following analogies:

The condom, safe-sex message is like telling your teen not to speed and then giving them a radar detector. HPV vaccination is like telling your teen not to speed, while reminding them to wear their seat belt. You want them to have protection from harm if they are in an accident – whether their fault or not.

and for the Christian philosophical basis for the vaccine:

As Jesus taught us in the story of the woman caught in adultery, Scripture teaches that we can/should show compassion by protecting others from the consequences of sin (while not endorsing sin or promoting continued sin). Facing death by stoning, Jesus protected her and offered forgiveness before calling her to a path of righteousness. He showed grace and compassion, not requiring her to commit to some standard prior to offering protection.

The American Academy of Family Physicians' (AAFP) email contained concerns about the ability to fund the vaccine and to obtain enough vaccine to administer it to all the eligible girls. The AAFP already had a provisional statement, but the move in several states, including Texas, to make the vaccine mandatory prompted the following:

"The AAFP feels it is premature to consider school entry mandates for HPV vaccine until such time as the long term safety with widespread use, stability of supply, and economic issues have been clarified."

Recently, there has been increasing state level action considering mandating HPV vaccination with proof of vaccination required for school attendance among other mandates. Upon review of the situation, the Commission on Science felt that this usage does not fit the classic public health model for infectious diseases such as measles. Several issues arise when considering a mandated school entry requirement. These include:



HPV does not adhere to the public health model for control of infectious disease in a school setting. (e.g. measles, chicken pox)

Universal school entry requirement would come at a cost of approximately $900 million per year to provide coverage for the female birth cohort (2 million girls: $120 per dose plus $25 administration fee; 3 doses). This would be a significant burden on state public health budgets.

There would have to be an assurance of supply of 6 million HPV doses per year to meet the school entry cohort. Given the recent experience with shortages of new vaccines such as the MCV4 for meningitis and Thimerosal-free influenza vaccine for three year olds, it is not clear that this new vaccine could be produced in adequate amounts to meet such demand at this time.

As with the costs for public health departments, there is concern that physician practices may not be able to afford such a large scale requirement at this time.

The Texas Medical Association leaders gave interviews to reporters concerning their reaction to the Governor's Executive order.

"We support physicians being able to provide the vaccine, but we don't support a state mandate at this time," said Dr. Bill Hinchey, a San Antonio pathologist and president-elect of the TMA, which represents 41,000 physicians. "There are issues, such as liability and cost, that need to be vetted first."

Other reasons cited by doctors in Texas and across the country include the vaccine's newness; supply and distribution considerations; the possibility opposition could snowball and lead to a reduction in other immunizations; the possibility it could lull women into not going for still-necessary cervical cancer screenings; gender-equity issues; and the tradition of vaccines starting as voluntary and becoming mandatory after a need is demonstrated.

Hinchey said that TMA leadership expressed their concerns to Perry on Tuesday. He said the TMA arrived at its position after debating the issue in committees in recent days.

A spokeswoman for Perry reiterated Tuesday that the governor stands by the order. She said he is listening to the discussion but thinks the vaccine is safe and effective.

Texas HPV Vaccine

One of my goals is to translate between the pro-life and pro-family community that has a religious background and those who do not necessarily count themselves as religious. Sometimes, it seems that's all I do.

Governor Rick Perry evidently surprised most of the world with his brave move concerning a vaccination against Human Papilloma Virus, a group of sexually transmitted viruses that cause abnormal pap smears and cervical cancer. While he follows a 2003 law, he has been criticized by the Family Policy Center, the American Association of Physicians and Surgeons and many Texas conservatives. Even the Republican Party of Texas issued a statement calling on him to rescind his Executive Order.

Although I normally agree with these groups, I think they are wrong in this case. The Christian Medical and Dental Association agrees with me. And Governor Perry, since he went so far in his EO to protect the right of parents to "opt out."


The vaccine will not interfere with our efforts to teach and encourage our children to abstain from sex outside of marriage. In fact, I hope that by giving the vaccination before 6th grade, younger children will be less likely to connect the vaccine with sexual activity and will be protected when they do have sex for the first time. The fact that the vaccine is so necessary could also be used to teach the fallacy of "safer sex."

The research showed that younger girls show stronger immune responses to the vaccine than older girls and women. And logically, vaccines only work before contracting the disease.

Studies of teen girls have shown that over 2 years, 40% to 80% of them will become positive for HPV, and over 10% of them will have the high risk virus, HPV 16, that is associated with over 50% of cervical cancers. Admittedly, the infected girls must be exposed. However, contrary to popular opinion, the viruses can be spread by the hands during heavy petting.

Besides the pain and cost of the cancers and the 400 deaths per year in Texas from cervical cancer, however, there is the cost of the early precancerous changes from the viruses. There are the every three to six month repeat paps and HPV tests, the freezing and lasers, and the weakened cervices that can result in premature labor.

Gardasil, while new, is produced the same way most insulin for diabetics is manufactured these days: by recombinant DNA. It’s not a weakened or killed virus, isn’t grown in human tissues and doesn’t contain mercury. The vaccine contains copies of antigens that are part of the outside covering of the virus, not the DNA that causes infection and cancer. Vaccinated patients make antibodies against four strains that cause the most harm.

In contrast, the last two vaccines mandated for schoolchildren in Texas are manufactured using human tissue cultures that resulted from abortions. Many parents object to the “Chicken Pox” Varicella and Hepatitis A vaccines – although the children were not aborted in order to obtain the vaccine, and there is some ethical support for accepting the vaccines because the unethical act is isolated from the intention and act of the vaccine.

(Edit: The Hepatitis B vaccine is also made by recombinant DNA, and not one of the un-ethical methods. This was added to strengthen the case for the safety of the recombinant technique, similar to the evidence due to the wide spread use of insulin from recombinant DNA. I could have added that Hepatitis B is another virus that is unlikely to be spread by casual contact in school. That fact is also true of another mandated vaccine for Tetanus - what we used to call "lock jaw.")

The vaccine against Hepatitis B, which is spread by blood and bodily fluids, has been mandated for school children in Texas since 1998.

The Texas Legislature gave the Governor the power that he exercised as the head of the Executive Branch: the power to regulate the Medical Board and the Department of State Health Services. The Legislature has passed law as recently as 2003 that allows the Department and Board to add vaccines as they deem them necessary.

The Governor's language strongly promotes the parental right to "opt out" and orders the Department to make the “opt out” provision available on the Internet. Currently, parents have to make a request in writing for an affidavit, which has to be notarized and then delivered to the Department - eventually the Department mails the exemption to the parent. (Can you imagine? There's no way we could have ever managed to get parental consent forms this complicated or the process so convoluted for abortions.) The Governor's language would make the opt out process easier.

Governor Perry’s Executive Order: here.

The Texas Education Code: here.

Gardasil prescribing information: here.

Statement from the Christian Medical And Dental Association: here.

Texas: First to Mandate STD Vaccine

That'll shock 'em on the coasts, won't it? Not to mention France and England, since the story has gone global.

Governor Rick Perry reportedly (free registration required) has signed an order mandating that teen girls in the State of Texas receive the vaccine against four strains of the Human Papilloma Virus by 12 years old and that the State pay for the vaccines that are not covered by health insurance. Two of these strains cause most cases of cervical cancer, and the other two cause most of the big, ugly genital warts that, while they don't cause cancer, can obstruct the urine or bowels and definitely cause bleeding and pain.

We all hope that our daughters and sons will meet their perfect mate, get married while they are both virgins. Then, we wouldn't have to worry about 99.7% of all cervical cancer. However, as Dr. Gene Rudd of the Christian and Dental Medical Association has said, no matter how well we raise our daughters and sons, their future husbands and wives may not have benefitted from the same background. A virginal wife can catch the virus from her husband on their wedding night(and vice versa - although he has vastly less risk of cancer of the penis in the US).

Another shock will probably come when (what the Houston Chronicle and the Austin American Statesman are calling) "the Governor's base" does not rise up in revolt and rants.

There is a strong lobby in the State against mandated vaccines (largely driven by objection to mercury preservatives, the vaccinations that are grown in human cell cultures and the troubles with the pertussis [whooping cough] vaccine from the '70's and '80's.) However, while good people who probably agree with the Governor's pro-life, pro-family views on other issues, these are not quite large enough to be called the Governor's "base."

In my opinion, the Governor decided that the vaccine is too important to leave to politics - especially in a State still healing from the redistricting fight of 2003, that ended up with first the Democratic Representatives and then the Democratic Senators running away from Austin and leaving the State to stall legislation.

I wish he would go ahead and let both the boys and girls get the shot -- Take a look at this video on "herd immunity." If we're going to do this thing, we might as well eradicate as much of the virus as possible.

I am concerned that no one knows how long the vaccine's effects will last.

On the other hand, this is Texas.

We don't like the government mandating anything. We can be convinced that some things are for the good - at least for other people - if you sell it right(grin).

The Governor must make a huge effort to convince the parents of Texas that this is good for the boys and girls in Texas, and that the money spent on the vaccine ($360 per girl, for 3 shots over 6 months) will save lives and money by preventing cervical cancer, genital warts and even anal cancer in both men and women.

Contraception and abstinence in the news

The news today reports on a study by the Alan Guttmacher Institute that abstinence doesn't make as much difference in the overall teen pregnancy rates in the US as increased contraceptive use.

I'm still looking at the data in the report and trying to understand their methods and statistics. (Free Abstract here).


Comparing data from the National Survey of Family Growth, 1995 and 2002, the researchers found,

Our data suggest that declining adolescent pregnancy rates in the United States between 1995 and 2002 were primarily attributable to improved contraceptive use. The decline in pregnancy risk among 18- and 19-year-olds was entirely attributable to increased contraceptive use. Decreased sexual activity was responsible for about one quarter (23%) of the decline among 15- to 17-year-olds, and increased contraceptive use was responsible for
the remainder (77%). Improved contraceptive use included increases in the use of many individual methods, increases in the use of
multiple methods, and substantial declines in nonuse.

On the other hand, some of the blogs and pro-life news sites have been talking about a new study that shows strong evidence that there is protection in abstinence based sex ed.

John Jemmott, PhD of the University of Pennsylvania Annenberg School, reported in Toronto in August, 2006 that his team had compared abstinence-only education with

The PowerPoint slides showing efficacy of the abstinence only approach, from the presentation in Toronto are here.

And here's a review of the discussion in the media, at the time:

A study of 662 African-American Grade 6 and 7 students from inner-city middle schools in Philadelphia found those taught an abstinence-only approach to sex were less likely to have had sexual intercourse at 24 months' follow-up compared to those put through a "safer sex" intervention that emphasized condom use but made no mention of abstinence.

And while Bill Clinton, the former U.S. president, told delegates to the International AIDS Conference in Toronto yesterday that abstinence programs delay sexual activity but make teens less likely to use condoms when they do start having sex, the study found the opposite to be true.

"It did not reduce intentions to use condoms, it did not reduce beliefs about the efficacy of condoms, it did not decrease consistent condom use and it did not decrease condom use at last sexual [encounter]," lead author John Jemmott, of the University of Pennsylvania, said.

The youngsters in the study ranged in age from 10 to 15; half were girls. Twenty-three per cent said they had had sexual intercourse at least once before the study began.

"There aren't any studies that show that children are less likely to use condoms as a result of an abstinence intervention. I've looked in the literature, there are no studies that show that," Mr. Jemmott said in an interview.

UK: Teaching children how to use condoms no help

This month, the British Medical Journal (sorry, subscription only) has published a report on a randomized controlled study on enhanced sex ed that failed to reduce the numbers of pregnancies or abortions in teen girls. Essentially, the "programme" involves education for boys and girls 13 to 15 years old, including teaching them to obtain and "handle" condoms (how to put them on), role playing and games about sexual situations. This is in contrast to "Conventional Education" in the UK, which is described this way in the report:

In the 12 control schools sex education for third and fourth years varied from seven to 12 lessons in total, primarily devoted to provision of information and discussion. Only two control schools routinely demonstrated how to handle condoms, and none systematically developed negotiation skills for sexual encounters. The cost of conventional education varied, with individual packages starting from about £20. Few teachers had more than one day’s training, which would have cost about £180 a day, and some had received none or only a few hours’ training.

Luckily, there are some good reviews online:
"Sex Education Fails to Cut Teenage Pregnancies" from the Guardian.

"Role playing sex classes fail to cut abortions," from the Telegraph.

An enhanced sex education programme for teenagers has proved no better than conventional teaching in cutting unwanted pregnancies or abortions, a detailed research study said yesterday.

The programme was based on an intensive £900 training course for teachers that was then delivered to 15-year-olds over three years.

Five years later, conception rates were measured in 20-year-olds who had been on the programme and compared with those in young people who had not.
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The teaching system, called Share — sexual health and relationships: safe, happy and responsible — included group work, role play and games. The teenagers were shown how to use condoms and access sexual health services and were given leaflets on sexual health.

The programme and research was devised and supported by the Medical Research Council (MRC) and the Education Board for Scotland, now Health Scotland.

Teachers in the schools used for comparison had less instruction or none at all.

"Sex education "only does so much'" from BBC News notes that schools are required to teach sex ed from ages 11-14 in England and Wales, but there has been no such requirement in Scotland.

And from the November 23 "Learning and Teaching Scotland" web site, we learn that the program was introduced throughout that region last week.

The UK press reports that the teen pregnancy rates under 18 are going down, from 44.3 births per 1000 girls ages 15 to 17 to 42.9 since 1998, and declared this a "success."

Edited 12/29/08 for labels.