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," www.cnsnews.com, 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.