Medical Examiner

Sex, Science, and Static

Pro-abstinence politics meddles with a CDC conference.

The upcoming National STD Prevention Conference, sponsored by the Centers for Disease Control and Prevention, among other groups, has just been given an unhealthy shot of ideology. The conference was supposed to include a symposium designed to explore how abstinence-only sex education may undermine other efforts to reduce STDs. The papers and panelists had gone through the customary vetting of peer review. But now the symposium has been abruptly retooled to include two proponents of abstinence programs—and to exclude a well-respected detractor. This is bad news, not only because abstinence-only work is scientifically unfounded but also because the switch represents a new level of government intrusion into the peer-review process of a major scientific meeting.

The biannual STD conference, which takes place next week, is one of the premier professional forums in the country for discussing sexually transmitted diseases. It is expected to draw at least 1,200 academic scientists, STD clinicians, and public-health practitioners. The symposium that’s been meddled with was originally titled, “Are Abstinence-Only-Until-Marriage Programs a Threat to Public Health?” Its convener, Bruce Trigg of the New Mexico Department of Public Health, proposed a skeptical look at abstinence education, which the Bush administration is funding to the tune of hundreds of millions of dollars. As moderator, Triggpromised to ground the critique in scientific evidence. His panelists were to be John Santelli of Columbia’s School of Public Health and William Smith of the Sexuality Information and Education Council of the United States, a well-regarded sexual-health organization. Santelli recently wrote a position paper on abstinence-only education for the Society for Adolescent Medicine in which he argued that abstinence programs are medically unethical because they misrepresent and withhold basic health information.

Trigg’s symposium proposal went through all the steps of peer review, including an expert panel, and was accepted. This week, however, a different title and lineup were announced on the conference’s Web site. Now called “Public Health Strategies of Abstinence Programs for Youth,” the program will no longer be moderated by Trigg, though he and Santelli will still present. Smith, by contrast, has been bumped from the program.

Taking his place are two staunch proponents of abstinence-only education, Eric Walsh and Patricia Sulak. Walsh is a family physician affiliated with Loma Linda University, a Seventh-day Adventist institution in California. His approach to public health is explicitly ideological. “Dr. Walsh seeks to serve the Lord through medical missions and the preaching of the Gospel in all the world,” an online bio explains. Sulak, meanwhile, is an obstetrician-gynecologist at Scott & White Memorial Hospital in Texas and the founder of “Worth the Wait,” an abstinence program noteworthy for its negative messages about condoms and stereotypical statements about girls and boys.

So, who’s responsible for the switcheroo? Two senior scientists connected to the conference said they were told that Rep. Mark Souder, R-Ind., had intervened. Souder is a longtime antagonist of comprehensive sexual education who helped to spearhead congressional hearings on the human papillomavirus in 2004 that were a thinly veiled excuse to poke holes in condom use. According to the two senior scientists, Souder reportedly reviewed materials for next week’s conference and contacted an official at the Department of Health and Human Services who then leaned on the CDC to add more “balance” to the abstinence discussion. If Smith had not been removed from the panel, the scientists say, the symposium would have been canceled. The CDC confirmed that questions had been raised about the “balance of opinions” on the original symposium. Souder’s office did not return repeated phone calls requesting comment.

The new cast of speakers was hastily assembled. Sulak said she first heard of the conference earlier this week. “I don’t even know who these people are,” she told me, referring to the other members of the symposium.

Sulak is a good candidate for promoting a pro-abstinence message. “Since when is abstinence until marriage a threat to public health?” she asks. Of course, most experts believe that abstinence is a healthy choice for teenagers. They simply don’t believe, based on the evidence, that abstinence-only programs do much good. And they worry that these curricula—which often include medically inaccurate material and disparaging information about condoms—will leave kids ill-equipped to protect themselves, if and when they do choose to have sex. According to Trigg, public-health physicians in New Mexico reviewed Sulak’s “Worth the Wait” program and rejected it because of gender bias and medical errors.

The most vexing thing about this episode is not that STD researchers will apparently have to duke it out with two pro-abstinence ideologues. It’s that the event’s peer-review process has been undermined. “This conference has always been run as a scientific meeting,” said Jonathan Zenilman, chief of infectious diseases at Johns Hopkins Bayview Medical Center and president of the American Sexually Transmitted Diseases Association, one of the groups organizing the conference along with the CDC.

Politicians now appear to be setting different standards. “My sense is that the leadership in Washington just thinks this is business as usual and doesn’t even realize that these kinds of things didn’t happen before,” Santelli said. These things didn’t happen. And they shouldn’t start to.