Monthly Archives: April 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,", 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.

Cesar Chavez school

I spoke today at the Cesar

Chavez Public Charter School for Public Policy, which is a wonderful

school that I have visited before. It’s a crowded warren of rooms on an

upstairs floor of a former industrial building, where kids are intensely

involved in regular classes, public-service internships, and the study

of public policy. If we are going to have broad-based, creative, informed

leadership in the District of Columbia (and other troubled cities), then

experiments like Chavez must work. It seems quite clear that the school

is successful at present—one hundred percent of its graduates

attend college, and all seem inspired to work on social problems. There

are, however, the usual questions about whether the Chavez model is replicable,

or whether it depends on remarkably charismatic and dedicated leadership.

Today, I was sent this

article on the Internet commons by its author, a former president

of the American Library Association. It seems to be an important contribution.

the point of civics

I was interviewed over the weekend by a group called Civic Honors.

The interview is posted here.

It was an opportunity to say why I personally believe in civic engagement.

I said:

My philosophical position would be something like this: (1) Volunteerism

is an inadequate form of civic engagement, because it replaces political

action with service, which does not address the root cause of problems

or tap the political capacities of the volunteers. (2) Civic engagement

should be cultivated for two reasons. First, if we don’t deliberately

teach it, the least advantaged among us will be the first to disengage,

leading to political inequality later on. Second, civic participation

is a good human activity. It is not the only or highest good activity:

theoretical reflection, spiritual contemplation, appreciation of nature,

creation of art, and care for family members are some of the other activities

that are inherently good. All of these ends or projects are preferable

to the forms of life that are more frequently advertised to young people:

consumerism, athletics, and sexual gratification. Moreover, in public

schools, we cannot teach activities connected to spirituality or care

for family. Therefore, we ought to teach civic engagement (along with

art and science) so that it is an option available to young people.

our kids’ product

Our high school students’ online history project tells the epic

history of their own schools’ desegregation, from 1955-2000. It includes

an introductory slide show, a timeline and graph of the county’s massive

demographic changes, a set of oral history interviews, and then a deliberative

forum on the topic, "What should have been done to address school

segregation in 1955?" The project will never be complete, because

students can always add interviews, historical data, and new perspectives.

But it is now ready for a public launch at an event tomorrow. Therefore,

we invite anyone and everyone to visit and participate. The URL is

kids in urban planning

I wrote part of a grant proposal today that would allow our high school

students to conduct research connected to nutrition, exercise, and

obesity. They would identify local opportunities for recreational

exercise and healthy food, and also local sources of unhealthy food and

barriers to exercise (such as streets without sidewalks). They would place

these items on an online, public map along with the routes of local buses

and Metrorail. Their goals would be (a) to show local residents how they

can get to healthy opportunities; and (b) to show local policymakers how

inaccessible certain important opportunities are.

At the same time, students could calculate how much unhealthy food (i.e.,

grams of fat) can be purchased in various locations for one dollar, versus

how much healthy food can be bought. These figures could also be displayed

on a map. Students could then compare statistics from comparable areas

such as Takoma Park or Silver Spring, MD.

I have been thinking more generally about how young people—especially

non-college-bound kids and kids of color—can learn to play a role

in local decisions about zoning, economic development, and transportation.

They are disproportionately affected by these decisions, yet they rarely

participate in public meetings or discussions. CIRCLE has identified "non-college

youth" as a group that does not vote, does not attend community

meetings or join local groups, and does not have the knowledge necessary

to participate. Furthermore, habits of participation or non-participation

are usually set in adolescence, so unless we find ways to involve these

young people while they are still in high school, chances are they will

be uninvolved for the rest of their lives. One promising idea is to get

them interested in using technological tools for urban planning, such

as the many wonderful products described by