Science, not religion, must guide health policy

September 10, 2004|By Thomas J. Coates

SCIENCE RISES or falls on integrity. That's why claims of bias in scientific findings, distortion of results when clinical trials are funded by pharmaceuticals and outright falsification of scientific data are so disturbing. Our reliance on science is based on the application of objective methods to achieve replicable results, and we all suffer when that process is distorted.

The essence of any theological or religious stance is integrity. That is why everyone loses when science is used to support theology-based decisions and in that process the science is perverted.

Imagine that you have been diagnosed with brain cancer. Your neurosurgeon recommends several strategies. Because you have confidence in a doctor, you go forward, but your cancer gets worse. And then you discover that your surgeon treated you using techniques not backed by scientific evidence.

Worse, you learn that the scientific evidence for the interventions the doctor implemented have been proved ineffective or even harmful.

Public health malpractice is what the U.S. government is practicing. Public health requires the same adherence to scientific evidence as does clinical medicine.

The Bush administration proposes that $270 million, nearly one-third of its domestic HIV/AIDS prevention funding, focus on abstinence. Draft regulations published in the June 16 issue of the Federal Register require the censoring of any government-funded content that is even vaguely "sexually suggestive" and require that all materials include information on the lack of effectiveness of condoms.

The President's Emergency Plan for AIDS Relief, the centerpiece of the administration's fight against the world's HIV/AIDS pandemic, stipulates that fully one-third of the prevention funds distributed through that program must support abstinence and monogamy education programs.

No one opposes abstinence and monogamy. Abstinence should be an option that is provided to everyone so that individuals are not forced to engage in sexual relations when they don't want to. Delaying first-time sexual intercourse by a year might save lives. Younger individuals are more immature emotionally and physically, rendering them more susceptible to HIV/AIDS. But abstinence should be one option among others, and individuals exposed to abstinence-only education are not being given the full range of tools that they need to care for themselves.

This is not the only instance in which science is being distorted for the sake of theology.

Recently, first lady Laura Bush defended the president's decision to limit stem-cell research to existing stem-cell lines - numbering only eight, some of which are not appropriate for application to human therapeutic uses because they are derived from animals.

Mrs. Bush defended her husband's decision by discounting the speed with which therapeutic applications from stem-cell research will be derived. Certainly, if the research is restricted, therapeutic applications will be delayed indefinitely.

Young people are at grave risk for HIV today. Fully one-half of the new HIV infections in the United States occur in people under the age of 25. One-third of the 37.8 million people living with HIV worldwide today are under the age of 25, and people under the age of 25 account for half of the new infections in the world.

The moral high ground, and any values-based decision, requires that we use the best science we have to protect our young people. And the science is clear: There is no evidence to support financing programs that focus only on abstinence and monogamy. And that is not from lack of evaluation: The programs have been studied and have been found ineffective.

Virginity pledges, abstinence-only programs and abstinence-until-marriage programs have been shown to have the unintended consequence of increasing the probability that adolescents will have unprotected sex at the time of first intercourse.

Science cannot be bent to support theology-based decisions. Science is science and theology is theology. If the latter is to be used to make public health decisions, then the theological thing to do is to act with integrity and be honest about the basis upon which clinical medicine and public health and scientific research are being allowed to develop and practice.

Thomas J. Coates is a professor of infectious diseases at the David Geffen School of Medicine at UCLA and a member of the Executive Committee of the UCLA AIDS Institute.

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