Most people accept and acknowledge that behaviour is an important factor when it comes to matters of health. Although we cannot change our genetics, certain people are predisposed towards conditions such as cancer, there are things that we can do to mitigate risk and attempt to maintain optimum health. We know that smokers substantially increase their chances of contracting disorders affecting their pulmonary and circulatory systems, we accept that eating saturated fats and salt in large quantities increases our risk of heart attacks, we accept that obesity is linked to diabetes and that ideally we should eat at least five portions of fruit and vegetables a day as well as take regular exercise.
Very few people kick up a fuss when the benefits of adopting certain behaviours are suggested and promoted by the government, we know that excessive drinking is bad for us, we know that pregnant women shouldn’t smoke and various health authorities and advisors are playing around with the idea of financially incentivising or discouraging certain behaviours in the interest of public health. One health authority is trialling the idea of financially rewarding mothers who breastfeed with a voucher system, in order to reboot and kick start a culture of breastfeeding which, if the mother is able to do so (the overwhelming majority of women can breastfeed with the right advice and support) is best for the child. We’ve seen minimum alcohol pricing introduced in Scotland and mooted in the UK, along with taxes on fast food, dubbed the ‘fat tax’. There’s also talk of making vaccinations compulsory for children in order to qualify for child benefit.
So why is it, when it comes to issues of sexual health, proposing certain behaviours should be adopted, such as abstinence until marriage and remaining faithful and monogamous to one sexual partner only, becomes the subject of immense vitriol and scorn?
Those who follow me on Twitter, would do well to have a look at an illuminating discussion held over the course of the last few days. Leaving aside the usual awfulness comprised of “you have bizarre morals, you’d rather your children got cancer than had sex, you are twisted, everyone hates you, oh look now you’re playing victim again, you’re only doing this for attention, you ought to get off Twitter, no one listens to you and thank God you are not like most Catholics” (requisite skin of a rhinoceros is yet to form, it is hard to repeatedly attract such unfounded abuse) what seemed to be causing unprecedented amounts of opprobrium was the idea that sexual behaviour is key in terms of maintaining optimal sexual health and avoiding the transmission of STDs.
The first issue being that of the HPV vaccine which it is recommended that girls receive in early adolescence before they commence sexual activity. In a misleading advertising campaign, the NHS suggests that once the girls receive the vaccine they are therefore “armed for life”. As this interview with one of the lead researchers responsible for the development of the vaccine used in the UK, Gardasil, makes clear, HPV vaccination has its disadvantages as well its advantages. Instead of being armed for life, as the NHS advert suggests, the vaccine has a limited effect, lasting up to 15 years maximum.
The vaccine is not an immunisation against cervical cancer, but rather the HPV virus, which is present in almost all forms of cervical cancer and believed to be responsible for the condition. While considering whether or not one ought to allow one’s child to be vaccinated, one needs to weigh up all information available, such as efficacy and benefits versus the risks.
As with all vaccines, there are risks with Gardasil, including auto-immune disorders and even death, although these are rare. As Marcia Yerman points out, this vaccine does not protect women for life, they can still get other HPV infections which are not covered by the jab and they must not neglect regular cervical smear tests, which are vital in terms of discovering and treating pre-cancerous cells.
An immunisation may protect you from certain forms of HPV which could lead to cancer, however cervical cancer is as my gynaecologist once put it, “one of the must stupid cancers to die from” in that is is easily treatable if caught early. Regular pap smears detect abnormal or precancerous cells which are then promptly removed before they have a chance to develop into full-blown cancer.
The best way to avoid infection with HPV, which is a purely sexually transmitted disease, is to limit the number of sexual partners you have, the ideal being to have just one sexual partner and remain faithful them to the rest of your life. If your sexual partner has equally never had any sexual contact with anyone else then your risk of developing an HPV infection which could lead to cancer is negligible. Worringly, there seems to be an emergence of head and neck cancers related to HPV infection, contracted through oral sexual contact.
While HPV vaccination could prevent infection, aside from the small risks of an adverse reaction, the danger is not that it will encourage promiscuity, (and regardless of vaccine, promiscuous behaviour is risky) but that it will encourage the phenomenon of risk compensation, as experienced by Professor Edward Green, former Professor of HIV Prevention at Harvard. Believing that they have been immunised against cervical cancer, girls may be encouraged not to use barrier forms of contraception and/or engage in sexual behaviour that they would otherwise have avoided, under the illusion that they were safe and protected. Most concerning is that they may be discouraged from participating in the cervical screening programme, (most women approach their smear with reluctance, no-one relishes the experience, it is a necessary uncomfortable part of health care) believing that they are protected from cervical cancer. An HPV jab isn’t going to prevent the development of precancerous cells let alone treat them.
Pap smears have never killed anyone. Pap smears are an effective screening tool to prevent cervical cancer. Pap smears alone prevent more cervical cancers than vaccines. The argument is best summed up by Marcia Yerman thus:
Gardasil is associated with serious adverse events, including death. If Gardasil is given to 11 year olds, and the vaccine does not last at least fifteen years, then there is no benefit – and only risk – for the young girl. Vaccinating will not reduce the population incidence of cervical cancer if the woman continues to get Pap screening throughout her life.
If a woman is never going to get Pap screening, then a HPV vaccine could offer her a better chance of not developing cervical cancer, and this protection may be valued by the woman as worth the small but real risks of serious adverse events. On the other hand, the woman may not value the protection from Gardasil as being worth the risk knowing that 1) she is at low risk for a persistent HPV infection and 2) most precancers can be detected and treated successfully. It is entirely a personal value judgment.
What is left out is that 95% of all HPV infections are cleared spontaneously by the body’s immune system. The remaining 5% progress to cancer precursors. Cancer precursors, specifically CIN 3, progresses to invasive cancer in the following proportions: 20% of women with CIN 3 progress to invasive cervical cancer in five years; 40% progress to cervical cancer in thirty years. There is ample time to detect and treat the early precancers and early stage cancers for 100% cure.
So really there is no need for the “Lord spare us from ignorant Catholic houseswives putting out dangerous information” “your daughters will get cancer”, “Farrow is spreading dangerous lies”, “you are pro-cancer and pro-HIV” invective spewing across my timeline.
Problem is, in a society when personal autonomy and choices are gods, suggesting anything other than all choices are of equal value (moral relativism) is akin to judgemental bigotry. It might be extremely convenient for me that Catholic doctrine on sexual morality is scientifically sound, natural law is entirely logical, but it’s a nightmare for sexual libertines, most of whom seem to be unhealthily preoccupied or obsessed with others’ approval. Advocating a certain course of action is automatically deemed ‘judgemental’ or ‘blaming’ of those who don’t take that course of action and allegedly stigmatises those who do suffer from adverse health, regardless of whether or not they have engaged in risky behaviour.
The idea of a society when people can have as much sex as they like, with as many people as like, consequence free and that we can protect people from STDs might well be a beguiling one, but it is highly irresponsible. HPV vaccines, condoms, birth control and abortion all add to this masquerade, which is why people become so angry when their lifestyle is challenged. It’s easy to dismiss moral concerns as being based upon religious grounds but pointing out irrefutably scientifically established health risks raises things another notch. It must be disconcerting to learn that the prejudiced bigots are right, better to attack their motivation, values or character, instead of the issue itself.
The whole canard of HIV prevention in Africa was once again raised, with all evidence being dismissed as biased, simply because of the fact that it was presented by me and supported Catholic doctrine. As has been demonstrated, the Emeritus Pope was entirely correct when he pointed out that condom promotion exacerbated the problem of the spread of HIV. Condoms have a typical use failure rate of 18%, the spontaneous nature of sexual urgency makes laboratory conditions of perfect use, extremely difficult to replicate. Problems are exacerbated in countries such as Malawi, which as aid workers testify, are flooded with condoms nearing their expiry date and which have been stored and shipped in conditions making them more susceptible to damage. People are making risky decisions on the false premise that they are protected.
I guess I’m rather nonplussed, it’s bizarre to see coherent evidence denied simply because it supports your worldview. The ‘debate’ veered from accusations of making stuff up, of putting out irresponsible information on internet that would cause deaths, to an admission that I hadn’t actually said anything factually incorrect, but was cherry-picking the evidence to suit my own purposes. Isn’t that what most people do, come to a conclusion based on the evidence available?
Sexual health is not the only area in which emotions are inflamed when suggestions are made of an unhealthy lifestyle as being a contributory factor to certain conditions, and the age of moral relativism means that all are equal. Hence the perennial wars on baby websites about breast versus bottle. Health decisions, especially for children always involve heavy personal investment. I’ve taken decisions (such as miscarriage management) that may not have been advocated as the best course of action as others, but the difference is, I’m not going to get offended if someone suggests I should have done something else, in the same way, I couldn’t give two hoots if someone thinks my cesarian-sections were because I was too posh to push. I know a natural childbirth is ideal but just because life doesn’t always work out the way you’d hope, doesn’t mean that we shouldn’t aspire to the best.
Trying to discourage promiscuity, instead of relying upon the illusions and false promises of the pharmaceutical society, has to be a much more sustainable, long-term and ultimately cheaper solution. Pointing out that condoms don’t always work should not be an issue to cause such bad feeling. Why aren’t we asking why until the HPV jab was developed, that condom manufacturers and family planning officials were not widely publicising that they didn’t fully protect from HPV?
Evidently I’m still a naif, in that I’m still taken aback and surprised by the animus coming in my direction, for stating a medical fact. Stick to one sexual partner only (or remain celibate) if you want to seriously lessen your chances of contracting a sexually transmitted condition. It may not be the easiest, it may take willpower, but it’s no more impossible than say quitting smoking or cutting out the booze. You just have to want to do it. Stating the ideal does not blame the unlucky.
I may well get a t-shirt printed – Catholic teaching on sex corresponds with medical fact, get over it. What is more dangerous, giving an illusion of protection, or presenting the pure unadulterated facts as they stand?
While I should no longer be surprised, I still find myself taken aback nonetheless. Why are otherwise intelligent people so willfully blind when it comes to the consequences of sexual behaviour? Uncharitably, the only conclusion I can arrive at that is that it’s concrete proof that sin really does darken the intellect and make you stupid. People are too attached to a certain behaviour to want to admit that it could cause harm.