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Vaccine Marketing

Front page of today’s Washington Post Metro section had a big article on the support for the new HPV vaccine, Gardasil.

This week, the District became the latest jurisdiction to propose adding the vaccine to the list of shots girls would have to get before enrolling in the sixth grade. Yesterday, Mayor Adrian M. Fenty (D) voiced his support, saying hearings to flesh out the program should satisfy parental concerns.

At least two similar bills were introduced last week in the Virginia General Assembly. And in Maryland, state Sen. Delores G. Kelley (D-Baltimore County) has prepared a bill that requires middle school vaccinations. Kelley said she expects strong support from teachers and female lawmakers.

I addressed this topic back in June when Gardasil was approved by the FDA. Then as now I can justify a parent wanting his or her daughter vaccinated. This vaccine does prevent a sexually transmitted disease that can lead to cervical cancer. What I cannot justify is making the vaccine mandatory. Contrary to the hype, this vaccine does not prevent cancer. It prevents a sexually transmitted disease, human papillomavirus(HPV). It is true that most cases of cervical cancer are linked to an infection with HPV, but prevention of cervical cancer is a secondary, not a primary effect of the vaccine. Other vaccines are mandatory because the diseases they prevent cause a public health risk with casual contact in a school setting. Unless the lesson plans have gotten way out of hand, the risk of spreading HPV in school is very low.

Of course the pharmaceutical companies are very savvy. They aren’t marketing this as STD prevention. It is cancer prevention only. Who wouldn’t want to prevent cancer? You can see this is muddying the debate.

Joseph Zanga, professor of pediatrics at East Carolina University's Brody School of Medicine, favors the vaccine for girls who plan to be sexually active. But "mandating is the wrong approach to this issue," he said.

"If a kid with measles is sitting in a classroom, he or she is going to infect many other classmates. A kid with HPV infects no one other than one she might have sex with," he said. "We're not protecting the public health in the same way that we protect public health when we require measles vaccine."

Virginia Del. Phillip A. Hamilton (R-Newport News), sponsor of a bill that would mandate HPV inoculation for middle school children, disagrees.

"This is not a prevention for a sexually transmitted disease. This is a prevention for cancer," he said. "And if a vaccine can eliminate even one case of that, I think it's a worthwhile initiative."

Sorry, Delegate Hamilton. This is prevention of a sexually transmitted disease. A noteworthy bonus is it will tremendously decrease the incidence of cervical cancer. Interestingly, widespread behavior modification, aka chastity, would do the same thing. Of course it is much easier to mandate a vaccine than it is to mandate chastity.

UPDATE: This post got a look from someone at Merck, manufacturer of Gardasil


Rosemary Bogdan said…
Wow, what a great post. You really hit the nail on the head.
Michelle said…
Yes, but those who think that chastity for anyone over the age of 16 is impractical (and in anyone over 20 is unnatural) think mandating this vaccine is a no-brainer. After all, your daughter will have sex and she may contract HPV from that boy and then give it to this boy who will then give it to my daughter who will get cervical cancer and die and it will be all your fault since you didn't vaccinate your daughter. And even if I vaccinate my daughter as my choice, you must be forced to vaccinate your daughter for her own good despite what you think about it.

I'm really glad that my girls are very young so I have time to figure out how I'm going to handle this.
funny, I just posted on the absurdity of their false marketing claims myself.
Anonymous said…
But, abstinence is not enough!

Even if a woman *did* wait until she was married to have sex, she could still get HPV from her husband. Women can also get HPV if they are raped. HPV vaccine protects women from HPV and cervical cancer even when abstinence can’t.

Anonymous said…
Lisa, I absolutely agree that choosing to vaccinate yourself or your daughter against HPV is a valid choice. What I question is the right of the state to make that choice. Unlike measles, mumps, etc. one does not happen in to HPV exposure through casual contact. It is not a public health issue in the same way. I may very well recommend my daughter receive the vaccine. I just want that to be my decision or my daughter's decision. A young woman who is living a chaste life is at extremely low risk for contracting HPV. The vaccine itself is not risk free though current reports show only one report of a life-threatening response. There are also other options. HPV DNA typing is available and is a simple test done at the same time as a pap smear. If a woman did not receive the HPV vaccine but has concerns that she could have been infected, she can ask for this test to be done. Deaths from cervical cancer at this time are primarily in immunocompromised women, most notably from AIDS, and in older women who did not have regular pap smears in their younger years. Routine pap smears will usually detect pre-cancerous or early cancerous changes so that treatment can be initiated in these early stages and full recovery is expected. HPV vaccine does not remove the need for continued pap smears.

Bottom line for me is this is an individual choice. There is not enough of a public health risk to make it a government mandate.
Catholic Mom said…
I don't know why blogger called me anonymous?! I'm signed is as Catholic Mom! That last long comment was from me.
Anonymous said…
To Catholic Mom,

Thanks for your very thoughtful response.

You are right that HPV isn't transmitted by casual contact but at least 50% of the population will get HPV and about 80% women get it by the time they are 50. So even a young woman leading a chaste life who eventually gets married still has a decent chance of finding a spouse who *does* have HPV. While you may be able to teach your daughter the skills she needs to make specific life choices about sexuality, you will not have control over *who* she marries and what his past choices were. And even chaste women can be raped.

I am a physician, too. HPV testing is not an adequate replacement for the HPV vaccine. In addition to deaths, we are also preventing women from having to have repeat biopsies and colposcopies, cone biopsies, LEEPS, and the hysterectomies, radiation treatment and chemo that are cancer treatments. I've seen women who haven't had children yet need to have a hysterectomy for cervical cancer. These outcomes are also worth preventing. For my daughter, for your daughter and for all daughters.

Our actions as individuals and as families can affect the whole society. We may never get 100% of the population vaccinated but the more people who are vaccinated, the fewer people will ever get HPV. The fewer people who get HPV means fewer people can spread HPV. When you reach a critical mass of people who are vaccinated, a stray virus has no where to go. (It's called "herd immunity" in public health). This is how we were able to elimiate polio in many areas. In Africa, when religious and political leaders told people to stop getting vaccinated--there was a resurgence of polio.

So, if you get your daughter vaccinated--it not only helps her--it contributes to the greater health of the society. If vaccination is mandatory, it will be less likely that your daughter will get HPV from her husband.

Cancer is most certainly a public health issue. We have the capacity to safely prevent most cervical cancers with a vaccine. We also have a moral responsibility to prevent and relieve human suffering. Why, do you think, as individuals, as parents, as a society, would we choose not to do that?

Catholic Mom said…
I don't mean to be argumentative, but I do not think the case is made for mandatory vaccination. I think there is a very good case made for individuals to choose to be vaccinated. The statistics quoted of 50% of all people get HPV and 80% of all women get HPV by the time their 50 are very misleading. This refers to all of the numerous subtypes of HPV, including those that cause no discernible disease. Many women contract HPV and their healthy immune system clears it without any consequences. The HPV vaccine addresses only the 4 subtypes that are associated with cervical cancer--6,11,16, and 18 with types 16 and 18 accounting for 70% of the associated cervical cancer. The incidence of infection with these subtypes is far less than the 50% and 80% quoted. Another good discussion of this topic can be found at Dr. T.P. Collins' site.

So as a physician, I would feel comfortable recommending this vaccine to my patients, just as I recommend women have pap smears, mammograms, cholesterol testing, bone scans, etc. I am just not convinced this is an issue that the "nanny state" has to poke its nose into.
Roci said…
Thanks for your comments on my site. I agree with your points.

At my site, I was particularly interested that the news reporting of this ignored all of these points and focused only on the abstinence issue.

Of course your definition of public health issue hinges on how you define causal contact. It seems that sexual activity in DC schools is rampant enough to qualify as casual. Not your problem If you are not from around here.

I also note that your commenters who are worried about chaste women getting HPV from their husbands are not advocating manadatory vacinations for men too.

And why limit it to public schools? Why not the entire adult population? Wipe out the disease in one generation.

I think that DC city residents are possibly a special case where the nanny is required. They seem to be unable to competently run their own lives on a lot of issues.
Anonymous said…
Roci, all men/boys and women over age 26 (or under age 9) cannot have the vaccine... yet.. until the FDA approves it. Only women/girls from 9-26 can receive it. Otherwise, I think we would advocate that everybody gets it. I don't like the idea of 'mandatory' anything from the government, but I wish we had this vaccine years ago.
I am one of those women over 26 with a husband that can transmit HPV. He feels bad about the choices he made in his youth and it definitely affects us every day. Fortunately, I have always had normal pap smears, but I wish I could take the vaccine.
Anonymous said…
Just because you are over 26, that doesn't mean you can't get the vaccine. It just means that insurance probably won't pay for it and that the FDA isn't recommending it yet which means that the vaccine company can't recommend it yet. But honestly. There's no major difference between an 24 year and a 28 year old. There's no concern that the vaccine will hurt you and no proof that it won't help you. Remember that only three strains of HPV are in the vaccine however.

I believe the cost will be $200 per shot, and you need three shots in all. I'm just an internist, but I know a couple gynecologists in their 30s who are planning to get it soon. They both are single and say they can't trust their eventual partner won't already have HPV.
Anonymous said…
I have to say that I feel this has become a religious moral question when it is one of health. We have finally found something to prevent cervical cancer. Thank God for that! The responsibility is ours to teach chastity to our youth. The ignorance around this vaccination is disgusting. I wanted to wait until marriage for sex. I was raped & because of the rape I had to deal with HPV & cervical cancer. I didn't have a choice with this - the choice was taken from me. If the vaccination was around when I was young I would not be dealing with this. The rape was bad enough - now I have to deal with cancer. Your daughter may not have a choice if God forbid this happens to her. Be smart & use this God Given scientific discovery. I thought I would never have to deal with this but now I do. You may think your daughter may never have to deal with this & I hope she never does but if she does, you will wish you gave her the gift of this vaccination
Anonymous said…
I am SHOCKED that they are making this mandatory!!

First, it was legalized abortion, then hepatitis B vaccines (a vaccine against an STD), and now in the pretense of 'saving lives' they are once again priming up our little girls -- from an earlier and earlier age at each evil step -- for vaccination from yet another STD. It is as if it is all to ensure that these young girls will be available 'toys' to be used and abused by those "enlightened men" waiting in their dark corners to sexually exploit them!

We can't let this slide. It is our duty to fight this -- and win.

Jonathan said…
I think that the statistics on Cervical Cancer rates versus population leave something to be desired in terms of the marketing of this vaccine as a cancer-preventative. I've posted a bit more extensively on my own blog, but the 10-14 year old population of Texas in 2005 was a little more than 800,000. The 2005 cervical cancer rates of women in the United States was expected to be roughly 10,000.

Besides this being more of an HPV prevention than a cancer-prevention (whatever the marketing), what is the prudence of spending this money in this way versus directly on education, versus education about HPV and what it can do, versus food for the poor, or whatever else? I am willing to bet that there are no such studies or considerations by the Texas Governor.

Catholic Mom said…
Dear Anonymous,
Your experience of rape and cancer is horrific and tragic. You are certainly in my prayers. Your experience is also very rare. The issue here is not whether or not this vaccine can prevent a scenario such as yours. The issue is whether or not this is a public health issue that merits a government mandate for the vaccine. Every parent has the option to bank their child's umbilical cord blood in case their child were to subsequently develop leukemia. There is no risk to the child in doing this. Most choose not to take this precaution because they calculate the risk is low and the cost is high. I think parents should be allowed to make this same risk assessment for their children when it comes to the HPV vaccine. What are the risks of contracting HPV vs the risks of the vaccine and the cost of the vaccine. We are only six months into the safety profile for this drug so it seems a bit premature to mandate it. Considering how many drugs have recently been withdrawn after release due to safety issues, let's watch how this drug does in those who voluntarily choose to take it.
sophiemichaels said…
I believe (what a lot of doctors and smart politicians are saying already). It's not smart to legislate it. Because people like the people on this blog will use that as an excuse. People who are generally against sex without consequences, but who are intelligent and want to make a more modern and reasonable argument, will be able to say it's a government intrusion issue, rather than a "we don't want to lose one of our deterrents to immoral unchaste behavior!" situation.

It's a lot easier to get the kids to buy the "it might turn green and fall off!" argument than the religious one. If birth control keeps them from getting pregnant, and we fix the disease situation, the abstinence battle becomes much harder to fight.

I would much prefer that my daughter not have sex until she's an adult. I just think the disingenuous lengths that the chastity people go to manipulate the kids is just silly.
Barb, sfo said…
I am reading, and learning....

Correct me if I am wrong--it will prevent SOME cervical cancers but not all. And only SOME cases of HPV will cause cancer, not all...
Catholic Mom said…
you are right. There are hundreds of subtypes of HPV. Only four are associated with the vast majority of cases of cervical cancer. The vaccine targets these subtypes of HPV that are linked to cancer. Non-cancer causing HPV is linked to venereal warts and the vaccine does nothing to prevent those. If you get the vaccine you still have to get pap smears. The vaccine increases your odds that your pap smears will always be normal.

Here's something to think about when listening to drug companies. Remember they are trying to sell you something. If you listen to Merck, being diagnosed with cervical cancer leads to all kinds of horrendous outcomes. If you listen to the folks who sell cervical cancer treatment they will tell you effectively treating cervical cancer is a piece of cake. The truth is somewhere in the middle.If a woman is getting regular pap smears any cancerous changes would most likely be detected very early and treatment is fairly simple. When companies start spouting about the cervical cancer death rate they need to specify how many of those deaths were in patients with a complicating illness like AIDS. That is the population that is suffering the most deaths from cervical cancer today.

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