Population Matters-USA – working for a sustainable world

This is actually a picture of cauliflower from Wikipedia

Ruby Carroll was a new patient who told me that she hadn’t had a Pap smear for a long time. “I think that there might be something wrong because I bleed when my husband and I have sex.”

On examination, I had to agree that something was wrong. There was an area on her cervix that resembled cauliflower. Instead of doing a Pap, I said: “Ms. Carroll, I fear that you are correct. There an area on you cervix that looks abnormal. I’ll do some little biopsies for tissue to send to the lab to be certain what’s there, if that’s ok with you. The biopsies will pinch a bit, and you’ll have some bleeding after.”

The biopsies did show cancer, so I referred her to a gynecologic cancer specialist for further evaluation and treatment. Ms. Carroll told him she was going to a naturopath who said he could cure her without surgery. A couple of years later I read Ruby Carroll’s obituary in the newspaper.

We know that cervical cancer is caused by some bad strains of Human Papilloma Virus (HPV). There are many strains of HPV; each one has its favorite places to live in our bodies. For instance, warts on our hands are caused by certain strains but the strains causing plantar warts are different. Two of the common strains that cause cervical cancer are 16 and 18. Fortunately, there are vaccines available to combat these and thus prevent this terrible disease. One of the immunizations, Gardasil^®?9, adds coverage against 7 other, less virulent strains of HPV.

Cervical cancer takes years to develop, and its precursor goes through stages. The idea of Pap smears, and the more recent tests, is to find an abnormality in an early stage before it turns into cancer.

Women who have received HPV immunization as teenagers are much less likely to develop cervical cancer or its precursors. The immunization is not perfect, however, so it is still wise to get routine screening for cervical abnormalities.

Since some strains of HPV are a sexually transmitted, aren’t men also susceptible? Yes! Even though a man doesn’t have a cervix, there are other places where these cancer-causing viruses live. Cancer-fighting vaccines help protect men from anal, penile and some oropharyngeal cancers, so all teens should get immunized.

No medical treatment is entirely safe, but immunizations, as a whole, are amazingly safe. The FDA is responsible for collecting ongoing information about side effects of drugs, including immunizations. There has been a concern that Gardasil^®?9 causes ovaries of young women to fail. Premature Ovarian Insufficiency (POI), in which a woman goes through menopause before she is 40, is quite rare, but it happens. It was alarming when a few cases occurred after receiving Gardasil^®?9. However, analysis of large populations of young women has not shown an increased incidence of POI after this immunization.

HPV immunization is recommended in over 120 countries, but it is too expensive or unavailable for most people to get it in many of the poorest places. Unfortunately, there are other reasons why many susceptible people don’t get it in the USA, including denial (“my teen Riley is a good kid—they’ll never have sex until they’re married), lack of knowledge and misinformation.

Misinformation about immunizations has become rampant in the USA. The current epidemic of measles in unvaccinated people makes this obvious, with 3 deaths from measles so far this year. The incubation period for measles is less than 3 weeks, and infected people usually have symptoms, so it is fairly easy to diagnose and track measles. On the other hand, cervical infections with HPV can last years without causing symptoms until cancer is present—when it may be too late. Prevention is always best, and HPV vaccinations do just that.

©?Richard Grossman MD, 2026

Recently a right-wing group which advocates for more children, published a report with which I agree, mainly. However, they have forgotten to include one important factor in their calculations.

The report, by the Institute for Family Studies, is named: “The Demographic Dead End”. It’s subtitle is more revealing: “Without Action, American Population Will Decline”. I heard about the report by reading a New York Times Guest Essay: “The Population Bust Is Coming Sooner Than Anyone Is Prepared For”, which was written by one of the report’s authors, Lyman Stone. Dr. Stone is the director of the Pronatalism Initiative at the Institute for Family Studies.

Let me be fair. Stone has earned a doctorate in demography, while I have never had any formal study of either demography or economics.

Here are two of the surprising points from the report:

Although fertility in the USA has declined, people want more children, on the average, than they actually have. Total fertility is 1.6 children but studies show that we wish to have 2.4.
Apparently peer culture is a major factor in deciding the number of children to have. If your neighbor has a large family, then you are likely to follow suit. That influence is also true with celebrities; people tend to follow the lead of the celebrities they admire when planning their families.

In the section titled “How to Restore American Family Growth”, the report suggests several inducements to increase family size. These include:

Giving people lots of money for having children. They suggest bank accounts larger than the measly $1000 “Trump Accounts” that were passed in the “Big Beautiful Bill”. Similar to a Finnish plan, the report advocates for a bank account that would be funded at birth for each child born in the USA. The child would only be able to access some of that money when they had a child of their own. Moreover, it would take a family of 3 children before the parent could access all the money in the account. However, international experience has shown little effect of paying people to have children.
Crediting new parents with social security benefits when they stay home from work after the birth of a child. Although new parents in the USA do get leave after the birth of a child, it is usually short. The social security benefit in this proposed plan would be for 5 years.
Doing away with financial penalties for getting married. “Getting married should never cause anybody to lose a benefit,” to quote the report.
Building family-friendly housing. In addition, the report suggests ways to change society to be more family-friendly: “Encourage Supportive Friendship” and “Promote Real-Life Socializing”.

An alternative to these ways to make society more supportive of parenting, I suggest cohousing. Gail and I live in Heartwood Cohousing, an intentional community, with people of all ages. Those of us who are grandparents help the young parents with childcare on a routine basis. I commend this way of trying to rebuild the old-fashioned community where people live close physically and emotionally.

What is the factor left out of these calculations and others worrying about the decreasing birth rate? Humans do not exist in a vacuum, but we are dependent on a huge, complex ecosystem with amazing biodiversity. We are already causing the rapid extinction of species and using up our progeny’s resources. With even larger populations, there will be less left for posterity. “One Health” may help guide our future: it is a movement that looks at the complex relationship between deterioration of our environment, animals and global human health. All people looking at the future of human population must also consider our effects on the natural world.