On Monday, the federal office that oversees the nation's family-planning program got a new boss who doesn't believe in birth control. Eric Keroack is a Massachusetts obstetrician-gynecologist who argues that abstinence until marriage is the only healthy choice for women. Until recently, he 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. 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.
Keroack's appointment, as deputy assistant secretary of population affairs within the Department of Health and Human Services, did not require congressional approval. The Bush administration picked him on its own. And women's health advocates, editorial pages, and bloggers, along with Democratic members of Congress, are right to think he's a crazy choice for this job.
The Title X family-planning program, which Keroack will now oversee, has a federal mandate to provide information and access to birth control, as well as pregnancy tests and counseling. (Patients may receive referrals for abortion, but Title X funds may not be used to pay for the procedure.) The program also offers information and treatment for sexually transmitted diseases and screening for breast and cervical cancer. Title X has been financially squeezed in recent years, but it still funds approximately 4,500 clinics that serve about 5 million patients across the country.
Keroack's professional history suggests a mismatch, to put it mildly, with Title X's goal of educating women about contraception and helping them get it. He has lectured widely for groups like the National Abstinence Clearinghouse, which disparages the use of birth control and disseminates medical misinformation. The policy statement of the pregnancy-counseling organization he served as medical director for, A Woman's Concern, says:
A Woman's Concern does not distribute, or encourage the use of, contraceptive drugs and devices. … A Woman's Concern is persuaded that the crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality, and adverse to human health and happiness.
The statement further claims that widespread availability of birth control, especially for young people, "actually increases (rather than decreases) out-of-wedlock pregnancy and abortion"—a view that flies in the face of persuasive evidence (see here, here, and here).
Misleading or factually false information about sexual health abounds in the group's educational materials and on its Web site. To disparage the notion of "safe sex" and make the case that abstinence is the only healthy choice, A Woman's Concern teaches that condoms "only protect against HIV/AIDS 85% of the time, which means you have a 15% chance of contracting it while using a condom." And, lest a patient consider having an abortion, it claims that teens who undergo the procedure "may face an eight times greater risk of contracting breast cancer by age 45."
These claims have been resoundingly discredited. Recent studies show that condom use can substantially reduce the transmission of HPV, herpes, and numerous other STDs. Condoms also dramatically reduce the risk of HIV infection. The research on condoms and HIV transmission that Keroack's group seems to allude to is a report by the National Institutes of Health that found "an 85 percent decrease in risk of HIV transmission" for condom users compared with nonusers (my italics). The twisted version of this statistic touted by A Woman's Concern implies that if 100 kids have sex while using condoms, 15 will become infected with HIV—an absurd suggestion.
As for the purported link between abortion and breast cancer, that old favorite of the pro-life movement was refuted by research published in the New England Journal of Medicine in 1997. After pro-lifers snuck an ambiguous statement on the topic onto a government Web site in 2002, a scientific panel appointed by the director of the National Cancer Institute knocked it down in 2003. That panel examined all of the available population-based, clinical, and animal data and found no link between induced abortion and breast cancer. Nor is there a plausible, biological mechanism that would connect abortion to breast cancer. As medical director, Keroack should have known better than to promote this information. That he didn't suggests a willingness to manipulate science to interfere with patients' ability to make informed choices—a willingness to breach the ethics of his profession.
In Keroack's own lectures and writing, he also makes claims designed to scare the bejesus out of kids to convince them to remain abstinent. One pet theory involves the neuropeptide oxytocin, which plays a role in mother-child bonding and social affiliation. Keroack claims that that people who engage in premarital sex experience chronic emotional pain, which lowers their oxytocin levels. This in turn impairs their ability to form healthy relationships down the road. "People who have misused their sexual faculty and become bonded to multiple persons will diminish the power of oxytocin to maintain a permanent bond with an individual," he writes.
Keroack's cites research on oxytocin levels in animals like prairie voles. There are obvious problems in extrapolating from voles to humans, whose brains are much more complex. A handful of human studies show a role for oxytocin in promoting sociability. But there are inconsistencies. One study found that lactating women who had higher plasma levels of oxytocin reported being more sociable. But two others found that women with higher oxytocin levels reported higher relationship distress—precisely the opposite of Keroack's claim. More crucially, there are no data to suggest a causal link between oxytocin levels and marital happiness—or between any of this and premarital sex. Keroack's claim is simply "not borne out by the current evidence," says Jennifer Bartz of Mount Sinai School of Medicine, author of an excellent review article. To be less polite, this is a guy who takes a neuropeptide and a prairie vole and spins from them science fiction.
In his new role, Keroack will have extensive power to shape the kinds of information disseminated to millions of women. He will be able to develop new guidelines for clinics, set priorities, and determine how scarce dollars get spent, says Marilyn Keefe of the National Family Planning and Reproductive Health Association. "We've seen that people in these political slots have a tremendous influence over how programs get implemented," she said. A spokeswoman for the Department of Health and Human Services defended the appointment in an e-mail, stating that "Dr. Keroack is highly qualified and a well-respected physician."
But at a moment when the need for subsidized birth control is rising, and clinics are struggling to pay for basic services—not to mention advances in screening and prevention like the HPV vaccine—a new hire hostile to family planning and accurate medical information is the last thing women need. Keroack has also won props from the Christian right for using ultrasounds in pregnancy counseling. He argues that the images dissuade women from having abortions and that at A Woman's Concern, the number of patients choosing abortions dropped dramatically when the ultrasounds were introduced. So, stay tuned. This innovation, too, may be coming to a publicly funded clinic near you.
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