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April 30, 2003

medical information on federal websites

My blog is listed as "exemplary" on the blog of Dr. John Gøtze, a Danish guy. At the risk of appearing to logroll, I would heartily endorse "Gotzeblogged" (as he calls his blog) for providing relatively technical (yet accessible) information relevant to e-democracy and e-government.

There has been a lot of controversy about specific cases in which medical information was changed on government websites, allegedly because of the political or moral biases of the incumbent administration. I have some thoughts about what to do about this problem—if it is a problem. For now, here are the relevant facts, as far as I can tell:

In 2002, various agencies of the United States Government removed information about condom use and abortion from their Websites, allegedly because elected politicians favored sexual abstinence before marriage and opposed abortion on moral or religious grounds. The National Cancer Institute (NCI) had posted information denying a link between abortion and breast cancer, but Rep. Henry Waxman (D-CA) objected, calling this denial "scientifically inaccurate and misleading to the public." The NCI Website was then changed to say (for a time) that the evidence was "inconclusive," until a scientific review panel required the Website to reinstate its original language. Likewise, the Website of the Center for Disease Control and Prevention removed its positive assessment of condoms' role in preventing the transmission of disease and removed citations of evidence showing that education about condoms did not lead to earlier or more sexual activity. After the removal of these statements was criticized, some similar material reappeared online with the following text added in bold: "The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected."

This last sentence is literally true. However, critics disagree with the strategy and motives that they see lying behind such statements. Participants in this controversy divide into two camps. Some believe that it is the responsibility of public health professionals to reduce the spread of sexually-transmitted diseases, especially HIV/AIDS. Private, voluntary behavior that does not transmit such diseases—or otherwise increase morbidity and mortality—is not the business of medicine. For this group, it seems best to advocate condom-use aggressively. Universal condom-use is a more realistic goal than universal abstinence, and condoms generally prevent the spread of disease. Caveats about the effectiveness of condoms, like the one in bold on the revised website, may have the effect of discouraging condom use. As Representative Waxman wrote in an official complaint, the website was "carefully edited to deny the public important information about the role condoms play in reducing sexually transmitted diseases and pregnancies."

Another group, however, believes that there are two evils to be minimized: (1) the transmission of dangerous disease, and (2) pre- or extra-marital sex, which is bad in itself. Ed Vitagliano, who represents the conservative American Family Association, said, "Science shows that condoms are not 100 percent effective, and offer no protection for certain sexually transmitted diseases like the human papilloma virus and to a lesser extent chlamydia and herpes …. We fall on the side of safety, encouraging children to wait until marriage, not only for moral reasons, but also for scientific reasons" (emphasis added). For this group, it makes sense to advocate abstinence, since this is a good in itself as well as a means to avoid spreading various diseases. Wholehearted, public advocacy of condom-use may strike such people as tacit support for non-marital sex. They disliked the website that was written under the Clinton Administration, seeing it as morally biased in favor of promiscuity. The other side in the debate, however, saw the revised text as morally biased in the opposite direction, and the conflict led to the current text, which still offends some observers.

Sources: Robert B. Bluey "HHS Defends Its Advice About Condoms, Abortion," www.cnsnews.com, December 27, 2002; Adam Clymer, "Critics Say Government Deleted Sexual Material From Web Sites to Push Abstinence," The New York Times, November 26, 2002, p. A18; Lawrence M. Krauss, "The Citizen-Scientist's Obligation to Stand Up for Standards," The New York Times, April 22, 2003, p. D3; Adam Clymer, "U.S. Revises Sex Information, and Fight Goes On," The New York Times, December 27, 2002, p. A15.

April 30, 2003 11:34 AM | category: Internet and public issues | Comments


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