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Abstaining From the Truth

Popular abstinence-only curricula teach schoolchildren falsehoods and stereotypes

When they learn about the birds and the bees at school, children might be avoiding more than just an uncomfortable conversation with their parents. According to a recently released report on nationwide reproductive-health curricula, they might be avoiding the truth.

“Abstinence-only education, which promotes abstinence from sexual activity without teaching basic facts about contraception, now reaches millions of adolescents each year,” states the report released last week by U.S. Rep. Henry A. Waxman (D-Calif.) of the House Committee on Government Reform. “These curricula contain misinformation about condoms, abortion and basic scientific facts.”

The report, which examined the curricula used by schools as part of the national “abstinence-only” education initiative, found that more than two-thirds of recipients of the funding were not only providing students with medically and scientifically inaccurate information, but also reinforcing stereotypes and presenting religious beliefs as fact. No one is holding them accountable for the content of their lessons.

“As condom usage has increased, so have rates of STDs,” reads a lesson taken from Navigator teaching guide, one of the more popular abstinence-only curricula cited in Waxman’s report. In another curriculum’s teaching guide, the lesson goes so far as to directly question whether safer-sex measures make any difference at all, saying that “the popular claim that condoms help prevent the spread of STDs is not supported by the data.” These claims have been repeatedly contradicted by both the Centers for Disease Control and Prevention and numerous experts.

According to the report, these programs have seen their funding more than double since 2001. A state profile released earlier this year by the Sexuality Information and Education Council of the United States determined that New York—which receives one of the highest levels of federal funding for abstinence-only education—received more than $7 million last year for such programs.

According to Waxman’s report, federal funding for abstinence-only education programs generally follows one of three paths. Section 510 of the 1996 welfare reform act provides a block grant to each state’s department of health for use for sexual education programs whose “exclusive purpose” is to promote abstinence. These grants are then dispersed to various school districts, health facilities or other agencies, making it difficult to track local recipients. Money is also provided directly to schools and other agencies through the Special Programs of Regional and National Significance—Community-Based Abstinence Education program and the Adolescent Family Life Act. Recipients of these direct grants are overwhelming organizations with religious ties.

In order to qualify for funding, the general rule is that organizations must simply pledge to focus their sexual education programs on abstinence, while refusing to discuss the use of contraceptives or safer-sex measures—that is, unless discussion centers on their rates of failure.

Along with this enormous gap in content, according to critics, abstinence-only curricula are not reviewed for accuracy by the government.

“I have no problems with trying an abstinence education program,” said Waxman in a recent interview. “But I think it ought to be measured by the same standards of any other program.”

And among the most popular curricula being taught by abstinence-only education programs around New York and the rest of the United States, errors and simplistic stereotypes abound—including some questionable lessons about the differences between men and women.

“Women gauge their happiness and judge their success by their relationships,” explains one lesson in the Why kNOw series of abstinence-only curriculum, adding that for men, “happiness and success hinge on their accomplishments.”

In similar fashion, another curriculum teaches that men “tend to be more tuned in to what is happening today and what needs to be done for a secure future,” while women are “not as concerned about preparing for retirement.”

Also cited in Waxman’s report is an abundance of misleading information regarding conception, abortion and the risks of premarital sex.

“Ten to twelve weeks after conception . . . he/she can hear and see,” explains a lesson in Me, My World, My Future, citing a source that, according to the Waxman report, does not support this statement about embryonic development at all. One curriculum describes the blastocyst, a ball of 107 to 256 cells, “snuggling” into the uterine lining.

Several curricula also dramatically exaggerate the dangers of abortion, telling students that women who have an abortion are likely to become sterile or give birth to mentally retarded children in the future. In similar fashion, a lesson from Navigator also warns that premarital sex puts women at risk for cervical cancer, while another curriculum teaches that feelings of jealousy, depression and disappointment can be avoided by being “abstinent until marriage.”

Despite this questionable content, the Bush administration continued its four-year trend of increasing support for these programs earlier this year by proposing $270 million in federal funding for them in 2005. Congress approved $170 million. Whether that money is well spent, however, tends to depend on whom you ask. While supporters of abstinence-only education insist that discussion of contraceptives, abortion and related issues increase children’s promiscuity, critics contend that comprehensive sexual education programs better prepare children for their sexual futures. They cite a study conducted recently by Columbia University that found that participants in abstinence-only programs like the “virginity pledge” were just as likely to engage in premarital sex as other students, but less likely to use a contraceptive when doing so.

Here in New York, a bill introduced in the state Legislature may provide the necessary tools to regulate sexual education curricula and reduce the rates of teen pregnancy and disease transmission. Introduced last year in both houses, the bill would require that reproductive-health curricula—whether comprehensive or abstinence-only in their approach—be scientifically accurate and that parents be made aware of lessons’ subject matter.

“Abstinence is a big part of [a reproductive-health] curriculum, but it’s not the only part,” said JoAnn Smith, president of Family Planning Advocates, an advocacy group pushing for the bill’s passage.

While the bill has yet to leave committee in either house, Smith and other supporters are hoping that the Waxman report’s findings will not only shed light on the lack of oversight plaguing sexual-education curricula, but also encourage parents to make “the talk” something that occurs between parents and children rather than just between teachers and students.

—Rick Marshall

rmarshall@metroland.net

 


Overheard

“I don’t know if I can send chocolate to a red state.”

“Hey, 49 percent of us didn’t vote for the guy. Don’t forget us.”

—Lissa D’Aquanni of the Chocolate Gecko, bantering with a customer from North Carolina.

 



What a Week

Tolerance Not Welcome

CBS, UPN, and NBC have refused to air an ad by the United Church of Christ that says the denomination welcomes gays. CBS rationalized that because of the proposed constitutional amendment on gay marriage, this ad (which doesn’t mention marriage at all) is unacceptable advocacy on a public-policy issue. This from the network that ran a Bush ad saying casual pot smokers support terrorism?

I’m Impartial, Really

Despite knowing that the controversial conviction of mentally-ill Christine Wilhelm, who drowned her son, was likely to be appealed, presiding Rensselaer County Court Judge Patrick J. McGrath told Good Morning America on the day after her sentencing that he felt no mercy toward her and thought she belonged in jail rather than a hospital. The state’s Commission on Judicial Conduct ruled on Nov. 12 that McGrath should be admonished for making the comments. Ethics rules prohibit judges from making public comment about “pending or impending” proceedings.

Caveat Emptor

Online gambling house Golden palace.com has forked over $65,000 for the “first ghost sold on eBay.” Actually, the casino bought a metal cane, offered by a woman trying to convince her young son that she had sold mean ol’ grandpa’s ghost (reportedly the boy’s grandfather had used the cane to “admonish” him). Golden Palace also scooped up the much-publicized grilled-cheese sandwich allegedly bearing the image of the Virgin Mary, for a paltry $28,000. These and other artifacts are being toured as “Americana,” and a portion of the proceeds are going to charity. Does gullibility count as a handicap?

Don’t Be Wimps, Boys

U.S. soldiers gave Secretary of Defense Donald Rumsfeld exactly the sort of grilling we’d like to see from the White House press corps during a recent “pep talk” in Buehring, Kuwait. According to the Pentagon, Q&A sessions with troops about to leave for war are standard practice. The questions are becoming more direct than usual, however. When asked about soldiers’ infamous lack of protective equipment, Rumsfeld replied, “You go to war with the army you have.” Regarding the controversial stop-loss policy keeping troops in Iraq past their expected return date, he said, “It’s nothing new. It’s well understood.”



Taking aim: Leonard Morgenbesser.

photo: John Whipple

Waiting for the First Volley

An Albany Common Council resolution to create a gun-violence task force nears its one-year birthday, and remains unfulfilledClippings of carjackings and armed robberies, stories about shootings and home invasions—this is the stuff of Leonard Morgenbesser’s collection. And unlike most collectors, he looks forward to the day when his subject matter gets too scarce and he can find a new hobby.

“As far as I can tell, it’s a problem that doesn’t seem to go away,” said Morgenbesser, who has kept an ongoing record of gun-related crimes reported by the local media for nearly three years. According to Morgenbesser’s most recent tally, there have been 186 gun-related crimes reported by the media in the city of Albany since Sept. 19, 2002, with one incident occurring nearly every four days.

“And the media accounts—they might just be an underestimate of what’s going on,” said Morgenbesser. “People say that crime’s way down, that it’s not a problem. But when there’s someone with a gun to their head every four days, that seems like a problem to me.”

And 72 of those crimes have occurred since Albany’s Common Council unanimously passed a resolution earlier this year [“The Task at Hand,” Newsfront, Jan. 15] that, according to Morgenbesser, could lead to a decline in subject matter for his ad-hoc study.

The resolution, sponsored by Councilman Dominick Calsolaro (Ward 1), calls upon the mayor to create a gun-violence task force for the city, composed of various law-enforcement agencies, community groups and business organizations. Since its passage, there has been little word from Mayor Jerry Jennings about actually forming such an entity. Calls to the mayor’s office about the resolution were not returned.

“All we could do was pass the resolution,” explained Calsolaro, “because the council can’t set up a task force or appoint outside members to it.”

According to Calsolaro, such a task force would be utilized in cooperation with local law enforcement as a sort of education and outreach program to supplement law-enforcement efforts. Calsolaro cited the city’s recent “Don’t Buy for the Other Guy” campaign, which targeted illegal gun purchases, as the sort of program a gun-violence task force might play a role in developing. A task force would also gather, organize and analyze information about gun violence in Albany and cities with similar problems.

“Maybe once a month or four or five times a year they could meet with police,” said Calsolaro, who described the task force as being more of a proactive—rather than reactive—approach to curbing gun violence. “It’s like going after a disease. You need to know what you’re fighting before you can really fight it.”

Local law-enforcement agencies have been cautious about putting their support behind the task-force proposal, however. After the initial resolution passed, members of the Albany Police Department expressed concerns that such a task force would simply duplicate efforts already underway by city and state law-enforcement agencies.

“We’ll work within any legislation that passes,” said Detective James Miller, spokesman for the Albany Police Department, “but it would be crazy to duplicate things, because you won’t be using your resources in an effective manner.”

Miller cited Operation Impact, a joint city and state program targeting high-crime neighborhoods, as one program that targets essentially the same issues as the proposed task force. According to Miller, approximately 60 guns have been seized in the last four months, and the number of shots fired in the city—along with the number of people shot—is decreasing over time.

While Morgenbesser acknowledged the efforts of local law-enforcement agencies, he insisted that communication between law-enforcement personnel and the community—rather than simply between law-enforcement personnel and other law-enforcement personnel—may hold the answer to stopping gun crime before it happens.

“I would be the first on the front line saying that this is not just [Albany Police] Chief Turley’s problem,” said Morgenbesser. “But we can’t just fight this as a criminal justice and police issue—it’s a public-health issue, too.”

However, Morgenbesser added that the recent election of Albany County District Attorney David Soares might signal that a community-minded approach to law enforcement is gaining acceptance.

“When does [gun violence] become a problem?” he asked. “When it starts happening once every two days?”

—Rick Marshall

rmarshall@metroland.net


Seeking answers and apologies: David Baker.

photo: John Whipple

Two Little Words

Local man seeking answers in his wife’s death wishes a policy called “Sorry Works” would come to Samaritan Hospital

Here is what David Baker understands about how his wife, Lisa Zenzen Baker, 42, died last year: She was admitted to Samaritan Hospital in Troy on Nov. 6, 2003, after a bout of nausea and vomiting, probably brought on by complications of her insulin-dependent diabetes. After four days, she was stabilized and expected to be sent home the next day. That night her blood sugar dropped to 55 mg/100mL (any measure below 60 mg/100mL is considered hypoglycemic) at 9 PM. She was given sugars but no complex carbs, which Baker believes is opposed to the hospital’s own protocol. Between 10 PM, when her glucose levels were last checked, and 2 AM, her blood sugar level plummeted to just 2 mg/100mL. She went into a coma, stopped breathing, and three weeks later, she died.

Here’s what David Baker doesn’t know: why or how this happened. Since his wife died, he hasn’t had any contact with any of the doctors involved in her care, despite many attempts on his part. “They didn’t give any explanation,” he said. He tried writing letters, and asking the Department of Health for an investigation. The DOH’s report, performed by the nonprofit health-care assessment company IPRO, said “the standard of care was met,” but again provided little to no details or explanation. DOH and Samaritan Hospital weren’t available for comment.

Baker is turning to a lawsuit, not because he feels he needs money, but “just to get answers. They won’t tell anybody anything until we put them under oath.” He’s been trying to get answers for a year, and says the absence of answers are prolonging his grief over the loss of his wife. “Here it’s been a year, and [I] haven’t even gotten to the point where [I] can start to move on, can’t even start the healing,” he said.

Baker’s experience is not unusual, said Doug Wojcieszak, a spokesman for the Illinois patients’ advocacy group Victims and Families. Wojcieszak, who lost a brother to a medical error, said that the members of his group have had similar stories to tell: “Doors slammed in our faces, records disappeared. Only after an attorney got involved did records surface, and only after money exchanged hands did they come to my parents and say ‘Gee, we’re sorry.’ ”

It’s not that doctors and nurses don’t want to take responsibility, said Wojcieszak and others. It’s that their defense attorneys and their malpractice insurance companies’ attorneys often dictate the policy, telling hospitals and doctors never to admit any wrongdoing or release any information that could be used against them in a lawsuit.

With medical errors claiming more lives per year than car accidents, according to To Err is Human, a report published in 1999 by the National Academy of the Sciences, and debate over rising malpractice premiums and tort reform getting national attention, the topic of medical liability is a hot one for everyone involved. (Depending on which study you look at, medical error causes anywhere from 48,000 to 96,000 deaths a year in this country.) But amid the debates, a new idea has been quietly taking hold that promises best-of-both-world results.

It started in 1987 at the Lexington, Ky., Veterans Affairs Medical Center. The hospital had recently faced some big financial losses due to lawsuits, and the newly installed chief of staff, Steve Kraman, had started a policy of internal investigations after every death or adverse outcome. “We stumbled into a case of a woman who died, and a few weeks after she died we found that there had been a medical error that had been directly responsible for the patient’s death, and the family had no idea,” recalled Kraman. “We decided the only proper ethical thing to do was disclosure.” They called the family in, advised them to bring a lawyer, explained all the details, apologized, explained how they would prevent such mistakes in the future, and said they felt they owed the family some compensation, which the lawyers would negotiate.

“That worked so well, we decided it was going to be our model,” said Kraman, who made every step of what they’d done in that case into a formal policy. It also was the policy to meet with families in cases where the hospital didn’t find an error. In those cases, the hospital staff opened up all the records and took as much time as they needed to explain what happened and why.

The results, said Kraman, were dramatic. The number of lawsuits plummeted.
“Ninety-nine times out of 100, [the apology] takes the anger out of it,” said Wojcieszak. “The biggest thing we get thrown in our face is a knee-jerk emotional reaction, ‘If you tell doctors to say they’re sorry, those lawyers will sue their butts off.’ [People] have a fundamental misunderstanding of how this works. Lawyers don’t file suits against doctors unless a family is mad enough to pick up the phone and call them.”

At the VA hospital, total liability costs also dropped, between fewer lawsuits and more frequent but much smaller settlements. Though the U.S. Attorney’s office, which had to approve settlements over a certain size, initially told them they were crazy, they allowed the experiment and quickly became supporters, said Kraman. The hospital developed a reputation for honesty among the local plaintiffs’ bar, who wouldn’t take a case if the hospital said it was going to fight it, because they knew the hospital didn’t cover up errors. And the hospital was better able to reduce errors, said Kraman, because of the open atmosphere that allowed people to disclose and talk about mistakes and work toward fixing them.

In 1999, Kraman wrote an article for the Annals of Internal Medicine called “Risk Management: Extreme Honesty May Be the Best Policy,” and a few other hospitals began to pick up the approach. The University of Michigan says its liability costs have dropped from $3 million per year to $1 million after implementing the approach. Disclosure and apology have also been quietly incorporated into the Joint Commission on the Accreditation of Healthcare Organizations’ standards.

Even some insurance companies have gotten on board. Copic, a nonprofit insurance company in Colorado, started a pilot program recently called the 3Rs: Recognize, Respond, and Resolve. Doctors in the program get training in communicating with patients, and whenever there’s an unexpected result they sit down with patient and family and “express concern, sorrow, and fault,” explained Copic’s George Dikeou. In about half the cases, Copic also provides a small amount of financial help—capped at $30,000. And they don’t require a release to get the money, so patients retain their right to sue. As of June, 592 cases had gone through the program. Only two were not fully resolved through the program; of those, one was resolved in the claims department without lawyers, and one was dropped. “If patients and their families are satisfied that they’ve been dealt with honestly and truthfully, they view the incident as a human mistake or human error. If they find out or think that’s something being concealed they think it’s malpractice,” said Dikeou. A 2003 state law that allows doctors to admit fault without that being held against them in court really helps, Dikeou noted. Copic is likely to expand the program to all its doctors.

And in Illinois, Wojcieszak’s group is pushing a pilot program dubbed Sorry Works, which is based on the VA’s approach. The pilot program will allow two hospitals to try the program “risk-free” (i.e. the state will pick up any increases in liability costs) for two years. (It’s a trickier thing to institute at a private hospital where an insurer has to be involved.) The program has passed the state Senate and is expected to pass the House as well.

Sorry Works has garnered praise from people of very different political temperaments, and those usually on opposing sides of the medical lawsuit issue. “For the Republican, pro-tort-reform crowd, it lowers lawsuits, lowers liability exposure, gives more control over exposure,” said Wojcieszak. “For Democrats and plaintiffs’ bars . . . more victims get justice, and no one’s constitutional rights are monkeyed with. They still have the right to sue, just most of the time it won’t happen.”

For Wojcieszak, who used to work for tort-reform advocacy groups before he lost his brother a year ago, supporting a program that is a true middle ground feels “like spring has arrived.” He’s helping to form a Sorry Works coalition that will include doctors, insurance companies, lawyers, and patient advocates, to take the concept national.

In the Capital Region, two major hospitals, Albany Medical Center and St. Peter’s Hospital, both say they follow the basic tenets of Sorry Works, though compensation offers are not quite as automatic. Both hospitals are self-insured, which allows them some flexibility, but spokesmen for the hospitals said it’s first a matter of ethics.

“Our approach is an ethical and moral one, rather than a financial one,” said Dr. John Morley, medical director of AMC’s hospital. “It’s our belief that patients have a right to know what’s going on with their cases. Doing what’s right, yet one more time, is a good financial decision as well.”

AMC does a “root cause analysis” of every adverse outcome, and also has a nationally known, aggressive program to track and learn from errors that don’t get to the level of patient harm, such as wrong prescriptions that are caught by the pharmacy, noted Tim Lesar, AMC’s director of pharmacy. Having an open, honest approach is essential to learning environment, said Lesar, but it requires a conscious decision beforehand of how to respond, because when errors occur, the human reaction is first one of defensiveness.

Those involved feel like honesty as a policy is spreading. “A few years ago we could say we don’t like slamming the doors on victims, but if we didn’t we’d go broke,” said Kraman. But, he said, with increasing numbers of hospitals lowering costs by saying “I’m sorry,” “we can’t say that anymore.”

—Miriam Axel-Lute

maxel-lute@metroland.net


Loose Ends

On Monday (Dec. 6), the state Senate overrode Gov. Pataki’s veto of a proposed minimum wage increase to $7.15 by 2007. The bill was championed by numerous worker advocacy groups, who celebrated its passage. Assembly Democrats, who overrode Pataki’s veto [“Race to the Bottom,” FYI, Aug. 5] in August, complained that the bill had been held up this long for use as political capital. . . . Some changes to the Rockefeller Drug Laws are in the works. On Tuesday, the state Senate and Assembly came to an agreement that will lower some of the harshest sentences for those convicting of selling or possessing very small amounts of drugs, and provide retroactive sentencing relief. While some advocates said that without a return of judicial discretion the reforms remain weak, Albany County District Attorney-elect David Soares, who made Rockefeller reform central to his campaign [“What’s a DA to Do?” Trail Mix, Sept. 9], urged support for the package, calling it a giant step forward. . . . Albany Councilman Michael Brown (Ward 3) took aim at Council President Pro-Tempore Richard Conti in a recent letter regarding the council’s decision to request that SUNY put a moratorium on new charter schools in the city [“Hang on a Minute,” Newsfront, Nov. 18]. In the letter, which Brown distributed to much of his constituency, he accused Conti of putting “politics above the education of our kids” by supporting the moratorium and “undercutting” parents’ ability to make choices about their children’s education. Under a moratorium, charter schools currently operating in Albany—along with two more that had already been approved—would stay open and would continue to enroll new students each year, but there would be a temporary halt on the opening of new charter schools until their effectiveness could be better evaluated. Albany’s New Covenant charter school was forced to close its seventh and eighth grades this year because they were failing, and the Brighter Choice charter school has yet to be evaluated.



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