Gardasil – I am sure you have all seen the TV commercials about Merck’s new vaccine, called Garasil, that guards against some of the viruses that prevent some types of cervical cancer. It is certainly one of the most aggressively marketed drugs I have seen in a while.
The vaccine recently received FDA approval. It represents a multi-billion market for Merck. Based on results of clinical testing and the size of the population who die from cervical cancer, giving this vaccine to every female in America, and assuming it is 100% effective (which it is not), would save .000008% of the population, or 2500 people. The vaccine requires three shots in the course of a year at $120 per shot making the full cost $360. Cervical cancer is almost always treatable due to its slow growth when common pap-smears are used to screen for it.
The vaccine was tested on 25,000 people of whom 1,184 were pre-teen girls. There is no data on long-term effects. There is no data on how long the protection lasts. Basically, we have a new vaccine here that shows promise of saving some lives. Cervical cancer accounts for only 0.66% of cancer deaths each year. Statistic and numbers obtained from article in Metrowest Newspaper Feb 14, 2007.
All of a sudden legislation is popping up all over the country attempting to mandate this medication be given to ALL girls at a certain age as part of their eligibility to attend school. So far cities in dozens of states have introduced a bill that would require 6th grade girls to receive this vaccine.
Merck, the manufacturer, seems to be spearheading this campaign. People who oppose this legislation are often being labeled “narrow minded grade-A religious nut jobs”. They are trying to suggest that only those with unreal views of sex would oppose this drug. I certainly do not believe I could be accurately labeled a religious nut job. I am a progressive liberal. I oppose the current bills being presented that would mandate this medication. I believe that parents should be making the decision at this point. Years down the road when more historical safety and efficacy data is available, I believe it may make sense to add this to the lists of vaccines routinely given to all young women.
What do you think? Do you share my concern about the ethics of those involved in this legislation? My plan is to study the medication further, discuss it with my doctor and my daughter, and let her decide. She’s 17. I will probably opt to suggest she get it. But I am not willing to mandate that decision to other’s.
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Comments: 72
But something stinks of bribery here. Why is legislating this as mandatory suddenly so important? This isn't the kind of a virus you pass around by touching door knobs. There isn't enough data yet to be sure this is really safe to give to everyone. It reminds me of the flu shot in the first years. I opted to take it because my wife was critically ill and the flu could kill her. But some people died from the flu shot, just like some die from the flu. It is better once the statistics are available so you can make an informed choice.
And to the point about the shot being carte blanch to have sex, that is just real live right-wing nut job tactics.
Based on what I know at this point, I am going to suggest to Jackie, my 17 year-old daughter that she get the shot. But I am going to do a little more research, talk to her about it, and let her decide. She has proven to me over the years she can make responsible decisions on such matters.
That being said, if I had a daughter she would've already received her shot by now. Contradictory to my point? Sure, but in my individual case I'll take even business over cancer every time.
It is sad to me that we don't encounter corporations that have the publics best interests at heart. It seems to me that is the root of so many problems in this country!
I don't find your point contradictory Kris. That's the same way I feel. I want my daughter to have the vaccine. I am just extremely suspicious of the money trail here and why such a new vaccine would be mandated. The flu is a much more serious threat to the population yet we don't mandate that vaccine.
I am becoming worried about the way the pharmas are aggressively marketing drugs. I had a doctor's appointment a couple of weeks ago and the doctor was dealing with an emergency so she was running late. While sitting there 4 different drug reps came by with samples, pens, literature for the lobby, charts for the walls. You can't watch a couple hours of TV without seeing Lunesta, Gardasil, Cholesterol, restless leg syndrome... They are beginning to invent diagnosis that weren't necessary before their was a "magic" pill!
Also, .66% of all cancer deaths?? Where did you get your numbers? Don't most victims of cervical cancer ultimately die from the resultant complications and, if so, then the numbers get watered down by the 'actual' cause of death listed on the certificate.
Kind of like cigarette smokers don't always die of lung cancer, the majority die from a host of other health complications/illnesses/diseases rendered by their habit of smoking.
This may be the same medication. I think the same virus, HPV, may be involved in herpes and other STDs. The "new" issue here is the linkage of HPV to cervical cancer and the aggressive marketing of the vaccine. If indeed this medication has been on the market for a while, then the reporter who wrote the article that triggered my rant today was somewhat negligent in not pointing that out, since it would certainly speak to the viability and safety profile of that vaccine. I am working on a project tonight (many hours to go still) so I can't dig deeply into that issue. But thanks for raising that question. You have stirred some thoughts because I am pretty sure strains of HPV are involved with STDs and this medication may only be new in this is a new indication and opens a more viable market because it is preventative versus reactive. Great point EB!
I will try to get answers to both issues you raised. The .66% and the question over the drugs usage in the past.
Coincidentally, I went to a new chiropractor last week, the nurse took my blood pressure and informed me that the next step would be the 'cervical' part of the exam, as she handed me a johnny! I never knew it needed an adjustment! :)
My point: Maybe your reporter was reading about the incidence of cancer in the cervix of the neck region?
I have conflicting opinions regarding the topic of this article. I would hate to think there is a drug that could help many young girls but because their parents want to live in some delusional state of denial about their sexuality they will be denied in lieu of "abstinence" teaching. On the other hand, I totally believe I would be dead if I had taken every new drug doctors have suggested to me over the years so I have strong objections to making this new drug mandatory.
My cancer was attributed to a drug my mother took while pregnant with me, so I don't know where that leaves virginity in this discussion. (For what it's worth, my mother told me I would not have fun, I woud be disowned, and I would go straight to hell if I had sex before I was married but I didn't believe her. I told my daughters never to think about marrying anyone they haven't had a sexual relationship with. I had cancer and so far the one who is past the age I was when diagnosed has had no problem.)
The US is a completely different can of worms. By mandating there, they are harming those who cannot afford this. I have survived several forms of cancer (supposedly), the first was cervical. It was found when I almost bled to death from internal hemmoraging. I am still 100% against this being mandated in the US.
The government is overstepping here, in the extreme. Nothing like this should EVER be mandated by the government.
I object to the drug on two bases. First and foremost because Merk is pushing it so hard with such a small and short study. I am old enough to remember when DES was touted as the miracle drug of the ages only to find out that years down the road a huge percentage of girls born to mothers who took the drug developed cancer. I want to see some longitudinal studies over a couple of generations before Merk is allowed to say this drug is actually safe.
My second objection is that this push to make the drug mandatory is nothing more than a corporate push for enormous profits for a vastly overpriced drug. By making it mandatory it dictates that the government will step in to pick up the bill for those unable to afford the shots. This greatly expands the profits Merk can make on this vaccine.
I do find the argument that giving it, and thus protecting a girl, will somehow encourage promiscuity. What that's saying in essence is that it's much better to expose your daughter to the danger of a slow death by cancer should she happen to exhibit bad judgment even one time, than it is to protect her against it and let her get away with having sex without some sort of punishment. It's the same arguments that were made about the birth control pill, the morning after pill, the ready availability of condoms, and adequate sex education.
I'm sorry but I'm not injecting my child with anything that does not have data on long term possible effects... What if in the long run this drug induced a type of cancer instead of properly preventing it?
As cancers go, metastatic cervical cancer is especially nasty. To get a taste of what the end stage disease was like in the age prior to PAP screening, check out the 1973 Bergman movie 'Cries and Whispers'.
As has been pointed out, the vaccine is for the three most oncogenic HPV strains. This isn't to say that other viral strains don't lead to disease -- they do. Therefore, routine PAP surveillance in all women who have been sexually active will still be indicated.
One of the things that I find a little disturbing is that the vaccine isn't being made available to men, too. HPV co-infection is a likely vector in many several other cancers, including most aggressive small cell carcinomas. It will be interesting to see if we see a decline in cancers, generally, as a result of widespread implementation of this vaccine. Unfortunately, that data won't be available for several decades.
Also the male analog of cevical cancer, cancer of the penis, while rare, is not unheard of. The incidence is somewhat higher in uncircumcised men, so parents who elect to allow there sons to remain intact should definitely be allowed to get the vaccine for their sons.
Cervical cancer is, techinically speaking, a sexually transmitted disease, which accounts for why hyper-religious types find this vaccine so exceptionable (yet another example of the medical establishment 'encouraging promiscuity'.) Early onset of sexual activity and number of partners both are risk factors, due to increased potential for and duration of exposure. However, there are still plenty of women who are in mongamous relationships and have only had one sexual partner who have positive PAP smears.
I would think that any parent concerned about her/his daughter's future health would want her to get this vaccine.
They do not care if it's harmful or not, well only proportional to for how much they will be sued. If I had a daughter and cervical cancer was not a part of our family history I would encourage that she not be a free guniea pig for Merck until we know exactly how this really affects women over time and we hear about the side effects that did not present themselves in the clinical trials.
So unless your city/state doesn't have this clause, what are we arguing about?
As I stated in my comments, I believe I will opt to advice my daughter to have the vaccine. I am not going to "make her" get it because she is 17 years old and has proven she can make good choices if given the data.
jJack, HPV did come up in my comments in response to EB, which look like they came around the same time as your comment. So we are trying to brush the fact that this is an STD under the table. In my mind the fact that it is an STD is not particularly relevant to my concern about the premature nature of mandating its use. I do not think that vaccinating against an STD with the potential to cause something serious like cancer is a darn good idea. I don't think doing so is an invitation for kids to have sex. In fact, from my point of view it is a great opportunity to discuss safe sex with your kid.
I always look for opportunities in life to work life lessons into everyday conversation, as in "sweetie have you heard about this new vaccine that can help prevent cervical cancer? Do you understand that the cancer is caused by HPV and that HPV is a relative of Herpes and is a sexually transmitted disease? Certainly gives you something to think about honey. It is really important that both boys and girls think about the risks involved. It's good to understand the risks and ways to prevent them. One way is to abstain, but I know all about teenage hormones! Another is a condom, education, and common sense. And most important, do what you think is right because you're a smart young woman and I trust you to take good care of yourself. Remember kiddo you're my retirement plan. I'm counting on you to take care of ME someday" (making sure she knows I'm mostly joking about the last part).
I'm not kidding. That's the kind of conversation that has to happen. My parents were like Sandy's in that they didn't advice marriage before sex. I remember my grandmother saying "oy vay, you wouldn't buy a used car without test driving it, and believe me, most of the cars are used if you get my drift!"
I think the most persuasive comment in this thread is Lori Leigig's. The fact the a government with a compassionate socialized medicine program endorse the vaccine is indeed a huge vote of confidence.
Although cervical cancer is treatable through other modalities as well (radiation, chemotherapy, hysterectomy) I don't know a single person who would want to go through that, if there was even a chance of it being prevented.
That being said, I don't agree that the immunization should be mandatory... I don't know many reasonable people that wouldn't choose to have the vaccine, or choose for their children to have the vaccine, but it should be a CHOICE!
Paige, I would tend to agree with you that one would want to take things that are known to be good for them. My core issue is "how do we know this medication is safe?" Because the FDA approved it? The FDA has approved some very dangerous medications and kept life saving drugs off the market. Call me a skeptic but I don't always find their motives to be wholesome. Much of the hidden subtext of my article here is that I am finding this whole issue a little bit fishy. To justify the level of advertising they are doing you'd almost think they'd bought themselves a congress-person or two or three. And the ads are so effective you are reciting the punchline word for word with your one less comment.
I have a lot of experience with medications due to having a terminally ill spouse with a rare condition that required radical and often risky medication. I have faced those choices. I have had to make the call while my wife was in a comatose state whether to do nothing, do something pretty safe with low success odds, or do something radical and risky but just might knock it into remission. There is no formula to do "the right thing" every time. You have to examine the facts, get other opinions (time permitting) and read your gutometer (hypothetical device that reads you gut feeling). I truly believe Cyndi lived 10 years longer then anyone dreamed possible due to decisions to go with medications "just approved by the FDA for this indication yesterday". An example was sildenafil, also known as Viagra. In Japan and other places it was showing remarkable results in help pulmonary hypertension patients. It was relatively untested in the US, but some progressive doctors were using it. Some patients were able to stop their usage of Flolan, which required a catheter directly into the heart pumping medicine 24/7 for the rest of their lives (or until heart transplant). In Japan patients actually had their catheters removed and they could swim again! So I am no wimp when it comes to evaluating and electing to try a new treatment.
But... I don't want to use my daughter, or anyone's daughter, as a guinea pig so Dick Cheney and buddies can get rich. I don't support the type of cronyism that seems to be the norm in the Federal government. I am flat out suspicious of why this is suddenly a priority and why a company would suddenly invest a decade's worth of TV advertising on it.
There is no long term efficacy data. There is no long term risk profile. The side effects are not well known. Isn't it maybe a LITTLE too early to target every adolescent girl in America?
Follow the money trail. Does it really lead to "one less" or does it lead to "a billion more"? Don't get me wrong, I have nothing against capitalism and making money, I would like to make some myself. But one cannot compromise their ethics to make money. One cannot ignore the lack of efficacy, risk analysis, side effects, and other data.
Up above there was a comment about why this isn't being offered to men. If my memory cells are firing on all cylinders there are clinical trials underway and I would suspect this vaccine will be approved for men soon.
Thanks everyone for participating in this. I have been getting alarmed by the level of direct pharma->consumer advertising and then politicians getting involved really raised a red flag. And you will note this is not a partisan issue. It seems members of both parties are ready to mandate our daughters get the vaccine. I've been hoping for some bipartisan alignment in government for a while but I was hoping it would be an issue more meaningful then lining pharma executive's pockets!
It is troubling to me that you imply that my role as father requires me to force a vaccine on a young woman who is old enough to decide for herself. I have no doubt she will opt to take the vaccine once presented with the facts. You see, parenting isn't about MAKING kids do things. It's about empowering kids to grow up and make decisions themselves.
I do know I am going to recommend my daughter get this vaccine. Maybe she'll even pop over here and read this discussion. She's been known to pop in on my rants before!
270,000 cases of Cevical Cancer deaths worldwide in 2002; 2,300 of those in U.S.
The vaccine is quadrivalent, protecting against the 6, 11, 16 & 18 strains against HPV. Two of these strains account for 70% of cervical cancers, and the other two 90% of genital warts.
On the face of it, it would seem that the vaccine is dedicating at least as much 'space' to warts, a nuiscance, as it is to a lethal cancer. However, I don't know to what extent there is cross-reactivity between these and other HPV strains. By 'cross-reactivity' I mean the ability to induce effective immunity against other strains. For example, there is a high degree of cross-reactivity between Herpes Simplex 1 and 2 -- something like 80%. A history of cold sores conveys a high degree of protection against subsequent genital infection.
A 'valent' vaccine contains pathogen surface proteins capable of inducing an immune response. It does not contain any live virus, and cannot induce disease (as has proven to be the problem with 'live, attenuated' HIV vaccines, which mutate back into the pathogenic 'wild type'.) It is still unclear how long the protection will last. Only data from anitbody titres several years post-vaccination will able to demonstrate if the immunity is lifelong, or needs periodic 'boosters'. As a general rule viral immunities tend to be much longer lasting than bacteria: for example, you need to get a clostridium tetani -- tetanus -- booster shot every 10 years. Conversely, the Hepatitis B virus vaccine, which, like HPV is a surface antigen, induces life-long immunity.
On possible side effect of the HPV -- or any vaccine or actual infection -- is the induction of an auto-immune response via a 'molecular mimicry' mechanism: the antigen (something that induces an immune response) is similar enough to one of your own proteins that the body starts attacking itself.
It is estimated that 35% of sexually active women in the US, ages 15-44, are infected with HPV. A 1998 study published in the Journal of Women's health demonstrated a 43% infection rate among college aged women.
Of course any effective induction of immunity requires an intact immune system.
Gay men who have unprotected anal sex are at least as much at risk for cancer of the anus as women are for cervical cancer: in on SF study, 90% of HIV+ men had either pre-cancerous lesions or frank cancer. However, it is difficult to assess the degree to which a compromised immune system contributes to this high rate of infection.
Austrailia will offer the HPV vaccine to adolecsent males, only the National Health Service will not pay of for it.
Precancerous lesions and carcinoma in situ detected by routine PAP smears can be effectively cured by cervical alblation of the affected region. However, the procedures are unpleasent, and can impact future pregnacies by compromising the integrity of the cervix. Also, as the cancer is caused by a viral infection, there is no guarentee that it won't come back: in fact, the biggest risk factor for a positive PAP is a history of positive PAPs.
Also, in order for PAP surveillance to be effective, women need to have annual OB/Gyn check-ups. While women are generally much more compliant than men when it comes to health maintenance, this situation might change as more and more enter the full time work-force: we all know how fast six months can pass for working people.
Vaccine comes from 'vaca' or cow. In the 18th century, the English physician, Jenner, noted that milk maids never got small pox. However, nearly all of them were at some time infected with a benign condition, cow-pox. Jenner scraped the surface of cow-pox leisions, and with a tincture he made from it was able to induce small pox immunity. Cow pox, or 'vaccina' and small pox are 'cross reactive': cow pox works like an 'live, attenuated' small pox.
Catherine the Great, a true creature of the Enlightenment, received Jenner's vaccine to demonstrate to her subjects that it was safe.
What I like especially about vaccines is their potential to confer a lifetime of protection. Were Merck truly greedy, they'd have developed some anti-viral drug that would have required chronic administration, like acyclovir for Herpes, instead.
As men are the pricipal vectors of cervical infection, I think that boys, too should be able to receive this vaccine. Male innoculation would exponentially increase 'herd immunity'.
Chicken pox vaccines are highly effective. Very few kids get it anymore, which is kinda sad.
Just think if all that lobbying money and advertising dollars were applied to problems like bridging the health care gap and other preventative steps! If Gardasil is as useful as it sounds it will be hit with doctors, HMOs and insurance companies and the legislation will have been overkill.
Also, as with the protease inhibitors, I think this vaccine may have been fast-tracked by the FDA, only in this case do to the urgent need for it in the majority world. Hopefully the $360 price tags for the series may in part go to underwrite implementation of this therapy where it is most needed.
I find it a bit disconcerting that it is not being offered to boys, too. Itroitus, after all, is the vector by which HPV is introduced into the cervix to begin with. Also, as I suggested this vaccine might prove protective against a variety of other cancers, in addition to cervical. Most small cell (VERY aggresive) carcinomas demonstrate HPV co-infection. I'm embarassed to admit that I have not been able to ascertain if these are the same serotypes responsible for cervical cancer.
If you have read any of my previous previous post with care, you will have noted that the only time I referred to HBV was as an example of a highly efficacious surface antigen vaccine. I am very careful in my usage.
A close friend of mine's mother recently passed away from hepatocellular carcinoma secondary to an HBV infection she received from a contaminated tranfusion after a C-section more than 30 years ago. It was a horrible, agonizing death: metastatic cancer in the setting of fullminent billiary cirrhosis. Trust me, you have never seen a yellow like that. This disease, now rare in the US, remains highly prevalent in regions where HBV is endemic. HBV is typically transmitted by a fecal-oral vector, and we all know that small childen are none too mindful about what they put in their mouths. I would aver that even to even suggest that some child be denied the protection conferred by an HBV series in infancy borders on criminal negligence.
I had a pretty strong suspicion you were an MD from the complete and accurate data in your posts. You have done me a great service by commenting on my article and adding significant value to the discussion.
I am going to talk to my daughter about this vaccine immediately. Paul, how do you suggest we go about getting the vaccine approved for boys?
You may have addressed this in an earlier post, but I assume the vaccine is ineffective on someone who already has one of the HPV strains, right? It will not help them learn to attack off the pathogen or will it? It seems that both a preventative vaccine and an effective way to nullify the effects of the virus for those who have it would be a real win for everyone!
Thanks again for bringing the medical data into this discussion. As you no doubt figured out, I am NOT a doctor but am a fairly well educated patient.
Chicks kill me with silly chick-like statements such as this one. Women have no problem telling men what to do, but heaven forbid a man has an opinion about a "female issue." You usually hear stupid comments like this one when feminazis are talking about abortion, but it certainly isn't the only time, as you can see.
All the government is trying to do is protect our daughters.
Anybody that feels as if they need "help" from the government to raise their children, shouldn't have children.
You say you "don't care about the money." Isn't that sweet. Since money is a factor in this legislation being passed, you certainly SHOULD care about the money.
Do you also want the government to "save you" from obesity, and mandate what you eat and how much you exercise?
Do you also want the government to "save you" from becoming a sex addict, and tell you who you can have sex with and when?
Do you also want the government to "save you" blah blah blah ?????
I find it PATHETIC anyone would PROMOTE this very bad legislation.
My doctor basically didn't give me a choice about getting the HepB vaccine when I was 16, even though I pointed out I was not at risk in any way and wasn't likely to be. I would have had to get it when I started studying nursing anyway, as it turns out, but I remember how irritated I was about not having a choice.
However, small children are very much at risk for HepB: infected children often spread the virus to other children if there is frequent contact or a child has many scrapes or cuts. Daycare is a perfect set up for this kind of transmission; and who doesn't send their children to daycare these days? How many stay-at-home parents do you know?
Infected children are far more likely to progress to chronic disease: mature, intact immune systems are much better able to mount an effective response to the virus (i.e. 'clear it'). Children who have been infected vertically (i.e. from infected mothers) often don't present symptomatically until they are four or five. However, as with the asymptomatic HIV+ population, they are still able to infect others.
There are 200,000 new cases of HepB in the US each year. It is considered the nation's number one preventable disease that can be prevented by immunization. 2-3% of the world's population has chronic HepB infection; and it has estimated that as many as a third have been exposed to it: it is extremely contagious. It has even been suggested that there might be an insect vector. I would contrast HBV with HIV, which is, comparatively, a fastidious bug when it comes to transmission. I suppose it was these huge numbers that led me to mistakenly assume a fecal-oral vector.
We have increasing number of immigrants to this country from endemic areas (China, South and Southeast Asia, Africa). While I'm certainly not advocating that we should close our doors to them (good God, anything but!!!), it's important that we keep in mind the disease burden these immigrants bring with them -- along with their skills and initiative -- in setting our public health policies.
And lastly, don't underestimate convenience! I'm all for getting people inoculated while we can! The older one gets, the more difficult compliance becomes. I have only to recall my own experiences getting my HepB series: I was working, and before I knew it the six month interval between the second and third shots had long since come and gone! Fortunately, the first two shots did the trick, and I was positive for the antibody. Otherwise, I'd have had to start this expensive series all over again -- out of pocket!
Which returns me to why it may be a good thing to inoculate girls against HPV prior to menarche. If we wait until they are nubile (pardon the prurient implications of that word, but at present I can't think of a better one), chances are they'll be involved in sports, activities, etc. And these days, they may have already 'jumped the gun'. Once exposed to the virus, the vaccine is no good.
I would like to end by saying that I find the early onset of sexual activity in general profoundly disturbing, and I am all for encouraging the 'regressive virtue of patience' (phrase borrowd from John Updike essay on Jane Austen). However, I think it is incumbent upon medical practitioners to stay abreast of social trends, regardless of how we may feel about them from a moral perspective. Our primary job should be to prevent illness, not to wag our fingers and say 'I told you so!' (which too many of us still do!)
I don't know if it's been documented, but given the extrordinary virulence of HBV I don't think 'remote' is the correct adjective in the context of possible infection. For example, the fact that both saliva and tears are counted among the bodily fluids capable of passing on the infection speaks both to a very hearty virus, and to a very small inoculum required for infection. I would contrast this with HIV, where the small amounts of virus found in tears and saliva are not considered risk factors.
Regarding HPV, I can't imagine why you think it is important to catch young girls before they're "involved in sports, activities etc".
The sad part is so few people have any idea how powerful the pharmecutical lobby is. It is a huge machine, that has one goal, making the industry money. If some people have positive outcomes becuase fo the meds they produce, that is good, but not the point.
When anyone or anything thinks it can legislate that chemicals be introduced into our bodies without our concent, then we must be very careful when deciding what the actual value is to human life verses the money to be made by such monstrocities.
Thanks again Rich
There was an article about this on the front page of the NY Times today. The vaccine was recently mandated in Texas, and sure enough the Governor's ex-Chief of Staff now works for Merck.
The article was saying the aggressive strategy may actually work to decrease the number of people who will ultimately get the vaccine due in part to the controversy.
The average person has no idea how corrupt politics are and how powerful certain lobbies are. I am working on a project where I am involved in some legislation forced through by various lobby groups representing big businesses. The way they often work is have a bill introduced, gain support, then slip in additional text in committee and never re-read the bill on the floor of Congress. Granted Congresspeople should read the bills before voting but the practice is so commonplace that none have time to reread every bill. We need some serious reform!
I was not making a connection between playing sports and contractin HPV; I was saying that once children hit early adolescence, their lives start to become micromangaged by 'activities' to an extent that might interfere with routine health maintanence like vaccinations. And these days, this age is about the time when a significant number beging to become sexually active. And while personally I don't think sexual activity is an age appropriate behavior for a 14 or 15 year old, it happens to a degree that I think it is important the young women be protected against this potentially ocogenic infection.
And in the matter of 'criminal negligence' in the setting of HBV vaccination, I think the duel facts that this virus is most virulent in the immunocompromised, a population which includes small children with immature immune systems, and nearly always lethal in its chronic form, warrents the earliest possible intervention. I see no reason why the legal standards applied to tuberculosis shouldn't apply here, too. As I said earlier, as much as on third of the world's population has been infected by it at some point: this is a critter that doesn't like staying in one place!
Morbidity and mortality aside, I think the overall societal cost of disease burden needs to be accounted for, too. Consider only the lost productivity of those people who refuse to get a flu shot, end up getting the flu, and are on their backs for two weeks.
Many of you have raised the issue of the pricing of this HPV vaccine. I would suggest that $360 for the series is not unreasonable, as Merck needs to cover its (very) significant R&D costs. They have a limited window of opportunity in which to do this: once the patent expires, anyone will be able to make it, and the cost will plummet.
Also, in addition to the above mentioned trauma to the cervix, the cost of ablating of cancerous or precancerous lesions likely exceeds $360; and all women with a history of positive PAPs require more frequent survaillence, which also increases health care costs.
So far as I can tell, this vaccine is a win-win situation. However, the medical community, and the science community in general, need to do a much better job at educating people about vaccinations, how they work, etc. This process should begin in the science classroom. That way, perhaps people won't get so freaked out by them.
Yes, I get the vaccine is a good thing and most people should get it. I support the government recommending this vaccine. I'd support the government subsidizing the vaccine. I'd support universal health care. I'd support an insurance company contacting their insured parties and indicating they want their subscribers to get the vaccine because it will improve their health and help reduce long-term costs. I'd support doctors recommending the vaccine. You have done an adequate job of selling me on the merits of the vaccine. But the question remains why should a powerful lobby determine what is injected into my daughter's veins? Why should a lobby representing a company that wants to make a profit tell families to cough up $400 per female child?
So we all seem to be going in circles. We all agree the vaccine is good. Vaccinate our children. Be one less. But have we reached a point where our health care decisions are now mandated by the government and the specific mandates are not driven by merit alone but by strength of the lobbying arm of the pharma?
I know someone who worked on a public health team during trials and she recommends it after doing so. I know her well enough to know she would have changed her mind had she found a reason to.
Exposure to HPV is not just a matter of voluntary behavior. Consider rape, molestation, etc.
Perhaps making it mandatory means that insurance HAS to pay for the people they cover, and gov'v programs have to pay too...? I dunno.
FWIW, if I was 16, I'd get it.
They THOUGHT they had this great new vaccine for chicken pox, and in reality that hasn't panned out.
In school districts that require the Chicken Pox vaccine, there are classrooms full of kids who all break out anyway.
Grand thing, but it doesn't work.
When this has been around long enough to feel safe to me I'll consider if my daughters will have it or not.
Personally, by 6th grade I believe the children need to have some voice in this decision. Heck if 6th graders can have babies (happens often) then they certainly should be able to give input into this choice as well.
I will never get this shot for my girls, ever. There isn't enough proof it works, or proof it isn't blatantly harmful.
Another thing; Where the heck does the government get off telling me that my daughter has to get a shot to prevent an STD, but her potential future boyfriend (who else would she get it from pray tell?) doesn't.
The last time gender played a role in a manditory "vaccination" program, the "vaccine" had added "goodies" in it to promote population growth. When the truth came out, that government just said "oops".
If this "vaccine is only meant for girls, what else is hiding in it, and what will it do to our children?
- my own doctor, not the government, suggested my daughter get the shot
- my daughter's doctor recommended she get the shot
- my daughter read up on the issue and added her own opinion to the mix
After all, it is HER body that will be vaccinated. Not mine, not the government's, but my daughter.
You raised a question that I have been pondering too. Is this vaccine effective for boys? I know they don't get cervical cancer but will it prevent the STD in boys? If so, why not recommend it to boys too?
Let's not forget that that this drug is put out by Merck. This is the same company that manufactured and marketed an osteoarthritis and menstrual analgesic, taken off the market in 2001, five years after its approval by the FDA, due to concerns about increased risk of stoke and heart attacks for those taking the drug for a period of eighteen months or longer. By the time they volutarily withdrew Vioxx from the market there were already pending lawsuits.
I don't have a daughter, but if I did, she would not be a guinea pig for this experiment, and that's just what whe would be if I allowed it.
I tried to get the shot for my daughters but they told me that my insurance isn't covering it yet and to wait a few months because they thinks its going to get approved later by the insurance.
I don't know for sure that shot is good, and I don't know it is bad. I just find some seriously alarming trends here:
1) Major pharma is doing direct-to-consumer marketing of ED drugs, restless leg syndrome, enlarged prostate, cholesterol, herpes antivirals, and now this
2) It would appear from trends that big pharma has lawmakers in their pockets given how quickly legislation passed regarding Gardisil.
3) Once upon a time doctors recommended medications based on a less flawed system (I say "less flawed" since big insurance companies still dictated the normal protocol for trying cheaper meds first.
Don't get me wrong folks, I'm a capitalist. I may be a liberal capitalist, but I am all for "business for profit". However there are certainly ethical lines that can't be crossed. I expect lawmakers to solidifying those lines, not blurring them and joining those pressuring us into taking their most profitable meds.
I have personal experience. Those who have read my article about how insurance companies almost killed my wife. They also help keep her alive once we understood what motivates them. At the end of the day they did more good then harm, but during the 10+ years I was the primary caregiver to my late wife I learned many disturbing things about the way the food chain in medicine works and who is driving the boat.
I am a type 2 diabetic. A study found that diabetics should proactively lower their blood presssure even if it is not high. This is because diabetics have high odds of dying from heart failure so their needs are greater then the average person's. The typical blood pressure drug used as the first protocol for treatment has been around a while and has a lower cost then some of the newer ones. So insurance INSISTS that docs try it first, and for the most part that is a reasonable requirement. EXCEPT that first line drug cause some very serious side effects. I developed a deep, bronchial style cough that made me feel like I was dying because I couldn't get oxygen. I was living in a house in Portland Oregon area but working in Seattle. So I had an apartment in Seattle and lived there on weekdays. I happen to be away from my normal doc when I had a serious episode and thought I was dying. I found a doctor who coul see me immediately who identified my problem as a side effect that occurs in 10%--that's one in ten people, that can be life threatening. What's worse is even after I stop taking that med it will take 2-4 months for it to totally detox out. They switched me to diovan, an almost identical, more expensive medication that has a lower incidence of this side effect. After many years I can say the diovan is working. BUT I RECENTLY SWITCHED INSURANCE AND THEY WOULDN'T PAY FOR DIOVAN until I repeated the typical prescribing protocol. I flat out refused since it almost killed me. After 3 weeks and reaching the top medical officer at the insurance company, I received authorization for the diovan.
Let's face it folks, whether we believe in free market competition or not, our health care system is broken badly. Profits are replacing compassion and empathy as motivating factors. Greed hidden behind "cost control" has put us all at risk. My thoughts (which some of you will hate, I am sure, but I have a right to my left opinion!):
1) Make direct to consumer marketing illegal again
2) Create a universal coverage that guarantees coverage for every american (and yes, cover illegal immigrants too, since one way or another we will be paying for their treatment).
3) Prosecute any laws that have been broken related to unethical and illegal graft and bribery.
4) Throw the bums who have refused to solve this problem and their party out of the white house, congress and local states and municipality and let's make health care a high priority. We can give in to their fear mongering or we can look at facts. Do you think more people die in terrorist attacks or die as an outcome of the current system of marketing and compensation for drugs.
I don't care if we "privatize" insurance or find other solutions. But we have the technology to fix this.
Sorry for the two rants but obviously this touches a nerve sitting on a big open wound!
By the way I understand trials are underway with boys. You see this really treats the HPV, a sexually transmitted disease. I can't wait to see how they market it to boys! Probably something like the distasteful "I have genital herpes" and "and I don't" commercials that are airing now for those antivirals. Don't get me started on THOSE commercials. Talk about irresponsible greed... I wonder why they choose to only market the "reduces the risk of spreading" rather then the fact that those medications allegedly also reduce the symptoms for the infected party. That seems like a rather important facet of the drug's profile that would matter to many folks.
I think I am suffering from restless finger syndrome tonight and I can't stop typing. Give me a pill, preferably one that won't cause me to drive off the end of a pier while driving a motorcycle nude in the winter...
My daughter recently turned 18. She is perfectly capable of making this decision. We discussed it with her doc recently and she (the doc) recommended the shot. I will support my kiddo's choice either way. I am leaning towards hoping she gets the vaccine, but it is not a strong lean!