Public Health – Population Matters-USA

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

I attended an international family planning meeting in Santo Domingo, the Dominican Republic, in 1984. At that time we were living just a short plane ride away in Puerto Rico.

The meeting was full of people from different countries speaking different languages and was an excellent opportunity to make connections in the family planning world. One person was outstanding.

I was chatting with someone one afternoon and mentioned that I was tired and was headed back to our hotel to take a nap. “You should stay and listen to the next speaker, Malcolm Potts. He is amazing, mixing a lot of knowledge with a bunch of British humor”.

I took their advice, and was not disappointed. Dr. Potts was a world leader in family planning. He died this spring at age 90.

Potts was an innovator. He helped to start the first clinic in Cambridge, England, that offered birth control to young people. He was also the first director of the International Planned Parenthood Federation. He collaborated with Dr. Karman, a psychologist, to develop a simple technique for treating miscarriages and performing early abortions. It uses a flexible cannula with vacuum created by a syringe, thus it is especially useful in places where there is no electricity. Although I learned the Karman method long ago, only by reading it in an obituary of Malcolm’s did I realize that he had aided in its invention.

Potts told me how he had helped with another innovation. The work of Henry David, a psychologist, is often quoted to help justify abortion. David studied children born to women twice denied abortion for the same pregnancy. He followed these kids for 20 or more years. The studies unequivocally showed that the children of unwanted pregnancies did not do as well as matched controls. Potts told me that it was he who suggested David study unintended pregnancies in Prague, Czech Republic, because they had stringent laws limiting who could have an abortion at that time.

In 1984 I interviewed for a job where Potts was the director. It had been called the “International Fertility Research Program”. Potts had realized that the name was long and might prejudice some people against the organization, so had it changed to the more copacetic “Family Health International”.

More recently Potts was the inaugural director of the Bixby Center for Population, Health, and Sustainability, and held an endowed chair at the Berkeley School of Public Health. He was an admired professor and used his imagination to innovate: his nonprofit, OASIS, advances education and choice for women and girls in the African Sahel. He also cofounded a company that is trying to bring birth control pills to the marketplace without the need for a prescription.

My favorite saying of Potts dates from the era when tobacco was sold in vending machines: “Birth control pills should be available in vending machines and cigarets only by prescription.” His wish has come partly true—now cigaret sales are much more restricted and reproductive health materials are available in vending machines. Many college campuses have machines that dispense condoms, pregnancy tests, emergency contraceptive pills and now, even Opill, the new over-the-counter birth control pill without estrogen (see photo above).

Potts was a pioneer in lowering barriers to reproductive health care. For instance, he set up a clinic at a central train station in India to perform vasectomies because people feared hospitals. He was known for this sort of imaginative, out-of-the-box thinking.

One of his coworkers, Alisha Graves, stated that Potts believed “We really have to trust that women are doing the best things for themselves and their families.” It took me years to come to the same conclusion.