Bioethics, contraception, law, politics, public health, research ethics, Sex ed, Sexuality

Parachutes, Abstinence, Randomized Controlled Studies

There have never been any controlled randomized trials on “Parachute use to prevent death and major trauma related to gravitational challenge,” according to this review published in the British Medical Journal in December 2003. And yet, in the nearly 3 years since it was documented in a prestigious peer-reviewed journal that the evidence supporting the use of parachutes by those who jump from planes is anectotal, Federal, State and private entities continue to support the private parachute industry.

The Government Accounting Office released a review (in pdf) on the accuracy and effectiveness of abstinence sex education programs, in response to a request by several members of Congress. Editorials from the Bangor (Maine)Daily News, the Atlanta Journal Constitution and others on the review indicate that abstinence education is “scientifically invalid.”

The International Herald Tribune‘s headline reads, ” . . . no-sex-before-marriage programs forgo accuracy, are ineffective.”

The GAO report actually covers several ways that an entire alphabet soup of agencies and States fund abstinence-until-marriage programs, how these programs are reviewed for accuracy and efficacy. There are also descriptions of problems that have been found and corrected. There is a mention of studies that are pending that would be equivalent to the “randomized controlled studies” that will supply “scientific validity” to measurements of evidence comparing outcomes in children who participate in abstinence-until-marriage programs to those in abstinence-plus programs and those who receive no structured sex ed according to standardized end points.

None of the sources give any references for “scientifically valid” “abstinence-plus” or “if you do it, use a condom and a back-up method of contraception” sex ed.

If I may, I’d suggest that editors learn to read reports and perhaps take a class in statistics. Or, they could follow the recommendation of Smith and Pell:

A call to (broken) arms

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

(Final emphasis, mine)

About bnuckols

Conservative Christian Family Doctor, promoting conservative news and views. (Hot Air under the right wing!)


7 thoughts on “Parachutes, Abstinence, Randomized Controlled Studies

  1. >When did science come into this debate?Abstinance education is used because a lot of parents are in favour of it for entirely non-scientific reasons of either religion or personal morality. Whether is actually works is entirely irrelivent – the proponents couldn't care less about statistics. They support it because, as far as they are concerned, too much sex (outside of narrowly-defined circumstances) is *itsself* a problem which must be addressed – STIs and pregnency are incidential.There are already many reports demonstrating why abstinance-only doesn't work – Planed Parenthood has a list on their site somewhere. Some from very credible organisations. All of them totally ignored by those who support abstinance-only education, because they approach it from a completly different angle: Their aim, first and foremost, is to try to steer young people towards an idealised version of a traditional lifestyle: One partner in their lifetime, and no sex with them until after marriage.This is why so many of those organisations that support abstinance-only are religions in nature.Studying the abstinance-plus programs is made much harder by problems of definitions. Abstinance-only covers a quite narrow range of possible teaching, and is easily defined. Comprehensive education covers a slightly larger area. But the abstinance-plus ones… they can be anywhere in between. I have seen some of the 'ABC' style programs jokingly refered to as 'ABc,' in reference to the way they may strongly deemphesise the condom element – spending an hour lecturing on the advantages of abstinance and fidelity, then quietly muttering something about contraception afterwards. Thus a program that is labeled as a type of abstinance-plus can really be equivilent to abstinance-only. Or, more rarely, the other way – a comprehensive program might be rebranded as an abstinance-plus to appear more acceptable to parents, but have only a short section on abstinance thrown in somewhere.

    Posted by Suricou Raven | November 27, 2006, 9:50 am
  2. >SR, First, we're noting the same phenomena, with different conclusions – based on different world views and life experiences. Second, the term should be "abstinence until marriage." The GAO report notes the criteria for the programs – they aren't "abstinence-only."And, I note that your own information is anecdotal.Information from your own country is not too promising for any kind of sex ed or contraception program. From the BBC With all the effort England has put into preventing teen pregnancy and births, the reduction from 44 to 42 girls per 1000 is not much of a success. The point is that common sense should allow us to draw conclusions while awaiting Mathematica's data. Common sense – in my case, coming from a background of work in domestic and sexual violence – is to urge delay of sex until a committed, monogamous relationship. Local doctors teach the STD lecture from "Worth the Wait" in our County. I usually teach the 6th graders. Texas law requires information on efficacy of various contraceptives if they are mentioned – and they are, in WTW.Few people advocate that sex before 17 or 18 is healthy for any child, boy or girl. Even fewer would recommend teen pregnancy, abortion or childbirth as the best practice. It appears that delay of onset is effective in reducing STD's, pregnancy, and numbers of partners. Teen pregnancy and birth rates are falling, although not as fast as we'd like.

    Posted by | November 27, 2006, 4:24 pm
  3. >"the term should be "abstinence until marriage."Noted. A small mistake… though it does leave me wondering what happens after marriage, when both partners might have only a vague idea of how to put on a condom and even less of any other form of contraception. Most (sensible) couples would like to delay children for a time, until they are fully settled in their relationship and financially stable – I can see that a lack of education on contraception might make this much less likely.I will see if I can back up those anacdotal obsevations with some studies… I found that list I mentioned, but underestimated the amount of political things I would have to wade through to find the studies… ah, here it is:"In fact, 88 percent of students who pledged virginity in middle school and high school still engage in premarital sex. The students who break this pledge are less likely to use contraception at first intercourse, and they have similar rates of sexually transmitted infections as non-pledgers (Bearman and Brueckner, 2001; Walters, 2005)."Bearman, P.S. & H. Brueckner. (2001). "Promising the Future: Virginity Pledges and First Intercourse." American Journal of Sociology, 106(4), 859-912.Other paragraphs of interest:"A 1997 consensus statement from the National Institutes of Health concluded that legislation discouraging condom use on the grounds that condoms are ineffective "places policy in direct conflict with science because it ignores overwhelming evidence . . . Abstinence-only programs cannot be justified in the face of effective programs and given the fact that we face an international emergency in the AIDS epidemic" (NIH, 1997)."PP is obviously biased, but they do cite their sources, if you want to check them. Their page on abstinance is – about the first half is on the political side, and the second half on the scientific/statistical side.I agree that the statistics in the UK are appalling. Both pregnency and STI transmission rates. But there are other countries where a very similar style of sex education has worked very well, so its not just a simple cause-and-effect. I think its just the youth culture in the UK tends to involve a lot of drinking, impulsiveness, risk-taking and very little serious commitment to anything.And a few magic bullets from the scientists wouldn't hurt either :> How long has that male contraceptive pill been 'nearly ready'? And some more STI vaccines would help too. Oh, well… hope for them, but dont rely on them.

    Posted by Suricou Raven | November 27, 2006, 8:03 pm
  4. >Seriously, did you really ask "what happens after marriage, when both partners might have only a vague idea of how to put on a condom and even less of any other form of contraception"? Back in the dark ages, we did just fine without classroom demonstrations, thank you.The rest is the subject of my next post. . .

    Posted by | November 28, 2006, 1:41 am
  5. >"Back in the dark ages, we did just fine without classroom demonstrations, thank you."Yes, by having children early. And lots of them.

    Posted by Suricou Raven | November 28, 2006, 4:59 pm
  6. >I had two children inspite of not being able to tolerate OC's – the first was born 3 years after my marriage.

    Posted by | November 28, 2006, 6:33 pm
  7. >I agree in considering S.R.'s comments scarcely believable. Honestly, is information on how to put on a condom, how to insert a diaphragm, or how to take oral contraceptives not available to, say, a young man or woman of 22 years of age who is planning a wedding? Give me a break. This stuff all comes with full instructions *in the package.* And it isn't rocket science to use, anyway. And if that weren't enough, any gynecologist or family doctor will discuss these things with a patient, especially an adult patient, in the privacy of his office. There are books you can get and reliable information on the Internet.I don't think that people seriously believe that we have to start making 12-year-olds put condoms on a banana in class, giving them endless lectures on birth control, and eventually teaching them in college methods of masturbation and the different kinds of sex toys in order that they should not enter marriage at age 23 or older ignorant of how to use a condom or take birth control pills! S.R. thinks advocates of abstinence until marriage have an agenda. Well, those of us who advocate teaching such things think the other folks have an agenda, too: They think it's really no big deal for 12-year-olds to be having oral sex and for their only-slightly-older siblings to be having full intercourse. It really doesn't bug them too much, and they are fully willing to take the chance of encouraging such behavior by giving graphic details to fairly young kids because the risk isn't that big of a deal to them in comparison to the wonderful benefits of making sure these kids, _none_ of whom are getting married (!!!), know how to "protect themselves." This never is and never was about making sure marriage-aged adults could access information on birth control. Anyone with two brain cells knows that such people have numerous avenues for such access. This is about making sure teenagers use condoms, even if in telling them all about sex, we encourage more sexual activity. (Not, of course, that a die-hard sex ed advocate will even admit that such causality is happening. But this, too, is in part because it really wouldn't bother him too much if it were.)

    Posted by Lydia McGrew | November 29, 2006, 1:42 am

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