Obama moves to overturn Conscience rules

For a couple of years, LifeEthics has covered the conscience of physicians and what it would mean if a doctor, nurse or hospital were to be forced to go against their consciences. My review is here.

From the LA Times, we learn that President Obama plans to rescind the ruling clarifying conscience laws in force in the US today:

Conscience' rule on abortions may be overturned
The Obama administration wants to clarify a Bush policy that lets healthcare workers deny services because of moral beliefs.
By Noam N. Levey
February 27, 2009
Reporting from Washington -- Taking another step into the abortion debate, the Obama administration today will move to rescind a controversial rule that allows healthcare workers to deny abortion counseling or other family planning services if doing so would violate their moral beliefs, according to administration officials.

The rollback of the so-called conscience rule comes just two months after the Bush administration announced it late last year in one of its final policy initiatives.

Inevitably, no matter what they say, the outcome will be to further politicize abortion and to force doctors to perform abortions and assisted suicide, force Catholic hospitals to allow abortions and sterilizations and - inevitably - physician assisted suicide.

Last month without official ceremony, Obama overturned a controversial ban on U.S. funding for international aid groups that provide abortion services.

The move by the Department of Health and Human Services to throw out the conscience rule is being made equally quietly as most of Washington focuses on the president's blockbuster budget plan.

On Thursday officials stressed that before the administration finalizes the rollback, a standard 30-day comment period seeks input from people across the ideological spectrum.

"We believe that this is a complex issue that requires a thoughtful process where all voices can be heard," said one official, who was not authorized to speak on the record about the policy change.

The officials said the administration would consider drafting a new rule to clarify what healthcare workers could reasonably refuse to do for their patients.

For more than 30 years, federal law has allowed doctors and nurses to decline to provide abortion services as a matter of conscience, a protection that is not subject to rule making.

In promulgating the rule last year, then-Health and Human Services Secretary Mike Leavitt said it was necessary to address discrimination in the medical field.

Whose life is it, anyway?

Trait selection in babies "is a service," says Dr. Steinberg. "We intend to offer it soon."

Whoops, someone noticed that some of this reproductive technology stuff might not be ethical.

Talk about controlling parents!

Eugenics is a done deal. The cat's out of the bag. There's no going back. (Don't think about the 14th Amendment that overturned Dred Scot and took the slaves from their "owners.")


Of course, the "Progressives" and human-plus groups only commit *good* eugenics. All they want is control and more money.


The "Progressives" started raising the alarm a couple of years ago, when they were pushing for a change in the Bush embryonic stem cell policy. The logic was that the reason there is no regulation is that the government isn't paying for enough research.

At the same meetings, they were adamant that their group must have the power maintain control. (Alta Charo, Laurie Zoloth, Jonathan Moreno, Insoo Hyun and the rest of the "Ethicists for Hire" crowd.)

Funny, in all these links, I didn't find a single comment about the doctors who lost a discrimination suit in California for refusing to fulfill a patient's request for IVF -- even in the midst of the hulabaloo about the mother of octuplets.

HT to Vox Popoli

US behind on regulation of reproductive technology

After hearing/reading for the last 8 years that there is too much regulation of research, there's now a call from the Jonathan Moreno and the "Progressives"(at the website that grew out the Center for American Progress, originally founded by John Podesta, Obama's advisor) for regulation of reproductive technology. See this post at the "Science Progress" blog.

Scroll down to the middle of the blog post on regulation to see a fantastic interactive map of regulation across the world.

Unfortunately, the regulation may not be easy to come by, or what those of us who are pro-life might wish for. The progressives mock those of us who believe that even embryonic humans have the right not to be intentionally killed or enslaved. See the comments in this review of Yuval Levine's book, Imagining the Future.

Human cloned embryos

Oddly, there is very little notice of the confirmation that Advance Cell Technology has created cloned human embryos. Current bioethics and science reporting evidently takes the creation and destruction of human embryos for granted. In fact, the embryonic humans were created with the intention of destroying them.

No one - or almost no one - seems to notice.


Wired Science has one of the few reports that narrows in on what should be the headline:"Research Breakthrough: Human Clones May Be Genetically Viable."

It is significant that (as reported earlier) human-animal hybrid embryos do not appear to be a practical source for human embryonic stem cells. However, after reading the article itself, it appears that the story with in the story may be - I believe should be - even more significant.

The article, "Reprogramming of Human Somatic Cells Using Human and Animal Oocytes," is available online and free, here, in pdf form. Supplemental information is available here.

Lanza and his colleagues report that they used human eggs and human donor DNA to create about 50 cloned human embryos, all females. They also write that they used a human embryo started by in vitro fertilization as a "control," or material to test the validity of their other results.

Cells were removed for testing from some of the cloned human embryos and the IVF human embryo. Other than that, we do not know the fate of these embryonic human girls.

Edited January 27, 2010 to correct a "Label" typo

Human-animal embryos don't work for stem cell production

The New Scientist has a good review article that explains a new research report from Robert Lanza of Advanced Cell Technology, that attempts with "thousands" of embryos created by placing human DNA into the oocytes or eggs of animals have failed to produce stem cells. NatureNews, the news arm of the journal, Nature discusses the report, here.

The abstract of the article, "Reprogramming of Human Somatic Cells Using Human and Animal Oocytes" published in Cloning and Stem Cells, is available here. The list of researchers is very long and they are from several different laboratories.

Each of the news articles above includes statements from researchers who do not believe that human-animal cloned embryos are a dead-end for stem cell researchers. However, the confirmation of the outcome from several labs, with different researchers, is strong evidence that it is unlikely that this technique is a reasonable way to produce "patient specific" stem cells - those that are an exact match for the donor of the DNA.

I have not read the actual article, yet, but from the news articles and the abstract, it appears that the "cybrids" do express the genes of the donor DNA and are clones of the donor. However, while enucleated human oocytes are able to reprogram the DNA of the donor to result in embryos that divide to the stage at which it is possible to harvest embryonic stem cells, the emptied eggs of cows and rabbits do not. The cybrids only divide to about the 16 cell stage and do not turn on the genes responsible for pleuripotency, or "stem-cell-ness."

See my Update, written after I read the report.

Adult stem cells in MS for reversal

In Multiple Sclerosis (MS), the immune system of a patient turns on his or her nervous system, destroying the myelin sheaths that serve as insulation around nerves, disrupting the transmission of nerve signals. The myelin damage often occurs in a patchy manner, at first. See the Medline Plus page from the National Institutes for Health for more information, including a patient tutorial in English and in Spanish. The Journal of the American Medical Association has a similar patient education page in pdf.

There have been trials using adult stem cell treatments in the form of bone marrow transplants and injection of adult stem cells in different manners for several years. (See ClinicalTrial.gov for some of these - if my search lapses, search "stem cell multiple sclerosis.)

The March issue of Lancet Neurobiology reports (Free access to the abstract) success from research at Northwestern University using the patients' own bone marrow stem cells, after harvesting those cells, preserving them, and then using chemotherapy to destroy the immune system before replacing the patient's stem cells. A review of the study is at the Science Daily and at this blog, Science Codex.

Here's the information on this trial from Clinical Trials.gov.

Any sort of bone marrow transplant is dangerous due to the lost red blood cells, platelets (to make blood clots), and the white blood cells that function as the immune system. This trial was set up to preserve all but the immune system. While it's still not a procedure to take lightly, it appears that the researchers at Northwestern have made it safer.

Senate defeats Republican SCHIP pro-life measure

Senator Martinez from Florida introduced an amendment to the Senate Bill concerning the children's health insurance bill that would have prohibited tex money going to non-government organizations in other countries and used to promote abortion, lobbying foreign governments to change their laws to accept abortion, and which would give those organizations more money to perform abortions.

This amendment would have placed into law the "Mexico City Policy" that President Obama overturned on Friday, January 23, 2009.

The vote went pretty much along party lines, with the exceptions of Republican Senators Collins and Snowe of Maine, Senator Spectre of Pennsylvania and Senator Mulkowski of Alaska. One Democrat, Senator Nelson of Nebraska, voted in favor of the prolife amendment. (Thanks to LifeNews for reporting the votes.)

The Senate version will allow families that exceed 400 times the Federal poverty limit t0 $88,000 and, in some cases, with incomes over $100,000, per year.

For more on the SCHIP Bill, see the Associated Press' "GOP fails to limit children's health program."

Democrats want to more than double spending on SCHIP. President Barack Obama has urged Congress to quickly send him a children's health bill that he can sign into law. The House has already passed a bill comparable to the one before the Senate.

Republicans offered an alternative approach through an amendment sponsored by Sen. Mitch McConnell, R-Ky. McConnell argued that his amendment focused more on helping low-income families and did not rely on tax increases to pay for the additional health spending. His amendment also would not allow federal funding to extend health coverage to children of newly arrived legal immigrants, as the Democratic bill allows.

Coffee, again

In June, LifeEthics reported that coffee drinkers are likely to live longer - or are at least less likely to die of heart disease.

Today, a new study on Swedes and Finns reports that 3 to 5 cups of coffee (I drink nearly a quart a day) when middle aged (I am) decreased the chances of Alzheimer's dementia by 60 to 65%.

Not only will I live forever, I'll know it!

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.

More pictures from the March for Life in Washington DC

These pictures are from our camera, my phone and my husband's phone.


I wore my white coat to the Rally, with extra layers underneath, but had to keep the heavy coat over it most of the time. We Texans still got pretty cold over the three hours we were at the Mall.

I'm wearing a "Texas Alliance for Life" cap.



The handsome bearded guy in the long coat on the far left is my husband.

The crowd was slow to gather due to its size. As I said in my earlier post, it took over 1 1/2 hours for us to clear the Mall. (I tried to sneak out the side. It took 30 minutes to weave across the crowd, and I ended up surrounded by the same group of people I'd begun with, as I walked out of the street onto the sidewalk of the art museum!)

There was no way that we were going to make it to the Supreme Court Building while the speeches were still going on, much less get near the speakers.



So, our group decided to visit the Newseum, the museum of news journalism that recently opened. (It's done well, but I'm not sure it's worth $20 a visit.) The pictures that seem to be from above the crowd were taken on the 4th floor balcony of the Newseum.

National March for Life Washington, DC, January 22, 2009

Several hundred thousand people gathered for the National March for Life on the Mall in Washington, DC on January 22, 2009 to mourn the 36th Anniversary of Roe vs. Wade. My husband and I were among them, along with two friends.

It took 1 1/2 hours for all of the Marchers to pass onto Constitution Avenue as they left the Mall on the way to the Supreme Court. That first picture above shows the last of them as they wound their way around the Capitol.

We saw pro-life activists everywhere we looked in DC throughout the week. There were groups of teens and some of the women wearing buttons declaring "I regret my abortion" at our hotel. We shared an elevator with Father Frank Pavonne of Priests for Life on Thursday night.

Conscience: more than abortion

Last month, a judge in Montana ruled that patients have the right to a doctor's assistance in their intentional death by suicide. Baroness Warnock argues that doctors who will not kill their patients on demand are "wicked." The States of Washington and Oregon already have legalized "Aide in Dying." Is it now my duty to inform my patients on Hospice that they have a "right" to "safe(?) and legal" death by prescription?

Here is part of a poignant Letter to the Editor from an Internal Medicine doc in Oregon:

I was caring for a 76-year-old man who came in with a sore on his arm.

The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy.

I had known this patient and his wife for more than a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart.

During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists.

Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the specialist called me and asked me to be the "second opinion" for his suicide.

She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.

I told her that assisted suicide was not appropriate for this patient and that I did NOT concur.

I was very concerned about my patient's mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription.

Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor.

His death certificate, filled out by this doctor, listed the cause of death as melanoma.

The public record is not accurate.

My patient did not die from his cancer, but at the hands of a once-trusted colleague.

This experience has affected me, my practice, and my understanding of what it means to be a physician.

ACOG: Abort or refer

The American College of Obstetricians and Gynecologists (ACOG) have finalized and published their Ethics Statement # 385. It looks like they ignored the ruling from the Department of Human Services on Conscience -- or believe it will soon be overturned.

The ACOG pdf is set so that it is not possible to copy and paste - I have typed in the first bit, myself. Click here for the full document.

ABSTRACT: Health care providers occasionally may find that providing indicated, even standare, care would present for them a personal moral problem – a conflict of conscience – particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in atimely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.

____________________________________________________________

Physicians and other providers may not always agree with the decisions patients make about their own health and health care. Such differences are expected – and, indeed, underlie the American model of informed consent and respect for patient autonomy. Occasionally, however, providers anticipate that providing indicated, even standard, care would present for them a personal moral problem – a conflict of conscience. In such cases, some providers claim a right to refuse to provide certain services, refuse to refer patients to another provider for these services, or even decline to inform patients of their existing options.

Conscientious refusals have been particularly widespread in the arena of reproductive medicine, in which there are deep divisions regarding the moral acceptability of pregnancy termination and contraception.

For more on the controversy, here are my posts on Conscience, and here is a history of the ACOG and DHHS statements.

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!

Baroness Warnock: doctors who won't kill are wicked.

Baroness Warnock took part in a debate in Belfast, Ireland on January 5, 2008.

According to a Belfast news report, the Baroness said that doctors who will not kill their patients are "genuinely wicked."

Baroness Warnock, who last year caused worldwide controversy when she said that some dementia patients had a "duty" to seek death, said last night: "I think that people should be able to beseech their doctors, nurses to end their life when it is no longer worth living (in the patient's eyes]."

Speaking of terminally ill patients who, while in good health, have made a written request to be killed when they reach a certain point in their illness, she said: "There are doctors, we know, who don't pay any attention (to those wishes to die].

"But that seems to me a genuinely wicked thing to do – to disregard what somebody had quite explicitly said, that he wants to die – not to be resuscitated in certain circumstances and in certain circumstances to be helped to commit suicide.

"I believe that if someone is diagnosed as having the beginnings of Alzheimer's or dementia, at that stage it is a positive duty that doctors should talk to them about what will happen when the moment comes where they reach steep decline."

Speaking of the impact that medicine-prolonged life has had, she said: "The consequence (of living longer] is financial, but much more importantly, I think of the number of people who end their life demented, unable to recognise family, unable do anything for themselves.

"They can be kept alive and are kept alive, but the question has to be: What is the point of the life at the last stages of Alzheimer's or dementia?"

The point of any life is one of those big questions, isn't it?

Teen Pregnancy Rates Increase at Same Rate as Others

It seems that everyone decided to have more babies in 2006, including teen girls from age 15 through 19.

The summary of the CDC report is available as a news release, here. A 100-page report is available pdf containing more numbers and breakdown of the data is at this link.

I don't believe that the information will answer any of the big political debates. The unmarried mother rate is too high, teens have too many babies too young, too few women begin prenatal care in the first 3 months, and too many had early births - both planned (scheduled C-sections) and unplanned.

We definitely need to discuss some of these numbers, however. 39% of children of white mothers, 50% of children of Hispanic mothers (who have half of all babies) and 70% of children of black mothers are born outside of marriage. The numbers of babies born to mothers under 15 years old should be a scandal (especially in the Black and Mexican and other Hispanic populations) and the focus of both public health and law enforcement. See pages 39 through 45) Note that the numbers of pregnancies under 15 have fallen precipitously since the 1980's, but the Hispanic community still

The biggest surprise to me? 494 women had babies after 50!

By the way, 2006 was the first year in quite a while that the US birth rate has reached replacement level.

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.

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