Senator Tom Coburn must have felt like a champ last week. He released his own missive on the CDC (Centers for Disease Control and Prevention), claiming in the title of the document that the CDC's "wasteful" spending indicated a "CDC Off Center." The 114 pages of that report have consumed more paper and staff time in its creation than it is worth. Until the CDC comes fully into line with Dr. Coburn's vision of fiscal restraint and public health strained through an ideological sieve, such diatribes make for amusing reading. I was pleased to see that yours truly made the cut when Coburn retold the story of how I got booted from a peer-reviewed panel at the national STD conference. I was tossed out because I was actually going to question the public health rationale for abstinence-only-until-marriage programs—of course, that's not exactly how Coburn told the story. Amusingly, the CDC ended up picking up the last minute tab for the goofs brought in to replace me—of course the report didn't mention that.
Yet Coburn must have been particularly pleased with the release of a second report last week to which he was tied. In cahoots with another comrade in the social issue assault on America, former Senator Rick Santorum (R-PA), Coburn managed to have a hatchet job on comprehensive sexuality education programs (PDF) released under the auspices of the U.S. Department of Health and Human Service's Administration for Children and Families (ACF). Not coincidentally, ACF is the entity that is charged with administering federally funded abstinence-only-until-marriage programs and has never funded any type of comprehensive program aimed at sexual behavior change. Perhaps to show some semblance of credibility, ACF farmed out the project to a third party.
Into the picture steps two right-wing organizations well-known as architects of Bush's extreme social agenda. The Sagamore Institute for Public Policy Research was contracted to conduct the Santorum/Coburn report. This group's founder, Jay Hein, was tapped by Bush in 2006 to take over the White House Office of Faith-Based and Community Initiatives. And who, among the luminaries in the public health arena did the Sagamore Institute reach out to? None other than Bush's favored Medical Institute (formerly known as the Medical Institute for Sexual Health or MISH), the Texas-based group that was at Bush's side when he was Texas Governor and has since reaped enormous fiscal rewards and extended national bragging rights for carrying out the administration's agenda.
The problem with the Santorum/Coburn report are numerous and in so many ways not worthy of rebuttal. Yet, they have to be addressed for at least two reasons. First, because the Bush administration has proven, once again, just how willing it is to sacrifice sound public health by slapping official government endorsement on politically motivated nonsense. (Make no mistake, ACF's imprimatur means that officially the report matters more than say the polemics emitting from Coburn's personal office.) Second, the sloppiness of the report disparages several prominent and well-known programs that have been proven to help young people be more responsible in their behaviors. This is of course, wholly intended. To quote the wizard behind the curtain, Robert Rector of the Heritage Foundation, as proof: the best way to defend abstinence-only programs is to attack comprehensive sex education.
To begin, the Santorum/Coburn report claims that a review of comprehensive sex education programs shows evidence of medical inaccuracies and insufficient emphasis on abstinence. On medical inaccuracies, they take issue with the fact that one curriculum refers to a certain latex barrier as a "dental dam" instead of the FDA-approved term "rubber dam." (It doesn't matter that no one in the public health field has ever heard of a rubber dam.) Several also referenced the use of the spermicide Nonoxynol-9 which had been recommended by the CDC prior to 2003 when many of these curricula were last released.
On insufficient emphasis on abstinence, the report follows Rector and Heritage not just in spirit but in practice. Recently, Rector issued his own report (PDF) on the treatment of abstinence in what he characterized as comprehensive sex education programs. What profound methodology did the wizard employ to determine the emphasis on abstinence? A word count. You know, the tool in your word processing program that allows you to search for a word. That is what passes for genuine inquiry at the Heritage Foundation these days and the Santorum/Coburn report follows suit. Now, what these bright folks fail to recognize is that motivating behavior change means you actually have to use terms that young people accept. So, because we all want young people to delay sex, good program developers have employed other words that are either too complicated to search for, or more likely, lack the black/white and abstinent/promiscuous dichotomies that create the ordered mania that passes for logic among the right wingers.
At the end of the day, the report does agree that the programs reviewed actually work. Most of them increased condom use and several helped delay sex. That is volumes more than abstinence-only programs do. The report is also forced to admit that "…the medical accuracy of comprehensive sex education curricula is nearly 100%." But these findings are buried on the underside of a teacup with a tempest inside it. Instead, the reader is led to the conclusion that the semantics over whether to use the word "dental" or "rubber" rise to the same level as previous evidence showing medical inaccuracies in abstinence-only-until-marriage programs such as that HIV can be spread through sweat and tears. Elementary word counts are also passed off as careful reviews of curriculum content.
This is classic public health rationale Bush-style and it is a shameful slip of hand to have our government's seal applied to in agreement. Is this a surprise? Hardly. Yet it comes just days after House Democrats agreed—despite so much evidence against it—to increase funding for one of the federal government's abstinence-only-until-marriage programs. Who would have guessed six months ago that the efforts of Santorum, Coburn, and House Democrats would combine forces to try and save crumbling abstinence-only-until-marriage programs from the public health ash heap? Not even Coburn, I'd say.