Will Future Doctors Be Forced to Teach Abstinence?

In April, the Medical Institute for Sexual Health (MISH) made headlines after the federal government announced that the group would receive a $200,000 grant to establish a sexual health curriculum for medical students. Sexual health experts affiliated with the U.S. Centers for Disease Control and Prevention (CDC) were taken aback.

Why the outrage? Despite what its legitimate-sounding name might suggest, MISH is really nothing more than a thinly veiled ideological interest group that manipulates science to advance its mission.

The History of MISH

Dr. Joe McIlhaney, an evangelical ob/gyn, founded MISH in Texas in 1992. According to the organization's website, after "witnessing first-hand the full effects of the sexual revolution," McIlhaney was "moved to dedicate the next chapter of his life to the prevention of these problems rather than continuing to only treat the effects." With initial funding from James Leininger, a prominent San Antonio business executive who has been called the "sugar daddy" of the far-right in Texas, MISH was born.

MISH is best known for the abstinence-only materials it provides to youth organizations and educators that rely largely on scare tactics. The group states that "behavior choices for optimum health are sexual abstinence for unmarried individuals and faithfulness within marriage." Translation: abstinence is the only acceptable method for unmarried couples to prevent pregnancy and sexually transmitted infections (STIs).

MISH has come a long way since its founding in 1992. Today the group has offices in Austin, El Paso, and Washington, DC. It has also expanded internationally, distributing materials in more than 40 countries.

Despite its national record promoting abstinence-only programs, MISH has tried to distance itself from the phrase "abstinence-only," presumably because it connotes ideology, ineffectiveness, and medical inaccuracy for many in the scientific community. Representatives of MISH have argued that the group is not a religious or biased one, but rather a "medical educational organization." The group's many critics disagree.

In 1995, the Texas Department of Health sent a letter to MISH criticizing a slide show that McIlhaney had been showing throughout the state. The letter included a detailed critique of the slides by two doctors, a registered nurse, and the director of the state's HIV/STI epidemiology division. "Some of the data presented suffers from investigator bias," the letter stated. "Dr. McIlhaney's presentation tended to report the outlier data [data that is markedly different from other values in a data set] as 'proof' that condoms don't work rather than present those reports in the context of the entire data set. The only data that was reported in the presentation are those which supported his bias on the topics he addressed. Intellectual honesty demands that he present all the data."

Friends in High Places

Despite the widespread criticism, MISH has grown to become a well-connected organization. The group has had close ties with President George W. Bush since his early days as governor of Texas. Bush has spoken at numerous events sponsored by MISH, and in 1999, MISH worked with then-Governor Bush's administration to produce the Right Choices for Youth abstinence conference. Bush and McIlhaney have been close politically and personally for many years, and many speculate that their close relationship is largely responsible for Bush's promotion of abstinence-only programs as president.

In December 2001, President Bush appointed McIlhaney to the Presidential Advisory Council on HIV/AIDS (PACHA). The Union of Concerned Scientists criticized the appointment in a 2004 report, characterizing it as "another high-profile appointment of a scientist with questionable credentials." Specifically, the group referred to McIlhaney's "published disdain for the use of condoms to prevent the spread of HIV and other sexually transmitted diseases and his continued advocacy of abstinence-only programs despite negligible evidence that they actually reduce pregnancy rates among young people."

McIlhaney's elevation in government ranks continued: in February 2003, he was appointed to the Advisory Committee to the director of the CDC, where he "advises the CDC Director on policy issues and broad strategies for promoting health and quality of life." And according to the MISH website, McIlhaney "meets regularly in Washington with Ambassador Randall Tobias, President Bush's appointee who heads the $15 billion Global AIDS Initiative, to discuss the medical issues surrounding AIDS policy nationally and internationally."

MISH's political power is not limited to McIlhaney. The group's National Advisory Board is comprised of a who's who of the abstinence-only crowd. Board members include Elayne Bennett, president and founder of the Best Friends Foundation, an abstinence-only group; Thomas Lickona, director of the abstinence-promoting Center for the Fourth and Fifth Rs; and Dr. Patricia Sulak, director of the Worth the Wait abstinence program.

Another prominent member of MISH's National Advisory Board is Dr. W. David Hager, author of As Jesus Cared for Women and Stress and Women's Body, which "recommends particular scripture readings as a treatment for premenstrual syndrome." Bush appointed Hager to the Advisory Committee for Reproductive Health Drugs in the U.S. Food and Drug Administration (FDA) in 2002, a position that allowed Hager to play a significant role in the FDA's continued delay in the decision to grant over-the-counter status for Plan B emergency contraception (EC).

MISH's relationship with the Bush administration has also paid off financially. The group has received more than $1.5 million in federal funding and has government contracts with the CDC, the Maternal Child Health Bureau, and the Texas Department of Health. In addition, high-profile members of the Bush administration regularly attend and present at MISH's annual conferences.

MISH also has close allies in Congress. In 2000, the group worked with Rep. Tom Coburn (R-OK) to convince the National Institute of Health (NIH) to hold a conference to examine the scientific research on condom effectiveness. The NIH invited MISH to participate in the conference.

The resulting NIH report confirmed that condoms were effective in preventing HIV and gonorrhea, but concluded that there wasn't enough evidence regarding the effectiveness of condoms in preventing the infection HPV. MISH latched on to the latter finding, and like many other abstinence-only organizations, used the dangers of HPV to advance its anti-condom agenda. A recent study published in the New England Journal of Medicine found that consistent condom usage significantly reduces the risk of HPV transmission, providing the evidence the NIH had been looking for.

As for the announcement about MISH's new $200,000 grant - according to a profile in Slate, the CDC hadn't posted any requests for proposals in determining the recipient of the grant, and there had been no competitive bidding process. Dr. Hager has been appointed to lead the project and has already selected a panel to write the sex education curriculum. It remains to be seen what the curriculum will entail, but all logic points to the probability that it will teach a dangerous abstinence-only message to a generation of future doctors.