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!

Virginity pledges: the rest of the story

The "kids" aren't "kids" and they aren't "teens." And they wait 3 years longer than their peers and no one knows if they even had a sex ed course in school.

Fox News reports on their interview with the author of a report on teens who take virginity pledges. She told them that religious teens wait 3 years longer than non-religious teens and (as reported here, last week), the background of those who take virginity pledges is more important than the pledge itself.

Click here to read the study in Pediatrics.

Note that there is no way to know whether any of the students took any type of abstinence-based sexuality education course, that the ages of the "pledgers" and "non-pledgers" evaluated and matched in the study were at least 15 in the first "wave," 22 or so at the end, and the average age of first intercourse for the group is 21 years old, three years older than the national average.

Rosenbaum, the author of the "new" study also removed all of the married participants in the study:

Her study also only looked at teens who were unmarried five years after taking virginity pledges, now ages 20 to 23. "The married are out of the picture, so they're not as interesting," she said.

Edited 1/3/09 at 6 AM.

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.

CNN objects to conscience

This subject again.

CNN, that bastion of upstanding plants ethics, objects to doctors with morals - or at least the ones who act on them.

The CNN video (not a "news piece") shows interviews with a woman who was refused contraception by one doctor and a second interview with another doctor who is Catholic and who does not believe that contraception is moral and so he does not prescribe it.

The reporter is shocked that 60% of doctors feel that it's okay to tell patients our moral views.

The reporter asked the patient whether she felt "rejected." The woman said that she did and that she felt that the doctor was judging her and imposing his morals on her. She said that any doctor who would not do what his patients wanted should not be in practice.

The woman isn't judging or imposing her morals on every doctor, is it?

Doctors make "judgments" all the time. We are not simply dispensers of products that people want. We must "impose" our judgment on patients who smoke (a perfectly legal drug) and drink (ditto) or who have become overweight from eating legal food and choosing not to exercise enough to burn off calories faster than they take them in. We are responsible for determining whether a patient is becoming addicted to pain medications, asking for a note for missing work when they were never sick, or a handicapped parking sticker when they're not disabled.

Much more often, we make judgments about the cause of a patient's symptoms or disease and how best to treat it. Our job is not to make the patient feel good about themselves, although most doctors I've met prefer to do so. What we do is diagnose and treat in order to help the patient be as healthy as we are able.

While I don't object to non-abortifacient contraception, it is an elective service in most cases. It is very rarely necessary to maintain the health of the body of patients. It is truly a "choice."

As I've said before, it would be simpler for people who feel that contraception is important to arrange to pay doctors who will write and dispense those medications and devices to go around to the areas where they are needed.

The alternative is to find a way to trust a doctor who will act against his conscience - to do what he considers the wrong thing for your pet issue - to do the right thing every other time.


Hat Tip: Blog.bioethics.net

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."

Animal Farm: Trojan Pigs and Devolution of Standards

Correction, here: Another blogger The same poster that found it necessary to rant that Fox and CBS wouldn't advertise condoms on the Bioethics.net Blog also posted on the Women's Bioethics Blog. Blog.bioethics.net has been "down" since I posted yesterday - Coincidence? (Update June 21 - they still haven't posted my post.)

There's a link to the commercial, which I have to admit, has some humor to it.

So many puns, so little time.

Trojan could have appropriately used horses, but chose pigs to represent men. Perhaps -if I can use Alexandra's word - it's due to the devolution that produced the same low standards that makes them think a men's room condom dispenser could change a woman's mind about having sex with a pig. Yeah, when "pigs fly."

Alexandra comments on the hypocrisy of TV networks that would deny anyone "sexual pleasure with a condom."

Come on! As the commercial shows, the vending machine is in the bathroom at the club. With product placement like that (for the condoms as well as the men and women) what difference is a commercial going to make to the rate of "unintended teen pregnancy"?

I know, I know. There's actual bioethics news out there. Wesley Smith has posted on ACT's claim to have finally done the experiment they said they did, before. There's Ian Wilmut's plea for human-animal hybrids, not to mention his being named "feature editor" for the new website, "Nature Reports Stem Cells." And there's even "Skinny Water."

Can't resist ending with a line from one of my favorite pigs: "That's all folks!"

Changing the rules of biology?

Kelly Hillis, over at the Bioethics.net blog scoffs at the opinion of Concerned Women of America on same sex parenting. She claims that "Science has allowed us to change the rules of biology, and DNA is becoming a tool, not a definition."

I strongly disagree. We can't "change the rules of biology." With quite a bit of effort, we can accommodate to ourselves to work within the rules enough that it appears that we ignore them. While biology isn't destiny, you have to deal with it.

Our very biology is one huge influence toward making emotional commitments to people (and animals and objects, too) that are not close relations. Where do you think the social constructs come from?

I'm a big proponent of acknowledging unconventional families. Especially in our mobile society, we often make "families" of people we love, where we are.

I'd rather add to protections than take away the unique legal protections given the "nuclear family," however. That's still where most of us live, and there's evidence that it's the best environment for children. "Best practices" don't grow out of wishful thinking or great efforts to go around the rules: usual things are usual, and we should only advocate public policy based on findings of a real pattern leading to a desired result.

An interesting designation for experimentation with unconventional families comes from the American College of Pediatricians - a conservative off shoot of the American Academy of Pediatricians. They call it "social eugenics," and don't approve of attempting to "change the rules of biology."

Vaginal approach to gallbladder removal

Or removal of the appendix through the mouth?


I finished my residency training in 1993, and was privileged to witness some of the first "laparoscopic" gallbladder removals on one of my rotations with some private surgeons. After 5 years or so of observing and assisting with the old technique that required a 7 to 10 inch incision at the right upper abdomen and months of recovery, I was used to patients lying very still and needing encouragement to breathe after the surgery. I nearly fell apart myself when, just an hour after we removed her gallbladder, one of my patients sat up in bed. I've never moved faster than I did that time, trying to catch her before she tore her wound or fell out of bed when the pain hit!

My first reaction to this story was one of alarm about possible harm due to trying a new, risky maneuver, just because it's surgically possible.

I wasn't sure how much of my distaste was a woman's reaction to invasion through the vagina. After I read the description of the appendectomy through the mouth, I decided that it's a true caution about the risk of such a route.


The biggest problem with recovery from surgery is the trauma to the tissues surrounding the surgical site, especially the muscles that are cut and sewn.

I finished my residency training in 1993, and was privileged to witness some of the first "laparoscopic" gallbladder removals on one of my rotations with some private surgeons. After 5 years or so of observing and assisting with the old technique that required a 7 to 10 inch incision at the right upper abdomen and months of recovery, I was used to patients lying very still and needing encouragement to breathe after the surgery. I nearly fell apart myself when, just an hour after we removed her gallbladder, one of my patients sat up in bed. I've never moved faster than I did that time, trying to catch her before she tore her wound!

The new technique allowed for us to remove the gallbladder - and later, the appendix (and other stuff) - by making 3 or 4 cuts, all less than an inch and using instruments and a camera that allowed remote or video-guided surgery. Without all that cut skin and all those layers of muscle, patients got better, faster.

It's almost routine to perform hysterectomies through the vagina these days. But let's face it, in this case, everything's right there. The surgeon just has to watch for the blood vessels, the bladder and the rectum, and virtually no muscles have to be cut, at all.

Either of these operations would require muscles and "surface" tissues to be cut, and each require that the surgeons' instruments pass other organs. There's also the problem of making the surgical field sterile and maintaining infection control.

With removal of the gallbladder, there is also the risk to the liver, and especially, the common bile duct from the liver to the intestines. For that matter, an oral approach to the appendix would require reaching past the lungs, the diaphragm, the liver and the intestines, unless the instruments can be passed through the esophagus and stomach. (How would you intubate this patient, protect her lungs, or handle the leaks of acid from the stomach into the abdominal cavity?

The surgeons quoted in the New York Times article are proponents of "no scar" surgery.

I'm a little concerned about the way they "read":

Dr. Bessler said his patient agreed to the procedure (two others had declined) because he told her he thought it would have advantages for her, and she accepted his judgment. She was the first in a study that is to include 100 women who need gallbladder surgery, appendectomies or biopsies taken from inside the abdomen. All the procedures will be done through the vagina.

Dr. Dennis Fowler, another surgeon who participated in the operation, said the team began experimenting on women because “incisions in the vagina have been used for a variety of procedures for decades, and proved safe with no long-term consequences.”
. . .
The operation took about three hours, twice as long as the usual laparoscopic surgery, but it was the team’s first operation on a human, and the time should decrease with practice, Dr. Bessler said. Also because it was the first time, to be on the safe side, the doctors did make three small openings in the abdomen for surgical tools. But their ultimate goal is to perform the operation entirely through the vagina.

About those ultrasounds before abortion

Over the last few days, Kelly at Blog.Bioethics.net has been blogging about House Bill 3355, passed in the South Carolina, which will require the abortion doctor to review the ultrasound with the woman or girl at least one hour before the abortion. The woman has to sign a statement that she's received the informed consent and a review of the US.

Kelly and several of the other visitors at the site are concerned that the woman who has made the choice to have an abortion is being unduly influenced, browbeaten and/or the target of images capable of emotional blackmail. (Words from the bloggers are in italics.)

Oh, and "a guy can go around and have sex until the cows come home,he's never going to have to deal with the emotional decisions attached to an unwanted pregnancy."

But, somehow, it's no big deal, anyway.

The conversation is the same one we've been having for 30 plus years, but you might want to take a look.

More on HPV, mandates, and tax money

All State Medicaid programs must offer the vaccines recommended by the (Federal) Advisory Committee on Immunization Practices, under the Vaccines for Children program. The States don't have to mandate the vaccine, however.

Some of the docs I've talked to are convinced that Medicaid and uninsured patients will have an easier time accessing and affording Gardasil than insured patients - unless the insurance companies are forced to cover it somehow.

I predict that within just 2 or 3 years, the private insurers will see that the girls who receive the vaccine don't have to have nearly as many repeat paps, fewer colposcopies and biopsies. Eventually, in 5 or 6 years, there will be fewer freezing and laser therapy treatments. Somewhere in there, they will begin to cover and strongly encourage the vaccine, without being forced.

It turns out that the transition from infection with the more virulent strains to a precancerous or even carcinoma intraepithelial neoplasm (cancerous cells in the surface layer - the kind that leads to repeat pap smears, colposcopy and biopsies and then freezing or laser ablation or removal of the surface layer of the cervix. The pathology-reported names given to these spots on the cervix include "Low Grade Squamous Intraepithelial Lesions, High Grade SIL, Carcinoma in Situ ) can occur within 2 to 3 years, although most take 10 years or so.

From an article available here, free on line,

The traditional view has been that this process takes years, if not decades, to occur after initial HPV infection. Recent studies suggest that these changes may develop more quickly than previously thought. Winer et al followed women after initial HPV infection for the development of CIN 2/3.

As shown in Figure 3, approximately 27% of women with an initial HPV 16 or 18 infection progressed to CIN 2/3 within 36 months [20]. A second study of a large health maintenance cohort found that approximately 20% of women 30 years of age or older who were initially infected with HPV 16 developed CIN 3 or cervical cancer within 120 months.

Women who had an initial HPV 18 infection had approximately a 15% risk of developing CIN 3 or cervical cancer at 120 months [21].

The strong correlation between infection with high-risk types of HPV and LSIL, HSIL, and cervical cancer suggests that HPV DNA testing would be a useful tool for the management of women with abnormal Pap test results, especially in the case of those with equivocal test results. In the case of an equivocal Pap test result, HPV DNA testing can help determine whether the individual should be referred for colposcopic assessment [22].

(Ault, Kevin. "Epidemiology and Natural History of Human Papillomavirus Infections in the Female Genital Tract." Infect Dis Obstet Gynecol. 2006; 2006: 40470. Published online 2006 January 30. doi: 10.1155/IDOG/2006/40470. Copyright © 2006 Kevin A. Ault.)


The biggest financial gain to the Medicaid program and then the insureres - as well as the biggest gain in decreased worry and actual pain and suffering of women - will not be from a decrease in diagnoses of the cancer, itself. It will be from the decrease in the visible warts, as well as precancerous changes from the occult infections that can't be seen with the naked eye and the repeat testing and biopsies, along with the cervical damage from excisions, lasers and freezing which can lead to infertility and premature births.

More information at this summary of another research paper. And this paper reports on 2 year risk of developing CIN.

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.

Feminists For Life History

I wrote about Serrin Foster's article on National Review Online, yesterday. Be sure and click through to the actual op-ed and to the Feminists for Life website. (Especially the "Covetable Stuff"!)

The actual founders of F4L were two women, Catherine Callaghan, Ph.D. and Pat Goltz. Like many of us in the '70's and '80's, these women recognized the conflict between abortion and feminism. Both were once members of the National Organization of Women. Ms. Goltz was expelled from her local chapter, and both eventually resigned from the national organization.

Feminists for Life reminds us how common it is to assume that we know all about other people and other groups. It seems that we quickly stereotype and assume division, rather than look for common ground.

I love common ground! My goal has been to offer that ground and possibly to offer my translation and peacemaking skills in order to demonstrate the logic of the prolife arguments to the domestic and sexual violence communities, non-Christians and even atheists, pro-life churches and other prolife groups who assume they have nothing in common. Unfortunately, far too many prolife organizations require members to agree to a Christian creed.

For more surprises and information on opposing abortion in the public square, take a look at Libertarians for Life and Democrats for Life. And then, check out the Atheists and Agnostics Prolife Leaque (you've got to see their url).


(For those Christians who are offended, I offer the book of Romans - I try to live so that others can see some of the insight in Romans 1 through my example. A little bit of truth can serve as a catalyst for more truth.)

Feminists For Life op-ed on National Review Online

Serrin Foster, whose latest essay is published on National Review Online, is one couragious woman. She is the President of Feminists for Life, which some people are absolutely convinced is an oxymoron.

No, it's not. At the least, half of all the human beings that are killed by abortion are female. In some of the world, many, many more of the abortions are for "sex selection" - meaning they're culling the culturally less desirable girls.

And then there are the women who, like me are convinced that women should not be pushed to "choose" as the mother of "Sophies' Choice" did: between their children (the child you're carrying now and the children of the future) or between their children and their lives, their education or their jobs. Or between being fully women (who do get pregnant and bear children, by nature) or more like the men.

Between someone else's definition of success and failure.

Ms. Foster writes about the pressures placed on college girls to abort - the only "choice" offered on too many campuses seems to be what kind of abortion to have.

(Edited above - to correct some spelling - including Ms. Foster's name and her title. See the February 2 post for more on Feminists for Life.)

Take a look at the next post on Feminists for Life History.

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.

Planned Parenthood's "Free EC Days" (for men and girls)

Planned Parenthood in Waco, Texas, Memphis, TN and Williston, Vermont, and probably a town or city near you, will host a Free EC (Emergency Contraceptive) day next week. (Waco on Dec. 8, Memphis and Williston Dec. 8. More sites can be found by searching Google or Yahoo for "Free EC Days" - including information from MySpace PP pages, and information on previous "Free EC" days before the med when over the counter.)

The Memphis Regional Planned Parenthood notice states:

We can provide EC to girls and women of any age and to men 18 or older. (emphasis mine)

The Waco Herald-Tribune

The event, billed as Free EC Day, is something Planned Parenthood affiliates are doing across the nation, said Pat Stone, education director for the local affiliate.

In general, it’s meant to raise awareness about emergency contraception.

But more specifically, it’s to remind women that the medication is now available without a prescription for people ages 18 and older.

. . .
That’s where Planned Parenthood’s event comes in, Stone said. The idea is that making the drug available for free might nudge some women into keeping a box on hand, she said. Planned Parenthood normally sells the medication for $25, but it costs up to twice that at stores around town.

Officials also are hoping the event will help remove any of the taboo or intimidation factor surrounding the medication or sexual health in general, Stone said.
Officials also are hoping the event will help remove any of the taboo or intimidation factor surrounding the medication or sexual health in general, Stone said.

For some women, all it takes is an initial visit to a health care provider for them to begin taking control of their sexual health, she said.

That’s why in addition to giving the drug away for free, Planned Parenthood officials also will be giving tours of their facility and handing out a price list for services, Stone said.

She added that men are welcome at the event and that it will be a come-and-go process to accommodate people who may have to stop by before or after work or during their lunch breaks.
(emphasis mine)

I'm very concerned that that Plan B is being given to minor girls, but especially about the promotion to men. This is the first time that hormonal contraceptives intended for women have been available to men without concern or knowledge of the women or girls who will be taking the medicine. How can there possibly be education or informed consent in the giveaways and over-the-counter sales in pharmacies, for the girl or woman who will be taking them. I'm concerned about the potential for abuse. Will men present the pill to the women as a reason to skip the condom? Will the women be faced with being forced to take the pill by their partners? And, since half of the partners of minor girls 15-17 years old who get pregnant are 2 or more years older than the girls, will the pill give license to child abusers?

As I've posted before (here and here), I don't believe EC, used as directed, will cause the loss of any embryos - there's good evidence that it does not block implantation and that it only works, when it works, to hamper ovulation and to interfer with the sperm getting to an oocyte or egg. It only has a contraceptive effect - it only needs to work - during the 5 days or so that a woman or girl is fertile - just before and the day of ovulation.

Unfortunately, JAMA (the article is reproduced on my blog), Contraception, and the British Medical Journal, reports show that even in women and girls who are part of a study and who receive education and follow-up, there is no change in unprotected sex, Sexually Transmitted Infections or pregnancy rates.

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.

Parachutes, Abstinence, Randomized Controlled Studies

There have never been any controlled randomized trials on "Parachute use to prevent death and major trauma related to gravitational challenge," according to this review published in the British Medical Journal in December 2003. And yet, in the nearly 3 years since it was documented in a prestigious peer-reviewed journal that the evidence supporting the use of parachutes by those who jump from planes is anectotal, Federal, State and private entities continue to support the private parachute industry.

The Government Accounting Office released a review (in pdf) on the accuracy and effectiveness of abstinence sex education programs, in response to a request by several members of Congress. Editorials from the Bangor (Maine)Daily News, the Atlanta Journal Constitution and others on the review indicate that abstinence education is "scientifically invalid."

The International Herald Tribune's headline reads, " . . . no-sex-before-marriage programs forgo accuracy, are ineffective."

The GAO report actually covers several ways that an entire alphabet soup of agencies and States fund abstinence-until-marriage programs, how these programs are reviewed for accuracy and efficacy. There are also descriptions of problems that have been found and corrected. There is a mention of studies that are pending that would be equivalent to the "randomized controlled studies" that will supply "scientific validity" to measurements of evidence comparing outcomes in children who participate in abstinence-until-marriage programs to those in abstinence-plus programs and those who receive no structured sex ed according to standardized end points.

None of the sources give any references for "scientifically valid" "abstinence-plus" or "if you do it, use a condom and a back-up method of contraception" sex ed.

If I may, I'd suggest that editors learn to read reports and perhaps take a class in statistics. Or, they could follow the recommendation of Smith and Pell:

A call to (broken) arms

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

(Final emphasis, mine)