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.

Top 50 Medical Blogs list

We made number 12, under Bioethics. The list appears to be a good resource - just come back here when you're done surfing the others!

Spelling corrected 1/6/09

Health care reform conversation

There's a comment from a proponent of single payor health care payments on one of my November posts. A few points need to be clarified:

The numbers about infant mortality are skewed in the US because we count more infants as "live births" than other countries.

We use Medicaid money to finance special education and Medicare to finance medical education -- are those included in those numbers?

Also, that $7000 is an average - that includes all the expensive care for very ill patients. It would be more interesting to note per-capita bone marrow or other organ transplant.

I would like to see how much of our medical spending is actually elective - Botox and plastic surgery as well as contraceptives and abortions.

The majority of Family Physicians are against or conflicted about about single payer. We don't have a great history of changing policy to the benefit of our practices. Medicare, medicaid, and Workman's Comp pays better for procedures like surgery and invasive tests than they do for cognitive and preventive skills.The Family Doctor could do more if we weren't under pressure to see 4 to 5 patients per hour.

Health care outcomes are strengthened where primary care is strongest, according to research.


What I want to see is a public policy that allows patients to own their own health insurance and for doctors to work for the patient. Medicare still won't pay for tetanus shots when a covered patient needs one.

I just worry that what we have is not working because of regulations and laws. I don't want more of those.

Fox builds hen house

In the same set of news alerts that notified me of the Vatican's condemnation of cloning and embryonic stem cell research, I read that Insoo Hyun is the lead author of the International Society for Stem Cell Research (ISSCR) Guidelines for the Clinical Translation of Stem Cells.

The Guidelines are also published on line at Cell Stem Cell and, along with a patient handbook and other supporting material, is available at the ISSCR website. Here is the link to the page containing links to pdf of the Guidelines, patient handbook, and other materials. That page also links to the Stem Cell Cell article.

The story in the Australian blurs the differences between destructive embryonic stem cell research and the non-destructive, ethical forms such as induced pluripotent stem cell research and adult stem cell research. The focus is on the former, detailing long anticipated (but not yet begun) phase 1 embryonic stem cell research, without mentioning on-going trials or previous achievements using the non-controversial cells.

The ISSCR in general and Dr. Hyun in particular, are very much advocates of embryonic stem cell research and cloning for research. Also on his task force were Laurie Zoloth and George Daley, both strong advocates of embryonic stem cell research. Daley has worked to create embryos slated for destruction in his own Harvard lab, although he has focused on non-destructive research, recently.

Dr. Hyun has a Ph.D. in bioethics and is on the faculty at Case Western University in Cleveland, Ohio. He has focused on cloning research, and his early work included assisting the Clinton Administration's National Bioethics Advisory Committee (that would have been along with Obama transition team members, Jonathan Moreno and Robin Alta Charo) on their "secular" article on cloning. He went to South Korea with Hu Suk Wu in order to study the effects of cloning research on the Koreans - before the Korean was exposed as a fraud.

I wonder whether there was even one member of the ISSCR team who considers embryonic stem cell destruction unethical? And how soon will Dr. Hyun join his former colleagues in DC?

Renewed fuss over conscience in medicine

For some reason, the media has decided to focus on the proposed rule from the Health and Human Services Department on the right of conscience, even for doctors, and even for abortion. I guess they felt it was the right thing to do.

LifeEthics has been following the conscience issue as it unfolded over the last year and I wrote a review of the history of the rule in November. Here is the actual notice of the proposed rule, in pdf.

Kaisernet.org, the Kaiser Family Foundation's daily on line newsletter article recalls the report by the New York Times last month that 3 of 5 members of the Equal Employment Opportunity Commission (two Democrats and one man, the legal council appointed by President Bush) released a statement that the new regulation would "overturn" years of protection. In my opinion, that is ridiculous in light of the recent debate about the American College of Obstetricians and Gynecologist's Ethics Statement #385 requiring member physicians to provide abortion, practice in close proximity to an abortionist, and/or make prior arrangements with an abortionist. In practice, all physicians who provide health care to women, including Family Physicians, Internists and Pediatricians, are held to the ACOG standards.

For those physicians and other medical professionals who are employed, the regulation will merely underscore and clarify protections. For those of us who are self-employed but subject to Boards and ethics statements like that of ACOG, the new regulation will provide protection from new pressures to act against our consciences.

For the worst report that is not on a blatantly pro-abortion website, see the AHN ("AllheadlineNews") editor's incredibly biased contribution. Practice your skills at unravelling biased non-news statements on this excerpt:

The Equal Employment Opportunity Commission has advised the president that the rule would overturn four decades of civil rights laws in the nation. They also say that current law protects people who have religious objections from performing duties that conflict with their religion.

Many groups support the regulation, although about as many oppose it.

******

The new rules probably wouldn't stop people with money or those living in large cities, or metropolitan areas, from finding the care they needed.

However, critics worry that poor people, or those living in small towns, might not be able to afford to travel outside their area to find a medical facility or health care workers that would provide them with the medical care they needed.

Thus the new regulation would create a two-tier health care system for some in America, while being funded from taxpayer money.

Overthrow protections by protecting? And, "Many . . . about as many?"

Remember that ACOG would requirements doctors who do not perform abortions to only practice "in close proximity" to those who do.

I still say that the ethical solution would be to make sure that pro-abortion OB/Gyns spread out to cover any shortage areas, rather than force the rest of us to clump together or make some areas - and all the men, women, and children that will never need an abortion - do without a local doctor so that no one ever has to be exposed to a conscience.

"Tea-bag" Adult Stem Cell Treatment for Stroke

British researchers report an amazing recovery for a 49 year old man who suffered a hemorrhagic stroke on October 15, 2008. The researchers at the company, "Biocompatibles," used adult stem cells from a healthy donor. The cells had been engineered to cause them to produce a protein that helps prevent "programmed" cell death (even after the bleeding stops and the pressure is removed) and embedded in tiny beads that had been sewn up in a cloth "tea-bag."

From the press release, published on the Medical News Today Neurology and Neuroscience website:

Stroke is one of the leading causes of death in the elderly population in the developed world. The incidence rate has been reported as 145 per 100,000. Hemorrhagic stroke is responsible for ~15 to 20% of all stroke and it is the least treatable form of stroke. It is associated with the highest morbidity and mortality rate of all stroke with only 44% of affected patients surviving the first 30 days. Only 20% of these survivors regain functional independence. The cascade of events starts with the sudden rupture of a blood vessel in the brain, causing haemorrhage and pressure inside the skull. Surgery may be used to relieve the pressure; but the haemorrhage causes a longer-term process of programmed cell death, or apoptosis, and it is this that causes the lasting neurological damage.

The CellBeads™ are delivered directly to the injury site during the surgery. They are programmed to deliver CM1, a proprietary version of a naturally occurring protein, GLP-1, which has been shown to have powerful anti-apoptotic effects. The delivery mechanism is a cluster of human adult mesenchymal stem cells obtained from a healthy donor and encapsulated in alginate beads. The cells are genetically engineered to produce the protein, which is delivered continuously, directly to the injury site. The alginate beads protect the stem cells from the body's immune system, which would otherwise destroy the foreign cells. CellBeads™ are transplanted within a retrievable mesh device and are removed completely after a treatment period of 14 days. Retrieval of the implant prevents possible long-term side effects from the transplanted cells.

The research is a "Phase I/II" trial, which means that the doctors and scientists are actually testing the safety of the treatment, and not the actual effectiveness of the treatment, itself. In other words, "does the treatment do more harm than good."

The CEO of Biocompatibles, Crispin Simon (that name is as British as tea bags), spoke to a Reuters reporter for a story published at Forbes online, stressing that the patient is young and other wise healthy, and had the standard of care for hemorrhagic strokes, surgery to relieve the pressure from the blood on the cells around the stroke. 10% to 20% of patients have similar recovery, without the Biocompatible beads.

Still, the report is a welcome source of hope for anyone who has watched and waited helplessly after a patient or a loved one had a hemorrhagic stroke.

Causal link between abortion mental illness claimed

Fergusson of Australia has published more data on his birth cohort from ChristChurch, New Zealand. This time, he's claiming causal relationship between abortion and later mental illness. A 3 invited comments in the same journal seem to accept that his conclusion is true: Abortion responsible for depression, anxiety, and substance abuse, at least do some degree.

The articles are in the British Journal of Psychiatry.for pay, but here's the discussion:

(a) For both models there was consistent evidence that even after extensive covariate adjustment, exposure to abortion was associated with a modest but detectable increase in rates of mental disorder. The concurrent data suggested that after adjustment for confounding those exposed to abortion had
rates of mental health problems that were 1.37 (95% CI 1.16–1.62) times higher than for those who had not become pregnant (P50.001). The lagged model produced a slightly lower estimate of 1.32 (95% CI 1.05–1.67, P50.05).
(b) Pregnancy loss was associated with a modest increase in the rate of problems using the concurrent measures of pregnancy outcome, with those who experienced a pregnancy loss having a rate of mental health problems that was 1.25 (95% CI 1.01–1.53) times the rate for those who were never pregnant (P50.05). However, under the lagged model, pregnancy loss was not associated with later outcomes, with an adjusted RR of 1.06 (95% CI 0.79–1.43, P40.70).
(c) For both models, having a live birth, whether with or without
an unwanted/adverse reaction, was not associated with significant
increases in the overall rate of mental health problems when due allowance was made for confounding variables