Three weeks ago, David Hager treated a 17-year-old girl suffering from sores caused by an incurable sexually transmitted disease (STD). "She was shattered when I explained to her that she had contracted a disease from this person who told her that she was the only person he had sex with. Her response was, 'Well, we used condoms most of the time.'"
At his Women's Care Center in Lexington, Ky., Dr. Hager says he treats hundreds of women who demonstrate similar confusion about how condoms work. Problem is, the government seems just as befuddled.
After years of promoting condoms as the key to risk-free promiscuity, government health agencies now admit that they really don't know how much protection condoms offer. The confession came in the form of the "Scientific Evidence on Condom Effectiveness" report released on July 20 by the U.S. Department of Health and Human Services.
Last June, the health department's National Institutes of Health (NIH) invited 28 researchers, including Dr. Hager and four government health officials, to determine the effectiveness of condoms. After reviewing more than 140 studies, they concluded that condoms do not offer 100 percent protection against any disease.
Although condoms significantly reduce the risk of AIDS and protect men (but not women) against gonorrhea, no evidence exists that they protect against the nation's most common sexually transmitted diseases, including the human papilloma virus (HPV). Infecting more than 5 million Americans a year, HPV annually causes cervical cancer in some 15,000 women-5,000 of whom die. That's more women than die of AIDS each year.
But NIH did not publicize the findings. After panelists submitted their conclusions to the NIH in June 2000, government health agencies refused to publish them despite repeated requests from the Physicians Consortium, representing some 2,000 physicians concerned about the inaccuracies of "safe-sex" education.
After waiting seven months for the report's release, the Consortium filed three Freedom of Information Act requests with both the NIH and the U.S. Food and Drug Administration. Neither agency responded. Only after members of a congressional committee threatened to subpoena the information did the NIH finally release the report last month-13 months after its completion.
Why the delay? Federal officials declined to comment, but Oklahoma physician Tom Coburn, a former congressman whose legislation funded the condom-effectiveness study, said politics played a big role: "We are fighting a tremendous psychological mindset that views any attempt to limit sexual freedom as an attack against the homosexual community. But this whole message that you can have sex with multiple partners without consequences is a bold-face lie."
While noting that "tremendous strides were accomplished in getting this paper released," Dr. Hager confirmed "that some people from the CDC were quite concerned about which direction this report was going."
That concern manifested itself in closed-door battles over what should be included in the final report. For instance, government health officials opposed the inclusion of studies showing that multiple sex acts significantly increase the risk of contracting STDs-regardless of how consistently condoms are used. "While a condom may help you during one act of sex, if you have repeated acts of sex with the same infected partner your chances of infection go up each time. That was not included, unfortunately," said Tom Fitch, a San Antonio physician who also served on the panel.
Little wonder those studies were ignored, considering that government-endorsed, safe-sex programs cite increased condom use as their main proof of success-as if that eliminates risk. More surprising were efforts by some panelists, despite murky evidence, to conclude that condoms "prevent" risk. "When I use the word prevent, I mean 100 percent. In medicine we don't normally tell patients something works unless we know for sure that it does," said Dr. Fitch. In the end, the facts prevailed and the final report concluded that condoms only "reduce risk."
After the report's revelations, both Dr. Coburn and the Physician Consortium have called upon CDC head Jeffrey Koplan to resign for failing to educate the public. "The CDC has forgotten that it is charged with disease control and 'prevention,'" said Dr. Coburn.
CDC officials declined to comment. Instead, they faxed a statement rehashing their party line that "condoms, when used correctly and consistently, are highly effective in protecting against HIV and can reduce the risk of other sexually transmitted diseases." But so far, condoms have only worked "consistently and correctly" in the laboratory. And as Kentucky physician Dr. Hager discovered, real life differs dramatically from the lab: "It's one thing to see how an STD organism reproduces in the lab; It's another to see how it destroys young people's lives and, well, you just don't get over seeing that."