Dr. Shaber tries hard to separate fact from fiction because, she says, "rumor and hearsay can start to seem real." In the past, she'd sometimes refer patients to government websites and printed fact sheets, or rely on those outlets to help create her own materials. Not anymore. "As a physician, I can no longer trust government sources," says Dr. Shaber. She is not a political activist or a conspiracy theorist; in addition to her own practice, she's Kaiser Permanente's director of women's health services for northern California and head of the HMO's Women's Health Research Institute. Yet this decidedly mainstream doctor and administrator says, "I no longer trust FDA decisions or materials generated [by the government]. Ten years ago, I would not have had to scrutinize government information. Now I don't feel comfortable giving it to my patients."
This should alert us to a problem: doctors don't feel comfortable using government produced health information.
How did it happen? Many prominent figures in science and public health think they know the answer. "People believe that religiously based social conservatives have direct lines to the powers that be within the U.S. government, the administration, Congress, and are influencing public-health policy, practice and research in ways that are unprecedented and very dangerous," says Judith Auerbach, Ph.D., a former NIH official who is now a vice president at the nonprofit American Foundation for AIDS Research. In fact, Glamour, has found that on issues ranging from STDs to birth control, some radical conservative activists have used fudged and sometimes flatly false data to persuade the government to promote their agenda of abstinence until marriage. The fallout: Young women now read false data on government websites, learn bogus information in federally funded sex-education programs and struggle to get safe, legal contraceptives—all of which, critics argue, may put them at greater risk for unplanned pregnancies and STDs.
For anyone who follows the news, this shouldn't come as a surprise. My own gynecologist back home has been outraged about the Plan B over-the-counter debate for the past couple of years. A year ago she was warning me that the block against selling Plan B OTC was entirely driven by rightwing ideology. Turns out she was right (read on)
If it had been left up to the FDA's Reproductive Health Drugs Advisory Committee, American women would be able to walk into any drugstore and buy the emergency contraceptive Plan B over the counter (OTC). When the committee was convened in 2003 to review Plan B, a "morning-after" method of birth control that can reduce the odds of pregnancy by 95 percent if taken within 24 hours of unprotected sex, all 28 members agreed that the drug was safe and effective. The vast majority of them also voted to make it available OTC at any pharmacy. Susan F. Wood, Ph.D., then the head of the FDA's Office of Women's Health, heartily supported that decision.
Because of her focus on women's health, Wood examined the research and closely watched the review process for Plan B, a drug that has been available by prescription since 1999. Among the facts: Several studies showed that it works with few side effects and that making it more accessible does not lead to an increase in unsafe sex or promiscuity. In 2000 alone, the drug prevented approximately 51,000 abortions, according to a Guttmacher Institute estimate. But women who need Plan B often have difficulty obtaining a prescription and getting it filled—hence the need to approve it for sale OTC.
"One member of the panel told me, 'I wish we had data this good on everything that comes before this committee,'" Wood recalls. Fast approval should have been a mere formality.
Great: so we have a drug that prevents thousands of abortions, and somehow the right wing is against it? So this isn't really about preventing unplanned pregnancies, but about making sure that women are forced to carry pregnancies that they do not want. How is this pro-life? Unless by pro-life you mean, pro-unborn life, and against women's lives. Every other objection to Plan B (that it might cause promiscuity, that teens might not follow directions correctly) has been proven wrong and/or shown to be unevenly applied to this particular product.
So we have the FDA board and medical professionals lauding this product, wishing that they always had such "good" data to back up drug decisions... And what happens? Wait for it, wait for it...
But Christian fundamentalist groups like the Southern Baptist Convention and powerful religious conservative organizations like the Family Research Council and Concerned Women for America campaigned hard against OTC status by lobbying members of Congress, testifying before the FDA panels and bombarding the agency with letters. They argued that the drug was dangerous, would lead to unsafe sex and would corrupt children. Pia de Solenni, director of Life and Women's Issues at the Family Research Council (a pro-life group that also believes there are "long-lasting negative consequences of premarital sex," including "emotional problems" and "future marital breakup"), also argued inaccurately in a press release that Plan B "will most certainly make [women] ill from an overdose of hormones and potentially cause further complications."
What? WHAT? These accusations fly in the face of the medical studies actually done by professionals without an ideological ax to grind. And they're telling me I'll get "ill" from an overdose of hormones? Excuse me, but wouldn't carrying a pregnancy make me feel pretty ill?? Have these people heard of morning sickness, complications, labor? Plan B is just a higher dose of the same hormones that women take every day (quite safely) in the birth control pill -- somehow I'm not convinced that the possible complications of Plan B are somehow more dire than those of an abortion or pregnancy (Plan B would prevent both).
Did science listen to science? Of course not!
The campaign worked. Rather than rely on the recommendations of its medical advisory board, the FDA delayed ruling on Plan B for nearly two years. Why? Insiders speculated that the delay was, in part, the handiwork of conservative activist and ob-gyn W. David Hager, M.D., an active member of Christian right political groups and the author of As Jesus Cared for Women: Restoring Women Then and Now. Appointed by the Bush administration to the FDA panel that reviewed Plan B, Dr. Hager first voted with the committee that Plan B is safe and effective, but then went on to write what he termed a "minority opinion," laying out a case against OTC status. Contrary to numerous studies and the review panel's findings, he argued that the drug might not be safe for teens and that they might not understand package instructions. Shortly thereafter, Steven Galson, M.D., a high-ranking FDA official, cited similar concerns in a letter to Plan B's manufacturer—denying the drug approval at that time. Some women's health advocates had hoped that the logjam would break when Lester Crawford, DVM, Ph.D. was confirmed as FDA commissioner in 2005. But last August, Crawford put off a decision indefinitely.
So why, you ask?
Why did Plan B get deep-sixed? According to FDA officials interviewed by the Government Accountability Office, the decision to deny approval for Plan B had been made by top political appointees at the FDA months before staff even completed reviewing the application; many others suggested that pressure from the religious right played a key role.
FDA spokespeople have denied those accusations, but religious-activist organizations crowed about swaying the FDA, and Dr. Hager claimed the decision was God's work. "I was asked to write a minority opinion that was sent to the commissioner of the FDA," he told an assembly at the Christian Asbury College in Wilmore, Kentucky. "God took that information, and he used it through this minority report to influence the decision."
If God's work includes meddling in women's lives by pretending to know better than the majority of scientists, then sure, you're doing God's work, Dr. Hager. Were you also doing God's work when you abused your wife? (If you missed it, Dr. Hager's ex-wife, who seems like an incredibly trustworthy woman, has accused him of raping and sodomizing her repeatedly during their marriage. Somehow, I'm more inclined to believe the victim in this case.)
Mainstream medical organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American College of Emergency Physicians and the American Medical Association, agree that emergency rooms should offer victims EC after a sexual assault. Doing so could prevent the estimated 32,000 pregnancies—and, subsequently, many abortions—that occur as a result of rape. "What person who has been raped would really welcome a pregnancy from that?" says James Trussell, Ph.D., director of the Office of Population Research at Princeton University in New Jersey. "Even if you oppose abortion, what could be better than preventing the pregnancy in the first place?"
So when the DOJ was developing its first-ever guidelines for the treatment of rape victims, an early draft included EC. Yet strangely, in September 2004, when the guidelines were issued, any mention of EC had been deleted.
Yes, what could be better than preventing the pregnancy before it happens? Especially as two recent, impartial studies have confirmed that there is basically no chance of Plan B preventing a fertilized egg from implanting. But most organizations (the WHO included) define pregnancy as beginning at implantation, so this also should be a moot point.
Maya Jacobsen* was one such victim. In fall 2001, she was raped in her room on campus at the University of Denver. After her attacker escaped through a back door, she sat crying on a couch, frightened and stunned. Like many sexual-assault victims, she was too shaken at first to report the incident and waited until the next morning before she drove to the closest hospital, Porter Adventist. She says she spent hours undergoing a sexual-assault exam, but nobody brought up the issue of how she might prevent pregnancy—until she asked.
"I said, 'What are my options here if I become pregnant?' The nurse said I would have to wait to take a pregnancy test, and if I was pregnant, there was always adoption. I said, 'That's it? What about the morning-after pill?' And she said, 'You would need to do that on your own.'" Fortunately, Jacobsen was able to get the drug from a nearby Planned Parenthood clinic later that day.
WHAT? Are we trying to punish women for being the victims of rape?
And here's my favorite section, on the new war on condoms:
It seems that conservative activists saw an opportunity with HPV. Here was a disease connected to cancer against which condoms weren't yet proven effective. The perfect argument against premarital sex, and condoms, was born. "Condoms, whether used correctly and consistently or not, do not prevent the spread of HPV," the Family Research Council warns on its website, going on to note that "HPV has been linked to over 90 percent of all invasive cervical cancers and is the number-two cause of cancer deaths among women." In truth, cervical cancer is only the thirteenth-highest cancer killer of women in the U.S., behind bladder and kidney cancer. In the majority of cases, the immune system fights off HPV before people know they have it. Even when precancerous cells develop, they can be detected early by a Pap smear.
Nevertheless, the HPV fear campaign continued to escalate. Through lobbying and testimony before Congress, the religious right attacked government sex-education programs that included information on condom use. The Family Research Council argued that such programs expose "our youth to incurable disease on a daily basis. Most notable among these diseases is human papilloma virus, HPV." The government appeared to be listening. Until then, the CDC had accurately encouraged condom use as smart safe-sex behavior—but in 2002, around the time of the HPV flap, it backed off. The agency suddenly removed from its website a fact sheet on condoms that stated "laboratory studies show that intact latex condoms are highly effective barriers to…HIV and other STDs" and that told readers how to use them. Later that year, the fact sheet was replaced with one stressing sexual abstinence.
Greeeeaaat. Because we all know how well abstinence works as a permanent way to prevent STDs. Um, what about when people get married and have sex? With the divorce rate, the fantasy that you'll have sex with only one person in your life time is naive at best.
At what point did these people actually get stupid enough to believe that it's better to tell teens not to ever have sex -- knowing full well that they still will -- than to equip them with the information they need to keep them safe?
Glamour has also discovered that blatantly false anticondom information has been incorporated into several federal and state health websites. One, an official Department of Health and Human Services (HHS) site designed for families seeking health information for teens, 4parents.gov, suggests that there is no evidence that condom use reduces the risk of HPV infection and downplays its effectiveness against chlamydia, gonorrhea and syphilis. Similarly, several states, including Louisiana, Wisconsin, Virginia and North Carolina, have online abstinence programs that link to a site called abstinencedu.com, which warns that HIV might be able to penetrate a latex condom (patently false), that "condoms offer no protection against HPV infection" (not true) and that "there is no scientific evidence that condoms reduce the risk of becoming infected with the other 23 major STDs" (also false). It even claims that "the Federal Drug Administration [sic] allows up to 4 percent of a batch of condoms to be defective before the batch is rejected!" (Actually, the FDA rejects a batch of condoms if even one-tenth that number are defective.)
How do lies like these become official government health information? Both abstinencedu.com and 4parents.gov get some of their information from yet another outfit, called the Medical Institute for Sexual Health (MISH), which opposes premarital sex and has become a leading provider of the kind of "scientific" data now appearing on government sites.
Lies I tell ya, lies!
For more than a decade, public-health doctors and scientists have charged that MISH generates dubious and sometimes outrageously false data. One example: A 1995 letter from David R. Smith, M.D., then the Texas Commissioner of Health, rebuked MISH for a slide presentation given by founder Joe S. McIlhaney, M.D., to a panel of experts about a proposed sex-education program. Dr. Smith called the show "misleading," "false," "inaccurate" and even "ridiculous." Yet MISH continued to present the same data for years, and in the last two years, the federal government gave the group at least $600,000.
Lies that our tax dollars are working to perpetuate...
Dr. McIlhaney told Glamour that in the early days of MISH, he was still working as a physician, not an academic, and did not have the same access to resources as the now-larger organization does today. Nevertheless, he continues to stress condom ineffectiveness against HPV. "I think our conclusions were right," he says. "I was right on almost all of it, and they were wrong." Yet science does not back him up: Last November the FDA reaffirmed that condoms reduce the risk of every major STD including HPV.
How about preventing HPV even more effectively, then?
Soon, there will be another weapon even more effective against HPV than condoms. The drug company Merck has found that its new vaccine Gardasil is nearly 100 percent effective against the HPV strains that most often cause cervical cancer. Another vaccine, Cervarix, made by GlaxoSmithKline, appears to be just as effective.
The world's first anticancer vaccine would represent an incredible scientific breakthrough. But conservative groups began voicing objections as soon as the drugs started making headlines. Sen. Coburn, for one, testified before the House of Representatives that "going after one or two types [of HPV] is halfway," a charge health experts find illogical since the HPV strains prevented by the vaccine account for most cases of cervical cancer.
"The public should be outraged at this misrepresentation of facts for political reasons," says Dr. Holmes. "This really reveals the true agenda for those who have argued that the reason for not promoting condoms is to protect girls against HPV." If you truly cared about HPV prevention, his reasoning goes, you'd be thrilled at the advent of a vaccine to save women's lives. "It really illustrates that the opposition to condoms has nothing to do with protecting women and girls," he says, "but everything to do with opposition to discussion of sexual health."
The movement against the vaccine—Merck's version of which could be approved by the end of the year—has left John Santelli, M.D., chairman of Columbia University's Department of Population and Family Health, mystified. "We have a vaccine that could prevent cancer," he says. "People should be lining up and saying this is a great medical achievement, and yet people are actually opposing it. That's nuts."
Yes, Dr. Santelli, it is nuts. But nutty is as nutty fundamentalists do.
Actually, THIS is my favorite part:
Teens are perhaps the people most in need of trustworthy sexual-health information. Ironically, they are also the most likely to absorb misinformation from organizations like MISH that provide pseudo-science not just to websites but to abstinence-only sex-ed classes in public schools. One reason why public-health researchers now take a dim view of such programs: They may mislead students. In a meta-analysis of abstinence programs published in the Journal of Adolescent Health, Dr. Santelli found that such curricula "do not seem to be well designed and have incomplete information, misinformation and questionable information." And last year, the office of Congressman Henry Waxman (D-Calif.) examined the most popular federally funded abstinence-only sex-education programs and found that nearly 70 percent of them include "serious medical or scientific errors." Among the wholly inaccurate claims: that up to 10 percent of women become sterile after an abortion and that "premature birth, a major cause of mental retardation, is increased following the abortion of a first pregnancy." Says Princeton's Trussell, "It's an outrage. This is clearly another ideological distortion of what the real evidence shows." Yet such erroneous facts continue to be taught in public school districts in Montana, California, Washington, Pennsylvania and elsewhere.
I never thought this was a problem, until I heard intelligent, rational people actually worrying that abortion could cause breast cancer. Just another lie being used by extremists as a weapon in what looks increasingly like a war against women's choice.
As a result, many experts believe abstinence-only programs leave teens unprotected against pregnancy and STDs. "These young women and men who are taught that condoms have a high failure rate say, 'Well they do not work anyway, so why bother?'" observes Kellie Flood-Schaffer, M.D., an ob-gyn and associate professor at Texas Tech in Lubbock, where high-schoolers are taught a strict abstinence-only health curriculum. "I'm a Catholic. I believe in abstinence until marriage. But I'm also a realist. And condoms prevent a huge percentage of STDs and are 90 percent effective against pregnancy."
She has data to back up her strong feelings. Along with Samuel Prien, Ph.D., Dr. Flood-Schaffer conducted a lengthy study that found that among girls under 18, the Lubbock area has quadruple the average national rate of chlamydia—an STD that often goes undiagnosed and that can cause infertility. Why are the rates so high? "It's the education they are not getting," says Prien, who considers himself a conservative Christian. "At least in our area, abstinence-only is not working."
So the right wingers have pushed for this false information, and where does it get us? An increased public health problem, as more people get STDs. Great! Let's use our tax dollars in a way that causes more STD problems that the state then has to deal with, using yet more tax dollars! So much for fiscal conservatism!
More on that lie about an abortion-breast cancer link:
Radical pro-life groups partly base their charge of an abortion-cancer link on research by a biochemist named Joel Brind, Ph.D., but his work—subsidized in part by an antiabortion group called Americans United for Life—has been widely discredited. So scientists protested vigorously when the NCI placed the statement on its website, and the NCI convened a special panel to address the issue once and for all.
The group found no increased risk of breast cancer after abortion—and by spring 2003, the NCI had amended its website to reflect that. But serious damage had already been done. The abortion-breast cancer link had gained airtime: Senator Rick Santorum (R-Pa.), speaking on the floor of the U.S. Senate, cited Brind's research to suggest that "abortion increases a woman's risk of breast cancer by 30 percent." And some state governments went further, actually passing laws requiring doctors to tell patients seeking an abortion that the procedure could increase their risk of breast cancer.
"The government allowed people to believe—and encouraged people to believe—that abortions were a risk factor for breast cancer, even when the government knew that this research had been discredited and that better research showed no connection," says Marcia Angell, M.D., a senior lecturer at Harvard Medical School in Boston and former editor-in-chief of The New England Journal of Medicine. She goes so far as to call the pressure from the religious right "a source of corruption."
To date, abortion-breast cancer laws, called "Women's Right to Know," have been passed in Texas, Kansas, Montana and Mississippi. Texas State Representative Dawnna Dukes (D-Austin) vociferously opposed such a law, pointing to the scientific evidence that abortion does not raise the risk of breast cancer. But, she says, legislators who "pushed this law, supported this law, were terrified by right-wing Christian organizations. Some of my colleagues said, in confidence, 'I agree with you, but we are told that if we vote with you on this, we are supporting abortion.' They knew this information was invalid. They were frightened. These folks are afraid of this Christian coalition." Why? She says legislators were worried that the groups would mobilize against them in upcoming primaries. Herb Brown, M.D., an ob-gyn and faculty member at the University of Texas Health Science Center in San Antonio, says these laws "put doctors in a terrible position. You have to show a pamphlet produced by the state to the patient and explain that it is part of the regulation. The conversation I have is that, 'This is what is written in the pamphlet. I disagree with it ethically and scientifically, but this is what the legislation has forced upon me.' That's all I can say… If I want to be consistent with the law, I have to lie."
So... we're going to make doctors lie to patients so that they'll do what we want out of fear (have a forced pregnancy).
It's extremely rare for a scientific conference to turn into something more like a political rally. "Scientists do not normally engage in what is going on in Washington, D.C., or politics," says Wood. But at the annual meeting of the American Association for the Advancement of Science last February, a special conference was added to the agenda to discuss how politics have invaded the realm of science.
It quickly became a standing-room-only event, and scientists applauded as speakers like Wood and Nobel winner David Baltimore, Ph.D., president of the California Institute of Technology in Pasadena, condemned the government's interference in research.
Thank God there are still intelligent people working against the attacks on science.
For a group of researchers, the rhetoric was fiery. Baltimore accused the Bush administration of suppressing science. And when Wood said that morale at the FDA had sunk to a new low because of overwhelming pressure from social conservatives, she got a standing ovation.
Outside of the halls of science, who are the real victims of this political maneuvering? "The American public, particularly American women," says Trussell. "Who's hurt when you can't get EC over the counter? When there is a suggestion that abortion causes breast cancer—something that is entirely made up? When it's suggested that condoms are not effective against STDs, when in reality they are effective against HIV and even HPV? Women."
But many women can't imagine how these lies could possibly have an impact on them, Trussell says. "The first time one of them walks into a pharmacy and can't get her birth control pill prescription filled, that will have a wake-up effect. Most won't feel the effects until these rights are gone—they can't believe there would be a time when these things would be outlawed. I hope their belief is true, but I'm very worried."
Brian Alexander is a contributing editor to Glamour and the author of Rapture: How Biotech Became the New Religion.
I'm very worried, too, especially with reports of pharmacists refusing not only to fill Plan B prescriptions, but also other more common drugs:
Cedar River Clinics, a women's health and abortion provider with facilities in Renton, Tacoma, and Yakima, filed a complaint with the Washington State Department of Health this week alleging three instances where pharmacists raising moral objections refused to fill prescriptions for Cedar River clients. The complaint includes one incident at the Swedish Medical Center outpatient pharmacy in Seattle. According to the complaint, someone at the Swedish pharmacy said she was "morally unable" to fill a Cedar River patient's prescription for abortion-related antibiotics. Cedar River's complaint quotes its Renton clinic manager's May 17, 2005, e-mail account: "Today, one of our clients asked us to call in her prescription... to Swedish outpatient pharmacy. [We] called the prescription in... and spoke with an efficient staff person who took down the prescription. A few minutes later, this pharmacy person called us back and told us she had found out who we were and she morally was unable to fill the prescription." (Cedar River thinks their client eventually got her prescription filled.)
Because it's soooo pro-life and morally upstanding to deny a woman treatment for an infection. Better that the woman die, right? That's totally what Jesus would do. In fact, when people were stoning a prostitute, didn't he throw the last stone? Oh, wait...
Cedar River's complaint, dated April 10, summarizes: "In each of the situations, we believe the pharmacist displayed behavior that was biased, unprofessional, and unethical. We are concerned that this type of poor treatment may be becoming a trend."
Yeah... so if they aren't doing their job, how about firing them?
The complaint also includes an incident from November 2005 in Yakima, in which a pharmacist at a Safeway reportedly refused to fill a Cedar River patient's prescription for pregnancy-related vitamins. The pharmacist reportedly asked the customer why she had gone to Cedar River Clinics and then told the patient she "didn't need them if she wasn't pregnant."
Having been to Yakima, and frequented many a Safeway (maybe even this Safeway), I'm appalled. So, now pharmacists want to protect their consciences from helping a woman and her fetus have a health pregnancy? Because, clearly, this woman believed she'd go to hell if she actually gave the vitamins to this pregnant woman. And by the by, since when does a pharmacist get to look at me and decide whether or not I'm pregnant, despite a prescription? And why would anyone have a problem with giving a patient freaking vitamins??
If this is just the tip of the iceberg with what we'll see if pharmacists gain the right to refuse to do their jobs... then I think we should all be very, very worried.
And shouldn't we all be worried, when, as the Tennessee Guerilla Women point out, Glamour, not the government, is the source trying to get accurate health information to women?