Shot in the Arm

There appears to be a great controversy brewing.  No, it has nothing to do with which is more appropriate: chardonnay and pinot grigio or vodka martinis and cosmos at Friday's playdate?

Nope - lawmakers across the country are debating the merits of mandatory HPV vaccinations for girls, which, proponents claim, would k.o. the virus linked to cervical cancer.  The American Cancer Society estimates that approximately 11,500 women will develop invasive cervical cancer and about 3,600 will die from it.  The question whether or not to require the shots (three doses over 6 months at $120 a pop) heated up a week ago when Texas governor, Rick Perry, issued an executive order requiring the vaccine for 11- and 12-year-old girls (parents can opt out for reasons of conscience).  In that time, 18 other states have opened debate and are similarly considering legislation, though the measures have drawn the ire of anti-vaccine and religious conservative groups.

Clinical trials indicate the vaccine stymied infection with two strains of HPV that cause 70% of cervical cancers and two strains responsible for 90% or genital warts.  Research indicates that most cervical cancer occurs in adult women, however, the Centers for Disease Control recommend the injections be given before puberty (11- to 12-years old) or as young as 9-years-of-age.  Opponents argue that although the vaccine, Gardasil, is effective in preventing cancer and genital warts, the glaring difference between HPV and other diseases currently vaccinated against (HepA, HepB, DVT, etc) is that HPV is contracted in only one way: through sexual contact.  Conservatives and parents rights groups argue the requirement would encourage premarital sex and interfere with the way they raise their children.  This is all well and good, but since most people with genital HPV never know they have HPV, it is possible (and, in some respects, probable**) they will be infected at some point in their lives.

Where do you come down on this debate?  Should it be mandatory?  Should it be up to the parents in this case?

I'm not sure where I come down on this yet.  I don't like being told by the government or others how best to raise my children i.e. when to have certain conversations, whether or not I can spank, whether or not I can drink responsibly in front of my children.  As an adult and parent, I have the freedom and the responsibility to make these decisions on my own without interference.  Would I consider having my daughter vaccinated against it?  I would.  But it's also up to Mrs. Big Dubya as well.  And I don't think it should be up to some legislator to tell me I need to get my daughter vaccinated against a sexually transmitted disease.

So, maybe I do know where I come down on this.  Look at that.

**According to CDC Web site and info on HPV

Comments

[Big R]

Hi,
Just ran across your site, very funny stuff!
I work in the College Health Care Field and we are in the process of giving Gardasil. It is the best gift you can give your child. Even if she doesn't have premarital sex..it doesn't mean her future husband won't.

Unfortunalty for "Good" Parents the goverment has to step in and protect the kids that have "bad" parents..and not for religous or medical reasons, but that they simply wouldn't have their kids vaccinated unless the government made them.

[Susan]

I have sons, so I've not really been thinking about this issue so much as a parent; instead, I've been remembering what a dumbfuck my 21-year-old college student self was when it came to boys and dating. And I've been counting all the women I know who have had Pap smears that showed abnormal or precancerous cells, and how many of THOSE women went on to have parts of their cervixes removed to stop the cancer.

My sons will be vaccinated for meningitis, which often spreads like wildfire among college students, because I see it as a chance to keep them safe at a part of their life when they won't necessarily make the best adult decisions. If I had a daughter, knowing what I know about my college years (and I was, on the scale of things, very very responsible, really) I would absolutely have her vaccinated.

Of course, I don't have a daughter, so this is all hypothetical.

[landismom]

I can't imagine not wanting my daughter to get this shot, personally. If there was an AIDS vaccine, would you give it to your children? Cervical cancer is a pretty horrible thing to have happen, and the idea that my kid could have a chance of avoiding it is pretty fucking compelling.

[Jeff Herz]

Ok, I don't seem to be on the same path as your other commenters but here goes:

If your statistics are correct, then approximately 11,500 woman get this annually, and 3600 die, then an astonising 69% of those afflicted with this same disease survive. Now assuming we have 300 Million people in this country and roughly 150 million of those are woman, then this means that only 0.007% of the population will actually need this drug. It does not seem reasonalble under any circumstances to innoculate millions of 9-12 year old girls with a drug, with a ton of side effects and no known long-term effects of this vaccine for a disease, while tragic, is not truly needed for public health, like polio or measles vaccines.

I agree with you that if my wife insisted that my daughter get this vaccine I would go along, but I don't want the government doing the job that a marketing group should be doing for a pharmaceutical, and that is what I think is going on here. Also, if my family had a higher risk for this type of cancer, you can bet your sweet ass I would get my daughter vaccinated, but in lieu of either of these scenarios, I don't want to subject my children to any unecessary medicinal intervention. It is just crazy and even more crazy for the governemnt to push it like candy on us, for a problem that only effects a few. But hey, that is just me

[Jeff Herz]

Ok, I don't seem to be on the same path as your other commenters but here goes:

If your statistics are correct, then approximately 11,500 woman get this annually, and 3600 die, then an astonising 69% of those afflicted with this same disease survive. Now assuming we have 300 Million people in this country and roughly 150 million of those are woman, then this means that only 0.007% of the population will actually need this drug. It does not seem reasonalble under any circumstances to innoculate millions of 9-12 year old girls with a drug, with a ton of side effects and no known long-term effects of this vaccine for a disease, while tragic, is not truly needed for public health, like polio or measles vaccines.

I agree with you that if my wife insisted that my daughter get this vaccine I would go along, but I don't want the government doing the job that a marketing group should be doing for a pharmaceutical, and that is what I think is going on here. Also, if my family had a higher risk for this type of cancer, you can bet your sweet ass I would get my daughter vaccinated, but in lieu of either of these scenarios, I don't want to subject my children to any unecessary medicinal intervention. It is just crazy and even more crazy for the governemnt to push it like candy on us, for a problem that only effects a few. But hey, that is just me

[dgm]

i'm with you, jeff herz and mr. big dubya. the guv'mint should not be mandating HPV vaccine for all 9-12 year old girls. mr. big d, i think you are absolutely correct to frame this as an issue of the appropriate role for government (and, incidentally, constitutional limits on state power) rather than as a question on the merits of the vaccine itself. for the same reason that the state should not mandate the hep B vaccine for newborns (because so few of them are very sexually active or drug abusers), it should not mandate HPV for pre-teens.

this is not the same as saying "the vaccine should not be available for parents who want to take advantage of it." just so you know.

[Kara]

Dub, the stat I remember hearing- and the one that is posted on the CDC website- is that a full HALF of sexually active individuals (of all ages and genders) will contract HPV at some point: http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common

Regardless of what we tell our daughters about waiting to have sex, there's still a 1 in 3 chance that one of our girls will be coerced into engaging in sex acts against her will:http://www.mass.gov/dph/fch/asets/fpcover.htm

I'm posting about this at my place today. This is a thought provoking issue to be sure.

[JayMonster]

The sad part about this is really is that the arguments at the levels of government are not any of the one's mentioned here (so far).

The only reason that this has been fought so hard against by lawmakers, is that the religious right somehow has decided that by giving a child a vaccination is somehow giving them "permission" to be promiscuous, and will apparently turn all our daughters into pre-marital sluts having sex at will because they got this shot. This I am sorry to say is the most pathetic "reasoning" I have ever heard.

While I prefer a limited role in government when it comes to such things, as in the examples given, if you gave parents the "option" to inoculate against MMR, then guess what... these would still be serious problems rather than basically afterthoughts as they are today.

While not "everybody" develops cancer and dies from HPV it is still a widespread disease that affects even at a smaller level millions more. (And to be honest, I am not willing to play Russian Roulette with my daughter's health, and play the "odds") Men (and boys) can even become carriers when coming in contact with someone with HPV, so even if a woman stays "pure" until marriage, if her husband doesn't she can still be infected with HPV and potentially develop cancer from it.

As for the suggestion of "Side Effects", somebody care to tell me where the "awful" side-effects are? (http://www.rxlist.com/cgi/generic4/gardasil_ad.htm)

The most common side effect was pain at the location of injection. You get this same thing with virtually any inoculation.

The concerns about the long term efficacy of the drug is of course a valid concern, but again, one that few lawmakers are considering when considering the drug. This is the most valid argument against it, and fairly can not be completely discounted.

In the meantime, insurance coverage is spotty. The only way to ensure that coverage is available, and that the drug is produced in quantities of scale to help drive down the price is to make it mandatory.

I agree there are reasons to be cautious, but in the end, I believe the benefits far outweigh the arguments against it.

[Mon]

Ditto to what Jeff said. Except I would be using a large amount of curse words. The government needs to back off! I could go on and on...arrrrgh!

[stickdog]

The Facts About GARDASIL

1. GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.

2. HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four "bad ones" protected for in GARDASIL) results in no known health complications of any kind.

3. Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don't get pap smears until after the cancer has existed for many years.

4. Merck's clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the "placebo") and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.

5. Both the "placebo" groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications -- as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.

6. Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM -- MUCH LESS DIED OF IT. Instead, this vaccine's supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and "precancerous lesions" (dysplasias) than the alum injected "control" subjects.

7. Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.

8. GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck's biggest cash cow of this and the next decade.

These are simply the facts of the situation as presented by Merck and the FDA.

For a more complete discussion on GARDASIL with sources, click on my name.