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09/25/2012

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Tony Francis

"There is no such thing as safe sex. Never was. Never will be."

Norman Mailer

A Canadian observer

It's just irresponsible for you to make a causal link between sex education in general and this specific case in particular. Teaching sex education to young people leads to a variety of outcomes, some you might agree with and others not. To suggest that this is a reason to not have sex education in public schools at all is really an overreaction, a moralistic exasperation, that I hope you Americans can really begin to eliminate from your public discourse.

Wade Kartchner, MD, MPH

Perhaps I have been less than artful in my explanation of this issue. Public health is at its core a preventative specialty. As many know, prevention can be of a primary, secondary, or tertiary nature. In most areas of medicine, primary measures of prevention are lauded as the most beneficial, and tertiary measures are considered a failure in a population context. As a simple example, hypertension and its complications can prevented in a primary fashion by proper diet and exercise, in a secondary way through medications, and finally, the complications of hypertension, such as heart disease, can be treated in a tertiary manner through more invasive means such as surgery. Traumatic brain injury due to firearms is another example. Tertiary means of prevention such as treatment of brain injury by the neurosurgical crowd is certainly not the ideal. Secondary prevention such as gun safety education is not considered adequate by some segments of the population. The true primary preventative intervention would be to ban guns altogether, and, again, certain voices in and out of medicine propose that as well.

Why should prevention of teenage pregnancy be any different? Would it not be better to facilitate a primary prevention model for the problem? Because it doesn’t work? The same thing could be said for the obesity problem, yet millions of dollars are spent in figuring out how to provide the health education necessary to convince millions of us to adjust our diets and eating habits, clearly a primary prevention model. If the current model of primary prevention of teenage pregnancy is ineffective, then it would seem that there should be a push to find a model of primary intervention that does work and not be satisfied with secondary and tertiary results. Our profession doesn’t accept this in most other areas of medicine.

The point is, this continuum of preventative measures is found all throughout medicine, and in my opinion, the New York City school system’s move to provide Plan B is an example of secondary or even tertiary prevention, and could be construed as a failure in the public health context as outlined above.

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