A new Kaiser Permanente study shows that HIV infection adds dramatically to the risk of getting cancer (in addition to AIDS). From the San Francisco Chronicle story:
People with HIV infections have a higher risk of developing certain cancers than those who aren’t infected, and the sicker they are, the greater their risk, according to a large study of Kaiser Permanente members. The study, results of which were published Tuesday, provides further evidence of the possible benefits of treating HIV-positive patients with antiretroviral therapy soon after they’re diagnosed – while they’re still symptom-free and before the virus has a chance to dramatically weaken their immune systems, HIV/AIDS experts said.
I am all for quicker treatment. But I want to take a different angle to this story. Before I get into that, let’s look at a few more details:
The Kaiser study is among the first, and largest, to compare cancer rates between HIV-positive individuals and people who aren’t infected but are similar demographically. The study looked at 20,000 HIV-positive Kaiser members in California and compared them with 215,000 members who were not infected. HIV-positive patients had higher rates of Kaposi’s sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, melanoma, and anal and liver cancer. Neither smoking nor drinking appeared to be a factor in any of those cancers other than liver.
Their risk was increased as much as 200 times in the case of Kaposi’s sarcoma, a rare cancer that is highly associated with HIV and AIDS. Other cancers ranged from a 40 percent increased risk for liver cancer and a 55-fold increase for anal cancer. For reasons that doctors don’t yet understand, the risk of developing prostate cancer is slightly reduced with HIV infection. HIV-positive patients who smoke or drink too much alcohol have a slightly increased risk of developing lung or liver cancer compared with uninfected people who are smokers and drinkers.
Now, let’s approach this from a different direction than usual with regard to stories describing the health consequences of sexual behavior. (Yes, I know HIV can also be spread with non sexually.) If our job as a society is to prevent risk and stop disease–both for humane and health care cost control reasons–why shouldn’t promiscuity be treated with the same cultural disdain and public health preventative campaigns as smoking? (Remember the old ad, warning that when you sleep with someone, you are also sleeping with everyone they have ever slept with? You don’t see that anymore.)
Clearly, promiscuity falls into the same dengerous personal behavior category as smoking. So, why do we not see concerted and unequivocal anti-promiscuity campaigns, like we do anti-smoking campaigns? Why do we not tax products, such as pornography, that promote promiscuity? Why not have warning labels on articles in Playboy and Cosmopolitan warning that promiscuous behavior can cause genital warts or gonorrhea? I mean, if Herman Cain got in trouble because an Internet campaign ad showed a man smoking, why not exhibit the same opprobrium when popular culture extols the fun of sleeping with someone they just met?
I would like to see a study computing how much promiscuity adds to the cost of health care in the USA. It has to be huge, what with unwanted pregnancies, abortion, STDs, herpes, HIV, depression, uterine cancer, etc., beyond etc. I have my doubts whether grants would be available for such a computation because some will think it smacks of moralism. but that isn’t the point. Besides, the information learned could demonstrate a public health need to reverse the growing licentiousness of our cultural flow, and there’s money in them thar hills!
But I think it is a fact worth learning and disseminating. Promiscuous behavior can be as dangerous as smoking and at double time.
November 23rd, 2011 | 12:28 pm
Amen
November 23rd, 2011 | 3:59 pm
1. $8 Billion a year in ~1995 dollars, not including HIV (I’m skeptical of that number due to under-reporting, but anyways). That price was up to $15 billion 10 years later.
2. In ~1995 dollars, smoking cost the US $80 billion. That rose to $170 billion 10 years later.
http://www.cdc.gov/std/stats03/trends2003.htm
Check with the Guttmacher Institute
Also,
http://books.google.com/books/about/The_hidden_epidemic.html?id=V9PdfOUJaJ4C
It is of no surprise, generally speaking, that the highest rates for STDs can be found in lesser educated, more religious, and more conservative segments of the country.
Data and evidence can be found here:
http://www.cdc.gov/std/stats10/surv2010.pdf
November 23rd, 2011 | 4:07 pm
Interesting, if one were to perform a regression holding for the assumed decrease in smoking prevalence, the cost may not match the usage decline (ie, the cost is greater)
Further, it may be safe to assume that sexual contact has at least remained constant (perhaps a slight decline as the population in general ages).
Therefore, if one ran a similar regression, they would find that costs to society for STDs are DECREASING compared to smoking with these seemingly valid assumptions*.
Until this conjecture is dis-proven, there is no reason for conservatives to rant about STDs and promiscuity.
Do some homework and scholarship first.
*(of course some day there may be so few smokers that the cost is negligible, while people will always have sex – whether we like or not)
Kathleen Lundquist Reply:
November 23rd, 2011 at 5:01 pm
@David,
“Further, it may be safe to assume that sexual contact has at least remained constant (perhaps a slight decline as the population in general ages).” (emphasis mine, of course)
Really? Don’t you think you could drive a truck through this size of “IF” in your calculations?
David Reply:
November 23rd, 2011 at 11:05 pm
@Kathleen Lundquist, for starters, there is no calculation there. I see no equation.
You definitely did not understand, so I shall try again.
Over a 10 year span the cost from smoking doubled. Over the same time, the cost of STDs doubled as well. Presumably, the # of smokers has declined as a % of the population – probably just slightly, though. At the very least, the very least, I would bet sexual contact has at least remained constant, if not increased a little.
Conjecture the following: smoking goes down, yet its costs double; sex goes up, and its costs only double as well.
It would be very interesting to see if this is true.
If so, would this change right-wing prude’s view of sexuality? Instead of ranting, the morality police should do some quality research and thoughtful analysis.
See, it’s not difficult.
November 23rd, 2011 | 5:36 pm
David, if and when I’m persuaded that the scientific consensus psycho-social detriments of sexual promiscuity are less than the benefits, I’ll change my position. For me, this has nothing to do moral absolutes or conservative ideologies — I’m neither an absolutist nor a conservative.
David Reply:
November 23rd, 2011 at 11:12 pm
@Lincoln Cannon, great; be whomever you wish. More power to you. Take any position you wish. But, why the heck are you telling me? I couldn’t care less.
I care about data and evidence. Do you have any of that?
November 23rd, 2011 | 6:01 pm
So…..do you have an actual point, or is this just more of your signature baseless verbal diarrhea?
Wesley J. Smith Reply:
November 23rd, 2011 at 6:17 pm
Yes. Promiscuity is like smoking. It is dangerous to one’s health. Not that tough to figure out. Nice crudity, by the way.
David Reply:
November 23rd, 2011 at 10:54 pm
@Wesley J. Smith, except I just sourced some data demonstrating smoking is far costlier than STDs. (don’t get me wrong, I’m all for more expansive sex ed that accurately explains the risks, and I’m all for taxing sex toys, porno, and STD diagnoses)
But, sex has a long, long ways to go before it costs as much as smoking.
I’m not even sure how one defines promiscuity.
Wesley J. Smith Reply:
November 23rd, 2011 at 11:26 pm
Not just STDs. Uterine cancer. AIDS. Abortion. Unwanted pregnancies. Mental health issues. And then there are the non medical costs. promiscuity is a huge expense item. Whether that equals tobacco isn’t the point.
David Reply:
November 24th, 2011 at 1:32 pm
@Wesley J. Smith, I definitely agree. I would love to see more of a public health push for better sexual health. Billboards, classes in schools, ad campaigns, etc I’m all for it.
HistoryWriter Reply:
November 27th, 2011 at 4:56 pm
@Wesley J. Smith,
Bad breath?
November 24th, 2011 | 12:25 am
David, I’m telling you because you mistakenly attributed this issue to conservatives. As it turns out, it’s not just the conservatives. As for data, use Google. I’m not going to do the work for you today.
David Reply:
November 24th, 2011 at 1:38 pm
@Lincoln Cannon, you mean like all the abstinence only education programs that are pushed by liberals? Or, are you referring to the expansive condom distribution programs run by conservatives? Oh, I know, you are referring to all the family planning programs set up by conservatives.
Come on, clue in.
So, I guess you don’t have any data or evidence for your position.
Lincoln Cannon Reply:
November 24th, 2011 at 6:41 pm
@David, everything you referenced is evidence that this is not just a conservative issue. Liberals wouldn’t bother if they didn’t recognize problems with promiscuity. Additionally, you wouldn’t be arguing with me if this were merely a conservative issue.
November 24th, 2011 | 3:37 am
I certainly agree with you, Wesley that, without a doubt, sexual promiscuity is to be avoided, because of the problems that can arise. But I think that the analogy that you’re trying to make, between it and smoking fails.
Smoking, done long enough, inexorably leads to a plethora of health problems. Sexual promiscuity, while very risky, does not necessarily lead to these problems. the fact that sexual promiscuity is so risky, would compel any reasonable person to avoid it, but we don’t need to come up with what I consider false analogies, between it, and things that unquestionably will result in major health problems, such as smoking, unless one quits, and even then, the health problems may arise.
With respect to sexual promiscuity, if one scrupulously sees one’s doctor, after every sexual encounter, and one uses a condom with each encounter, with the exception of acquiring at least one strain of the human pappiloma (HPV)virus, which is transmitted by mere skin to skin contact, and is hard to avoid, one is going to be diagnosed by one’s doctor, and given treatment for any STD that may have arisen. Most STD’s are treatable, HPV cannot be cured, but if one sees one’s doctor regularly, one can have any ominous lesions, that may turn into cancer removed.
Of course, HIV is uncurable, and is deadly. But this virus is fragile, and hard to catch. If one uses a condom every time, it’s unlikely one will catch it.
I’m not a doctor, so anyone reading please talk with your doctor about these things.
My point is NOT that sexual promiscuity is acceptable. It’s certainly not. My point is, that the analogy between it and smoking is a false one.
Smoking, as long as one continues doing it, will result is severe disability and death. And, although it’s very difficult on a pragmatic level, for promiscuous people to see their doctor, after every sexual encounter, it’s theoretically possible. No such theoretical possibilty exists with smoking.
Why not just say, what no reasonable person disutes, that sexual promiscuity is risky and to be avoided? Why over play one’s hand with analogies that cannot be rationally maintained?
November 24th, 2011 | 3:57 am
I would like to revise something I said. I read it, and it sounded very unclear. If one continues to smoke, one can, obviously, see one’s doctor regularly, and should. But unless one quits smoking, the doctor cannot cure the person of the diseases that arise. With respect to sexual promiscuity, one could, theoretically, see a doctor after each sexual encounter, and if one postulates that one also uses condoms, with the exception of herpes, HPV, hepatitis B (which all people should be vaccinated against), one could be cured of any problems that arise. HIV, as sttaed, is deadly, but hard to catch, if condoms are used. (everyone should talk with her doctor to get all details, since I may be leaving something out, here.
Of course, this would be expensive, but theoretically possible.
On a pragmatic level, Wesley, I full agree with you, that both smoking and sexual promiscuity are to be avoided. I have never smoked, and I’m not sexually promiscuous. But since we deal with ideas, I think on a conceptual level, the two just aren’t analogous.
Consider drinking. I don’t drink, either. But some people try to argue that drinking is as bad as smoking. One cannot properly analogize these either. Smoking is much, much, worse.
I would agree with you that everyone should be warned that sexual promiscuity is bad. It would take a highly unusual, and dedicated person, who is sexually promiscuous, to see one’s doctor after every sexual experience, and to always use condoms, and if they had this obsessive concern, they may be unlikely to be the type of person who’s sexually promiscuous anyway. (to anyone reading this who is sexually promiscuous, and thinks that, because they don’t have signs or symptoms of an STD, they don’t need to see his doctor, wrong. Most STD’s don’t manifest signs or symptoms).
So let’s have warnings against sexual promiscuity, since it often can lead to terrible problems, but let’s not argue that it’s as bad as smoking. No one should infer from this that sexual promiscuity is benign, not at all; just not as harmful as smoking.
Wesley J. Smith Reply:
November 24th, 2011 at 11:09 am
Actually, given the life discords it causes, promiscuity could very well be worse than smoking. But I said “like” smoking, e.g. it is an unhealthful activity that causes terrible illnesses and costs the society a tremendous amount of medical and other resources. If the purpose of government is to protect us from our own bad habits and behaviors, promiscuity should be treated similarly to smoking. But we don’t because there are tremendous forces making a lot of money and cultural advancements by pushing promiscuity. How is Playboy and Cosmo or porn any different in this regard than a tobacco company? Indeed, how are some of our television shows any different?
HistoryWriter Reply:
November 27th, 2011 at 4:58 pm
@Wesley J. Smith,
Life discords? What life discords?
Bret Lythgoe Reply:
November 25th, 2011 at 3:12 am
@Bret Lythgoe, I guess my previous comments didn’t go through. I’ll reiterate my main points, without all the details.
If we had a person hypothetically argue that, he could smoke, but by regularly seeing his doctor, he could smoke and be healthy, we would have to cure him of his fallacy. The evidence is clear: smoking is harmful to one’s health, in any form, period.
Fatty foods are also harmful to one’s health, perhaps warning lables are needed here, as well.
November 24th, 2011 | 5:14 pm
Tobacco smoking is a practice currently sustained mainly by the actions of companies which make money off people’s addictions. If no further smoking adverts were produced it is reasonable to assume that, given what we now know about the health risks of smoking, the practice would die a natural death. “Promiscuity”, on the other hand, has been with us from the dawn of time and will persist even if Playboy, Glee and all such ephemera were to vanish from our collective consciousness. The desire to engage in sexual intercourse with willing partners is one against which the gods themselves contend in vain. The societal challenge is to ensure that people engage in these activities responsibly.
The “costs of promiscuity” you list are, strictly speaking, costs of engaging in irresponsible sexual behaviour (and not of having multiple sexual partners per se). The United States has higher rates of teen pregnancy, abortion and HIV infection than most countries in Western Europe not because Americans are more “promiscuous” than their German or French counterparts but because they are less likely to use contraception or be properly informed about sexual health. The highest rates of HIV prevalence are to be found in the countries of sub-Saharan Africa, in nations in which one is unlikely to find much sex on public television or much naked flesh on billboards.
We all agree that encouraging responsible sexual behaviour ought to be an essential part of any nation’s public health policy. But there is such a thing as responsibly having sex with more than one partner. There is such a thing as drinking responsibly. There is no comparable approach to smoking – it is not an activity which, in moderation, may be part of a healthy lifestyle. You are right that we do not have a financial estimate of the costs of “promiscuity” to society. (We do not even have definition of “promiscuity” clear enough to make such an evaluation possible). We do know, however, that smoking is the largest cause of preventable deaths in the US (sending almost half a million people to early graves) and that between 2000-2004 it is estimated to have been responsible for about $193 billion dollars in annual health related losses in the United States [1][2]. It is understandable that many are far from amused by its gratuitous promotion in a presidential campaign ad.
Bret Lythgoe Reply:
November 25th, 2011 at 3:07 am
@Raven Chukwu, excellently written. I think that it’s accurate to say that, you are to the written word what Monet is to painting and Beethoven is to music, and that’s not heperbolic.
Clearly sexual responsible behavior is one thing we all can agree on.
your point concerning the ads for smoking is good. Perhaps a ban on all smoking ads would be advisable, we’ve already started down this road, correctly, in banning (at least in the U.S.) TV ads for smoking.
Raven Chukwu Reply:
November 25th, 2011 at 11:20 pm
@Bret Lythgoe, If only I deserved such high praise! Unfortunately, I happen to be the sort of guy who begins five successive sentences with the word “the” and peppers his posts with repetitive parentheticals and stock phrases. I doubt that there are any Monet paintings or Beethoven symphonies in which such slipshod workmanship is clearly evident :)
I do feel, however, that a ban on all advertising of tobacco products would be advisable. When one thinks about it, one realises how unacceptable the current situation is: Companies spend billions of dollars encouraging people to deliberately inhale known carcinogens and the rest of us are presumably supposed to sit back and shrug. Smokers expose others around them to toxins – not only via secondhand smoke (a term which ought to be familiar to all readers of this blog) but also through the pernicious effects of third-hand smoke, toxins which linger in the smoker’s hair, clothes and surroundings even if the initial cigarette was consumed discreetly. The surprising thing really is that people aren’t more outraged by smoking (and the antics of tobacco companies) than they currently are.
Bret Lythgoe Reply:
November 26th, 2011 at 2:23 am
@Raven Chukwu, I think that you’re being too modest. There’s no doubt that you’re an excellent writer, and have made great contributions here.
I agree completely that smoking ads should be banned. Although here in the US the laws concerning when one can smoke are left up to the states (provided that it’s at least eighteen), many young teenagers are highly influenced by smoking ads, and often smoke long before the law allows them to do so. This is an absolutely unconscionable situation. I may be incorrect, but I think that statistics reflect that, most smokers start smoking in their early teens; very few start when they’re adults. We also, in addition to banning ads for tobacco, stop the selling of tobacco products to those underage, and also thwart the other ways that they’re gaining access to tobacco products.
November 24th, 2011 | 9:47 pm
All points are moot. Tobacco use and sexual promiscuity are both legal activities. If a person chooses to engage in one or the other or both, that is their choice. Denying people their rights to choose what they do with their lives is fascism. The purpose of the government is protect us from foreign and domestic threats, not attempt to protect us from ourselves by making personal decisions for us. Whether one drinks, smokes, or is promiscuous is no one’s business except that person.
Bret Lythgoe Reply:
November 25th, 2011 at 3:19 am
@Mojo, I agree with you, that they’re legal, and should stay that way. But it’s essential that we get the facts, on their potential harm, and gently discourage people from engaging in harmful activities, whether these are smoking, drinking, promiscuous sex, drug use, too little exercise, etc.
Wesley can certainly speak for himself, obviously (and does a great job articulating his positions) but I think he, as a conservative, wants the government not to be involved very much in banning or warning us of the dangers, of say, smoking. But IF the government is going to have warning lables against smoking, they should be consistent and have warnings against sexual promiscuity.
K-Man Reply:
November 26th, 2011 at 11:20 am
@Mojo, you said, “Tobacco use and sexual promiscuity are both legal activities.” Not necessarily true concerning “sexual promiscuity”! Prostitution is legal in the US only in Nevada, and numerous US states still have laws (unenforceable given the present judicial climate) against sex outside of wedlock, adultery, sodomy (= homosexual activity), etc. In theory in some states, only the missionary position with one’s spouse constitutes “legal” sex.
No one really wants to see the nanny/ninny state begin to enforce such laws again. But it’s apparent that the law has historically recognized the grave potential harm promiscuity and sexual irresponsibility can bring.
Wesley’s point is that it’s silly to target primarily smokers and the obese when the present do-your-own-thing-sexually culture—much of it advocated and practiced by the same crowd that targets the other two groups—is just as bad and expensive, if not worse. Wait till the government under Obamacare realizes this and begins nosing into your personal relationships and sexual activities to save the system money and resources. That should make a lot of skinny nonsmokers tremble.
HistoryWriter Reply:
November 27th, 2011 at 5:03 pm
@K-Man,
Sodomy is no longer against the law (Lawrence v. Texas). Bestiality still is. Prostitution is illegal in most American jurisdictions, but promiscuity isn’t the same thing as prostitution unless money changes hands. I strongly doubt that any law against promiscuous sexual behavior (other than with a minor) will stand constitutional muster.
HW
K-Man Reply:
November 28th, 2011 at 5:09 pm
@HistoryWriter, you are correct about the present state of the law, as Lawrence v. Texas (2003) directly overturned another Supremes decision in Bowers v. Hardwick, 478 U.S. 186 (1986), that had upheld a Georgia sodomy statute. The point is that the judiciary can and will blow hot and cold on the constitutionality of laws regulating sexual behavior, and all it would take is a different set of justices sometime down the road.
The state laws declared unconstitutional (for now) don’t necessarily simply disappear. In some states they technically remain on the books—waiting to return to full effect and enforcement if a future court changes its collective mind.
And that is the risk under Obamacare or other such government health care schemes: sooner or later, as Wesley warns, the bureaucrats will look at the risks and costs of licentiousness and then will seek to monitor and control everyone’s sexual behavior, especially whatever they define as “promiscuity”. Then court rulings will miraculously change to suit the new atmosphere.
In other fields this has happened before. It can certainly happen again. Look at how Supreme Court rulings changed to favor FDR’s New Deal provisions after numerous rulings against many of them at first. Now watch for a future Supreme Court one day with Obamacare or single payer to say that, whoops, its ruling in Lawrence was wrong after all and states can regulate private sexual behavior between consenting adults…
HistoryWriter Reply:
November 28th, 2011 at 9:48 pm
@K-Man,
Interesting thought, but the doctrine of stare decisis is supposed to be observed by the Court, and prior decisions are rarely overturned unless there is a compelling necessity — such as Plessy v. Ferguson being overturned by Brown v. Board of Education of Topeka, KS.
Wesley J. Smith Reply:
November 28th, 2011 at 9:50 pm
HW: I never took you, of all people, for an idealist.
November 25th, 2011 | 8:30 am
I care about data and evidence. Do you have any of that?
Your data and evidence gave me a good chuckle.
You doesn’t prove promiscuity is in any way safer than smoking, but you did a great job proving that people will make themselves into nonsense to defend their vices.
BTW: If you’d really like to shift the discussion to dollar amounts, rather than actual health risk, please include all the costs of promiscuity. Thanks.
November 27th, 2011 | 11:14 pm
“why shouldn’t promiscuity be treated with the same cultural disdain and public health preventative campaigns as smoking?”
Because there’s no scientific study that links the number of one’s sexual partners with bad health. It’s nothing more than your opinion. And what can be asserted without evidence can be dismissed without evidence.
Wesley J. Smith Reply:
November 27th, 2011 at 11:28 pm
You have got to be kidding. I did a quick Google search. This was first up: http://www.ncbi.nlm.nih.gov/pubmed/10551663
HistoryWriter Reply:
November 28th, 2011 at 9:51 pm
@Wesley J. Smith,
The figures are interesting, but (a) they dealt with high school students, and (b) “safe sex” practices can be employed to reduce the odds.
HW
Wesley J. Smith Reply:
November 28th, 2011 at 10:51 pm
Do you miss points on purpose? The point was that there are studies showing the health harms risked by promiscuity.
December 1st, 2011 | 12:44 pm
[...] “Promiscuity is Like Smoking,” Wesley J. Smith, Secondhand Smoke [...]
December 3rd, 2011 | 9:05 am
[...] Continue… 0 [...]
December 7th, 2011 | 1:56 am
Wow. Quite a bit of talk defending promiscuity! From what I can see, the sexual revolution has brought great harm to many, many people. They are unstable, over 40, and all alone. There is widespread depression. They are so *&&** up that they can’t hold a stable relationship. I am surprised some people here don’t see it.
December 8th, 2011 | 9:42 am
[...] Promiscuity is Like Smoking Neither smoking nor drinking appeared to be a factor in any of those cancers other than liver. Their risk was increased as much as 200 times in the case of Kaposi's sarcoma, a rare cancer that is highly associated with HIV and AIDS. … Read more on First Things (blog) [...]
December 19th, 2011 | 6:37 am
[...] Latest Lymph Cancer Symptoms Hodgkin’s Disease News by admin on December 19, 2011 Promiscuity is Like Smoking HIV-positive patients had higher rates of Kaposi's sarcoma, non-Hodgkin's lymphoma, Hodgkin's lymphoma, melanoma, and anal and liver cancer. Neither smoking nor drinking appeared to be a factor in any of those cancers other than liver. … Read more on First Things (blog) [...]
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