The Family Un-Planner

Amanda Schaffer's Deadly Dishonesty

The chorus of venomous comments on Slate's web site directed at Dr. Keroack (and at President Bush, and at Christians in general) is obviously due in part to hatred of Bush and of Christians by some Slate readers. But it is also due in part to misinformation in Amanda Schaffer's article.

To put it bluntly, Schaffer lied.

What's worse, her lies can kill.

If the Slate readers knew the truth I hope that at least some of them would be less hard on Dr. Keroack and President Bush, and a lot harder on Ms. Schaffer.

A full point-by-point rebuttal of all the misinformation in Ms. Schaffer's article would require a very long article of its own, and I don't have the time for that tonight. Instead, I'll examine just her first accusation against Dr. Keroack, which is contained in the third sentence of her article:

"Until recently, [Keroack] served as medical director of a pregnancy-counseling organization that runs down contraception and gives out scientifically false health information - for instance, that condoms 'offer virtually no protection' against herpes or HPV."

That sentence is demonstrably false.

The organization in question is "A Woman's Concern Pregnancy Health Services" (AWCPHS) of Dorchester, MA. It is a non-profit, pro-life counseling service which "provides complete, accurate information and compassionate peer-counseling to women and couples who are making decisions about unintended pregnancies." They have a web site where you can read what they actually say about condoms, as opposed to what Ms. Schaffer claims: http://www.awomansconcern.org/dorchester/questions/sex

Here's what that AWCPHS web site says:

"Q: How safe is 'safe sex'?

A: Few professionals are using the phrase 'safe sex' anymore; most have switched to saying 'safer sex' because condoms do not provide 100% protection. If they are used correctly and consistently (every time any sexual contact occurs), condoms can reduce the risk of transmitting most STDs, but they work differently against different STDs. They are most effective against HIV but much less effective against other infections, especially STDs that are spread by skin-to-skin contact, like Herpes. For those, the infected area is often not covered by a condom, which means the condom is doing nothing to prevent transmission of that STD. The only way to completely avoid risk of STDs is to wait to be involved in sexual activity until you are in a faithful, lifelong relationship (like marriage) with an uninfected partner."

That statement is scientifically accurate. It also obviously bears little resemblance to what Ms. Schaffer claims that AWCPHS says.

Google can't find the 4-word phrase on AWCPHS's web site, which Ms. Schaffer put in quote marks. I don't know whether she just made it up, or took it out of context from some other source. Either way, it is a dishonest characterization of the carefully accurate and balanced information which AWCPHS actually gives to women and couples.

The truth, as APCPHS warns, but Schaffer denies, is that condoms do not provide reliable protection against the transmission of HPV.

What's more, the accuracy of AWCPHS's statement (and thus the inaccuracy of Ms. Schaffer's) is confirmed by an unlikely source: Ms. Schaffer's own words in another anti-abstinence article she wrote, last July, which you can read here: http://www.truthout.org/issues_06/070606HB.shtml

In that article, Schaffer admitted that, "In the late 1990s.... a few preliminary studies suggested that condoms might not protect against HPV..." But then she went on to cite a newer study, published in the NEJM in June, which "found that over a period of eight months, college-age women who used condoms 100 percent of the time were 70 percent less likely to acquire HPV compared with women who used condoms less than 5 percent of the time," though she admitted later in the article that just 82 women were studied, and that "some women [in the study] who used condoms consistently still became infected with HPV."

In other words, according to Ms. Schaffer's own description of the very NEJM article that she cited, even after just 8 months some of the women who used condoms faithfully nevertheless still contracted HPV! In fact, women who used condoms faithfully were almost 1/3 as likely to contract HPV as were women who rarely or never used condoms.

Even from Schaffer's spin, a careful reader can see that long term reliance upon condoms does not reliably protect against HPV.

But if you read the actual NEJM article, the picture for condom use as an effective protection against HPV is even bleaker. Schaffer omitted key information which contradicted her premise, but which is essential to making informed health decisions.

For example, the first footnote in the NEJM article states:

"Although evidence demonstrates that the use of condoms by men substantially reduces the risk of genital transmission of human immunodeficiency virus in women,⁷ data on the effectiveness of condoms in reducing the incidence of other sexually transmitted infections are more limited.^8,9 In particular, several studies have found that condom use by men does not reduce the risk of HPV infection in women,^{1,4,10,11,12,13}"

Compare that statement, with its six citations, to Schaefer's characterization that "a few preliminary studies suggested that condoms might not protect against HPV."

In Schaffer's version, the studies became "preliminary," six studies became "a few," "found" became "suggested," and "does not reduce the risk" became "might not protect." Obviously Schaffer was less than honest.

You can read the NEJM article here: http://content.nejm.org/cgi/content/full/354/25/2645

Nor is that the worst of it. Although the NEJM article doesn't include the raw data, one can infer from the data in the article that fewer than 1/4 (at most 20) of the 82 women studied actually used condoms faithfully for the full duration of the study, yet even among at most 20 faithful users of condoms, several nevertheless contracted HPV, in just 8 months. What's more, 40(!) of the total of 82 women studied contracted one or more types of HPV during the 8 month study period, and many of them became infected with multiple types of HPV, so that a total of 126 new HPV infections were identified in the study group of just 82 young women in just 8 months!

In just 8 months, more than half of the women in the study who did not use condoms became infected with one or more types of HPV!

Furthermore, since, according to the study, women who use condoms faithfully are nevertheless almost 1/3 as likely to become infected as are women who don't, we can infer that most of the sexually active women at that university who do use condoms faithfully will be infected with one or more types of HPV within 2-3 years, even if they never have unprotected sex.

Worse yet, 62% of the 126 new HPV infections seen in the study were characterized as "high-risk" types of HPV by the study's authors: http://content.nejm.org/cgi/content/full/354/25/2645/T2

Yet in her July article, Schaffer nevertheless wrote that "consistent condom use protects against human papillomavirus, or HPV." That is a deadly lie.

What's more, a follow-up Letter to the Editor published in the NEJM in September noted a likely explanation for how the study could have overstated the limited effectiveness of condoms, by plain old-fashioned selection bias. You see, the study that Schaffer cited made no attempt to identify the HPV infection status of the male partners of the women in the study. Obviously, a woman cannot become infected from an uninfected partner. Therefore, as the letter noted:

"The inverse relationship between the frequency of condom use and the incidence of human papillomavirus (HPV) infection, reported by Winer et al. (June 22 issue),¹ may be due to variation in the prevalence of HPV infection among sex partners with different levels of condom use. Men who use condoms more frequently may be more aware of the possibility of sexually transmitted infections and may be less likely to have sexual contact with high-risk groups, such as sex workers. The prevalence of HPV infection among men with a high level of condom use may be lower than among men with a low level of use. Therefore, such men would have a lower risk of transmitting HPV to female sex partners, even in the absence of a protective effect of condom use."

You can read the letter here: http://content.nejm.org/cgi/content/full/355/13/1388

Obviously Ms. Schaffer has an agenda, and neither the truth nor women's health is part of that agenda. Slate readers who make the mistake of believing Ms. Schaffer will think that condoms provide effective protection against the transmission of HPV. That simply is not true. Even if the NEJM study she cited turns out to be accurate, the fact remains that most women who make the mistake of relying on condoms to protect them against HPV will eventually become infected with one or more high-risk types of HPV -- and some of them will eventually die of cervical cancer.

Here's an analogy to help illustrate the point. Suppose you can choose to play Russian roulette with a revolver containing either one bullet or three. Does it matter how many bullets are in the revolver?

The answer might seem to be yes, but actually it depends on how many times you intend to play.

If you will play just once, then it matters a lot: having just one bullet reduces your chances of getting shot by 66%.

But if you plan to play 100 times then it does not matter how many bullets are in the revolver. Even if there is only one bullet in the revolver, you still will have only one chance in 82 million of surviving. Yet that is what Ms. Schaffer would call "66% effective protection."

Fortunately, HPV is far less deadly than Russian roulette. (It is more like Russian roulette played with the gun aimed at your foot instead of your head, because one shot/infection will rarely kill you, and it does matter how many times you are shot/infected.)

But the probabilistic principle still holds. If a woman is sexually active with partners whose HPV infection status she does not know, then within a few years she is almost certain to be infected with at least one type of high-risk HPV, even if she uses condoms religiously.

-Dave Burton

dave at burtonsys dot com but please no spam

Abstinence kind of crimps abortion. No wonder Planned Parenthood is hopping mad.

"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." -Manuel II Paleologus

bttt

Your Russian roulette argument is very effective in exposing the dishonesty spewed by libs about 'safe sex' and 'safer sex' with condom use.

"...obstetrician-gynecologist who argues that abstinence until marriage is the only healthy choice for women."

From a medical standpoint, you can't argue with that. Of course, since that cuts into the fundraising and profit raking abilities of groups like Planned Parenthood, this guy is in for a bumpy ride.

Good Luck, Doc! Keep the faith.

Are these people blinded by their ideology, or do the just not care about the women they are supposed to serve?

Are these people blinded by their ideology, or do the just not care about the women they are supposed to serve?

Yes.

Are these people blinded by their ideology, or do they just not care about the women they are supposed to serve?

It's sort of the same thing, I think.

These are people who support China's forced abortion and sterilization programs. These are people who think that the greatest need of starving refugees is for birth control pills and abortion.

I like to compare abstinence as an effective mode of preventing STDs the same way I view not touching a hot stove; if we extend that to the glove and the condom, we can easily see that the failure to use the glove isn't a chance of odds of burning oneself, but a matter of degree.

Organizations take on a life of their own wherein the survival of the unit becomes paramount.

Anybody who didn't like the Chinese would probably fall into that group.

I suppose ...

I consider the Chinese government to be hostile to the U.S., but that doesn't mean that I want Chinese babies killed.

In case you think that all this will soon be rendered moot by Merck's new anti-HPV vaccine, Gardasil, don't get your hopes up.

Gardasil protects against four types of HPV: types 6, 11, 16 and 18. Types 6 & 11 are considered "low-risk" because they apparently don't cause cervical cancer (though they do cause genital warts). Types 16 and 18 are among the "high-risk" types of HPV, because they do cause cervical cancer.

Unfortunately, the 126 new HPV infections detected in the Winer / U. Washington study included infections with 30 different types of HPV, not just 4. Only 21 of the 126 infections were of HPV types which can be prevented by the vaccine. Only 14 of the 78 new infections with "high-risk" types of HPV were types 16 & 18, which can be prevented by the vaccine. 57 of the 78 high-risk infections were with 16 other high-risk HPV types: http://content.nejm.org/cgi/content/full/354/25/2645/T2

-Dave

Correction: of the 78 new infections with high-risk types of HPV seen in the study, 64 (not 57) were strains of HPV which Gardasil does not prevent.

-Dave

In today's news (March 30):

"[Dr. Keroack] has resigned due to legal actions taken against his Massachusetts private medical practice by state Medicaid officials, according to the Washington Post."

Anybody here know what the "legal action" against Dr. K's private practice was about????

Keroack also promotes a wacky piece of pseudoscience: the claim that premarital sex disrupts brain chemistry so as to create a physiological barrier to happy marriage.

I'm not so sure that's wrong. Just take a look at the 18-35 age group. They have been the ones who are the hook-up generation, and how many of them are looking to make the trip to the altar?

Sounds like the real problem is that the good Dr. might just be a little too "religious" for Ms. Schaffer's tastes.

EdJay wrote:

Anybody here know what the "legal action" against Dr. K's private practice was about????

The Boston Globe had an article about it:

http://www.boston.com/news/local/articles/2007/04/07/doctor_who_quit_us_post_was_warned_by_state/?page=2

That link takes you to page 2 of the article, which is where the article describes the complaint filed against Keroack. I've bold-faced two particularly interesting paragraphs:

In the 2005 complaint, the patient's daughter, who had once been Keroack's patient, alleged that the doctor gave her mother money for groceries, evenings out with her husband, and a Cape Cod getaway for the couple. "What MD does this???" the daughter wrote the board of medicine in writing.
But she seemed most upset by a letter he had recently sent urging her to make peace with her parents, who had both been diagnosed with cancer.
Using exclamation points, all-capitalized sentences, and quotes from country singer Randy Travis, Keroack urged his patient's daughter to make up with her mother "before it's too late to fix it." "If either of your parents were to die tomorrow . . . . YOU and ONLY you will be responsible for the losses that will surely follow," wrote the gynecologist, now 47.
In her complaint to the board, the daughter wrote: "I haven't been able to sleep; I am upset all of the time because I cannot get over the fact the he would have the audacity to send me such an invasive, unethical letter."
Keroack could not be reached yesterday for comment. But in a 13-page letter to the board, he called the charges -- of insurance fraud, distributing medication to nonpatients, and behaving unprofessionally or unethically -- "patently false."
In a separate letter to the board, Keroack's patient defended him, telling the board that her daughter's complaint was "filled with false statements, distortions, misrepresentations and lies . . . ."
"Without Dr. Keroack's help, we would have been unable to put food on the table because medications cost us a fortune to buy," the patient wrote the board. "Dr. Keroack never asked for anything in return for these generous gifts, he merely asked that we accept them as being from him personally because he felt that we deserved to be helped. I admit it is unusual for people to display such generosity in today's world . . . but it isn't improper. It is right."
On Jan. 10, the board of medicine sent Keroack two letters. One warned him against practicing psychotherapy with patients without adequate training and supervision. "Should you choose to pursue this practice, you should do so only after receiving education in the identification and management of boundary issues," the letter said.
Doctors are barred from doing anything that oversteps the clear boundary between doctor and patient. "That can be a lot of things," explained board spokesman Russell Aims, "anything from a psychiatrist having sessions at the patient's home or a doctor driving a patient someplace after an appointment to loans, personal gifts, favors."
The second letter warned Keroack to conform to the state's prescribing practices. "You should familiar[ize] yourself with the Board's policy and adhere to the guidelines to avoid problems in the future. You may not prescribe to individuals who are not your patients," the letter said.
A warning is not considered disciplinary action, which would be reported to federal authorities, Aims said. Keroack came under heavy criticism from abortion rights advocates for his connection to crisis-pregnancy centers that show ultrasound images of fetuses to pregnant women in an effort to dissuade them from having abortions.

-Dave

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