Published: 7th February 2011
Between 24 January and 7 February, NICE ran an online consultation for stakeholders on reviewing the official 50-page 2007 guidance, a comprehensive and in itself well-written review in the formal language of epidemiology of the evidence base for the detailed 2007 advice.
The guidance was due for routine review, and the consultation was an opportunity for stakeholders to comment on the 5-page Draft Review Proposal. That Review simply concluded: Overall the experts agreed that: there was no new evidence that would require changes to the current guidance. However further evidence was due to be available in the near future and allow updating of the guidance at a later stage.
They recommended: The guidance should not be updated at this time. The guidance will be reviewed again according to current processes.
The online submission from CMF reads:
Christian Medical Fellowship upholds God's plan for human sexual expression, that it be within the context of a publicly recognised, exclusive, lifelong, heterosexual and committed relationship – marriage.
Were this followed totally in a population, there would be no STIs or unintended under-18 conceptions.
There is no evidence (of NICE quality) that not being sexually active has any adverse health consequences.
However, our 4,000 doctor members of course recognise the reality described in the 2007 guidance of 'early onset of sexual activity' and 'unprotected sex and frequent change of and/or multiple sexual partners'.
The STI situation has worsened with latest figures showing 482,696 new cases in the year to August 2010, a 3% increase over 2008. Current policies are not working.
A recent example of a policy's unintended consequences is the report, to be published in the Journal of Health Economics and trailed in the Sunday Times on 30 January, that handing out emergency contraception (the morning-after pill) in pharmacies to under-16s has increased STI rates.
We note that the 2007 guidance concentrates almost exclusively on secondary one-to-one interventions with individuals in groups already exhibiting at-risk behaviour.
We urge that far more emphasis be given to primary prevention strategies – empowering individuals to delay first intercourse and to avoid 'unprotected sex and frequent change of and/or multiple sexual partners'.
There is new evidence proving that social factors encouraging virginity and delaying first intercourse do show health benefit (the RAND Corporation study – Journal of Adolescent Health 2008; 43, 4, October: 341-348, and the Rosenbaum study analysed comprehensively and carefully – Pediatrics 2009; 123 No 1 January: e110-e120. doi:10.1542/peds.2008-0407)
We note the current uncertainty about future structures for government action in this area. Our strong recommendation for a greater emphasis on primary prevention, with a clear message about delaying first intercourse, may well be more the responsibility of education authorities, but without criticising any of the 2007 secondary intervention detail, we conclude that the guidance needs revising now.
We enthusiastically endorse the 'need for broader strategic guidance on what constitutes an effective and cost effective population based sexual health programme with associated quality standards' but this broad strategy must include emphasis on primary behavioural change – delaying first intercourse.
Given the current relentless media encouragement for more people to be more sexually active more often, this will be difficult.
We disagree. For the reasons above, the guidance should be amended now.
Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 4,000 British doctor members in all branches of medicine. A registered charity, it is linked to about 65 similar bodies in other countries throughout the world.
CMF exists to unite Christian doctors to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.