Testimony of Dr. Sharon Quick

 

Below is a revised copy of the handout submitted to the House Education committee.  I am working on compiling references for the psychological relationship to “at risk” behavior and can forward those later. 

 

Hope this will help.

 

Sharon Quick, MD

 

 

HANDOUT for Education Committees re:  HB2546 and SB6506.  Revised 2/8/02

 

I am Dr. Sharon Quick.  I am board certified in Pediatrics, Anesthesiology, and Pediatric Critical Care and have fellowship training

in Pediatric Anesthesiology.  My most important title, however, is

“mother.”  I have firsthand experience with teenagers who engage in “risky behavior” and am familiar with medical research and its use in the practice of medicine.

 

I encourage you to oppose HB2546 and SB6506.

 

I absolutely agree that sexuality education should provide scientific facts. My biggest concern with this bill is how the bill will be enforced; that is, who will make the decisions regarding what data is to be taught to our children and the far-reaching consequences of such central information control. 1.  Each medical study is done under specific conditions and is controlled for certain factors. Similar studies can produce varying results. Who will determine which studies are “valid” and which information to use to educate our children?  There is potential for medical facts to be chosen and presented in a manner that obscures the truth. 

Example (Not meant to be a complete or definitive review of condoms and

pregnancy):  Two large-scale studies of pregnancy rates in couples using condoms show about a 15% chance of pregnancy in 1 year.1,2 There are other studies with different results.  One small study, for instance, showed a 1 % pregnancy rate for 53 couples using condoms.  The criteria for subject involvement in the study were that “women should have had at least four pregnancies in the previous six years, including a live birth in the last 12 months.”  Nineteen had six or more children, and one was 43 years old with 19 children.3 A woman’s fertility and frequency of intercourse often decline with age.  Breastfeeding can temporarily decrease fertility as well.  Couples who use condoms over a period of years may achieve lower pregnancy rates.4,5  When does someone with 19 children have time for sex?  All or some of these factors probably contributed to the low pregnancy rate in this study.  There are obvious differences between the group of people used in this study and teenagers; one could not extrapolate the findings to that younger age group.  Yet, I would be stating a medical fact if I told teenagers that pregnancy rates as low as 1% can be obtained with condom use. If I added that condoms are effective in reducing the transmission of some sexually transmitted diseases (STDs), but said nothing more, they could assume that those percentages are reflective of degree of protection against STDs. To prevent misunderstanding they need to be told, in addition, that STDs can be acquired any day of the month, while pregnancy can be achieved only during several days out of the month and that condoms do not have the same effectiveness for all infections. The particular data that are chosen as well as the kind of information that is omitted can drastically alter the message.  Also, different data may be more relevant for different groups of people. It is a challenge to condense all this information into a form that is understandable to children, that holds their attention, and does not skew the truth.  In addition, the age and particular characteristics of the children being taught have to be taken into account when deciding the content of information to be presented.  The curriculum for sex education not only spans the fields of obstetrics and gynecology, pediatrics, infectious diseases, epidemiology, psychiatry and family practice, but also includes psychology and sociology.  Is there an organization or group with expertise in all those areas that can decide which information is “valid” as a state standard?  The field of psychology poses a particular problem in trying to define which psychological approach is “accurate” without knowing the characteristics of the children in the specific school.  Does the legislature then need a medical license for deciding which medical information will be provided to children?  I doubt they would enjoy the legal liability that goes along with the license.

 

2. Secondly, this bill contains no provision for prohibiting groups with a substantial financial interest in contraceptives, abortions, antibiotics for treating STDs, or other products that might be discussed in sex education from having any control over the information being taught to our children.  Such control would be unethical with the inherent risk of providing biased information.

 

3. Third, this bill may take away the power for choosing a curriculum for sexuality education from the local school districts as outlined in WAC 180-50-140.  Different schools across the state have diverse student populations which might be best served by slightly different approaches to education.  I believe each school should, within reasonable guidelines, be able to choose the program that best fits their students’ needs.  If a central agency decides what medical information and/or curriculum is “valid,” the schools lose their control.

 

4. Fourth, I am concerned that the definition of “medically and scientifically accurate information” as described in Sec.1, (2) (a), (b), and (c) might limit the advancement of science in this state.  Physicians use common sense and creativity in treating patients, not only information that has already been published and researched. If someone doesn’t take the first step to try a new chemotherapy drug in a patient, a better treatment might never be found.  If only sex education protocols that have already been studied and published can be used, the common sense and innovation of many bright individuals with a heart to help children in their own community will be stifled.

 

5.  Finally, if this bill takes away the option for abstinence-only education, as defined in the Title V amendment (and includes under (C) teaching medical topics of STDs and contraceptive effectiveness), which I believe has full support in the medical literature, it would be a travesty to the children in this state. The most recent NIH report on condom effectiveness found that consistent condom use reduces the risk of HIV transmission by about 85% (seroconversion drops from about 7% to 1% per year with condom use) and reduces the risk of gonorrhea transmission to men only. There was insufficient evidence to make statements about condom effectiveness for any other STDs.6 (See attached NIH Condom Report Press Release)  Therefore, the ONLY way to reliably prevent STD transmission is abstinence.  The primary problem of children who engage in at-risk behaviors is not medical but psychological and emotional in nature.  We cannot use only medical facts to teach children about love and healthy relationships and how to say “no.” Measuring the outcome of various sexual education programs with medical parameters of numbers of STDs and pregnancies is an indirect measure at best of how well we are treating psychological and social dysfunction.  We must be careful not to destroy the soul of the child by attempting to reduce a statistic.  Even if sex could be made perfectly safe from a disease and pregnancy standpoint, the vast majority of teenagers are not emotionally prepared for sexual intimacy; the experience is often psychologically devastating. There are no condoms for the heart.  Children are people, not diseases. This legislature has a sacred trust from the parents in this state to regard our children as whole persons, not as units in a risk-reduction campaign.

 

ADDENDUM: The testimonies of “incorrect medical information” that were given at the Senate Education Committee hearing on 2/4/02 included a combination of medical data that DO have support in the medical literature, medical data that DO NOT have support in the medical literature, and OPINIONS that have been incorrectly classified as medical data.

 

SUMMARY:  This bill’s goal of providing our children with correct and complete information is a good one.  However, mandating state standards for “medically accurate information” is fraught with complications.

First, synthesizing the vast amount of medical data into a state standard would be a huge undertaking, with constant revisions needed as new studies arise.  This sounds suspiciously like practicing medicine.  What governing body are you going to entrust with that legal liability?

Secondly, medical facts can be arranged to distort the truth. An example is provided in your handout. This bill contains no provision for prohibiting groups with a substantial financial interest in contraceptives, abortions, antibiotics for treating STDs, or other products that might be discussed in sex education from having any control over the information being taught to our children.  Such control would be unethical with the inherent risk of providing biased information. Third, schools could lose their power to choose their own sexuality curriculum.

Fourth, because of the strict terminology in this bill, research advancement in the area of sex education could be halted. 

And finally, abstinence-only education must be a priority in this state for both physical and psychological reasons. The most recent NIH report on condom effectiveness found that consistent condom use reduces the risk of HIV transmission by only 85% and reduces the risk of gonorrhea transmission to men, but not women. There was insufficient evidence to make statements about condom effectiveness for any other STDs.6 (See attached NIH Condom Report Press Release) Therefore, the ONLY way to reliably prevent STD transmission is abstinence.  The primary problem of children who engage in at-risk behaviors is not medical but psychological and emotional in nature.  We cannot use only medical facts to teach children about love and healthy relationships and how to say “no.” Measuring the outcome of various sexual education programs with medical parameters of numbers of STDs and pregnancies is an indirect measure at best of how well we are treating psychological and social dysfunction.

We must be careful not to destroy the soul of the child by attempting to reduce a statistic.  Even if sex could be made perfectly safe from a disease and pregnancy standpoint, the vast majority of teenagers are not emotionally prepared for sexual intimacy; the experience is often psychologically devastating. There are no condoms for the heart.

Children are people, not diseases. This legislature has a sacred trust from the parents in this state to regard our children as whole persons, not as units in a risk-reduction campaign.

 

 

References:

1. Jones, E.F., & Forrest, J.D. (1992).  Contraceptive Failure Rates Based on the 1988 NSFG,  Family Planning Perspectives, 24(1), 12-19 2. Hatcher, R., et al., (1998) Contraceptive Technology 17th ed., Irvington Publishers. 3. Peel, J., “A male-oriented fertility control experiment,” Practitioner, May 1969; 202:677-681. 4. Vessey, M. et al (1988, July}.  Factors Influencing Use-effectiveness of the Condom.  British Journal of Family Planning, 14, 40-43. 5. Vessey, M. et al.  (1982, April 10).  Efficacy of Different Contraceptive Methods.  Lancet, 841-842. 6. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services. (2000, July 20) Workshop Summary:  Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention.  May be found at:

http://www.niaid.nih.gov/dmid/stds/condomreport.pdf

 

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