Tuesday, May 29, 2007

Gardasil versus condoms

I have watched the arrival and deployment of HPV vaccine with mixed feelings. I celebrate the vaccine's existence. I know several women who have had cervical cancer. I like knowing that other women may be spared that trauma.

My conflict comes over the CDC's recommendation that all girls be immunized before starting sixth grade and some states' legislation proposing vaccination be mandatory (so far only Texas has enacted such legislation).

This flows from acknowledgement of HPV as a sexually transmitted disease. Granted, girls/women bear the risk of cervical cancer, but why should they be the only ones vaccinated. In fact, couldn't prevention of disease transmission be achieved just as well by mandating immunization of all boys? [note: I am talking about heterosexual activity here because that is what I assume legislatures are also considering.]

The desire to "protect" eleven-year-old girls from a sexually transmitted disease is admirable. But it raises two issues:

1. Why all the interest in HPV?

We don't mandate, or even recommend, that eleven-year-old boys carry condoms, which are effective against all STDs AND pregnancy, to0. In fact, as Little Red Hen notes, one cannot even distribute free condoms outside New York high schools.

We don't mandate or recommend mandatory use of birth control pills, which would protect girls against unwanted pregnancy (which affects far more girls and women than cervical cancer).

Is it that the thought of a girl with genital warts is more disturbing than that same girl with an unwanted pregnancy? Or that the risks of cervical cancer down the road are more grave than the risks of HIV? This does not make sense.

2. Why intervene in girls' bodies more than boys?

This one is easier. I think it is much easier to think of girls as victims, as timid creatures needing protection. Sexually active boys and girls run similar risks of disease transmission. But boys are almost expected to not only have sex but to inadvertently spread disease as part of it. Those rascally boys, with their herpes and genital warts. Best to do what's best for our daughters and give them extra protection.

How about injecting the boys and empowering our daughters to take control of their own sexuality and health?

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Blogger kristina said...

GREAT point about the condoms.

Point three might be that this is a new vaccine - many parents choose not to vaccinate because little is known about the long-term effects.

3:37 PM  
Anonymous Nev said...

The one thing that never seems to come up is that a woman could be assaulted and contract HPV. All that's ever discussed is promiscuity, sex before marriage, and abstinance. I think we do a grave disservice to younger individuals by ignoring the STD's contracted via assault--or when a faithful individual unknowingly has an adulterous partner. This is why I think the vaccine is a good thing.

This is a vaccine that could potentially prevent cancer. If the method of transmission were anything other than sex, there would be no argument about mandatory innoculations. It's unfortunate that it touches on the Stats' puritanical streak. Anything vaguely related to S-E-X causes such an arm-waving ruckus, that the original idea gets lost in the all the squawking.

3:48 PM  
Blogger fpmama said...

I think if sex were taken out of the equation, there would still be question about mandatory vaccination. The vaccine is effective against 2 of the strains which cause cervical cancer. Those strains are believed to cause about 30% of cervical cancer. That makes the vaccine at best 70% effective, not the nearly 100% the manufactor quotes (to be fair, it does appear to induce great response, nearly 100% immunity, to those strains.) Pap smear frequency and what treatment is done for an abnormal pap would not change. We are not sure if the immunity is long lasting yet. And the initial studies were relatively small - especially with regards to preteens and young teens, only a small study to determine antibody response is available for them, no long term data yet to know if the vaccine will even give long term immunity to these girls.
Pap smears can pick up early cervical dysplasia and prevent cervical cancer and cervical cancer deaths.
I can understand why many parents are not yet jumping on the bandwagon with this vaccine. No professional organization is encouraging mandatory vaccination at this point, either. With so much uncertainty, I'm quite comfortable leaving the decision making up to individuals, and individual parents for their minor children

11:04 PM  
Blogger fpmama said...

Arrgh, no way to edit. It should read that the two strains cause about 70% of cervical cancer, not 30%!

11:05 PM  
Blogger This Girl said...

fpmama is right about the risks. It is the mandatory part that has many up in arms. Especially when they are talking about their own family's views of sexuality. You have to assume the vocal parents are talking to their children about this issu. And it should be offered, and paid for, but it should not be mandatory. In Australia, they are trying to make it mandatory and NOT requiring parental consent. Something like that wouldn't be far behind. And despite how well condoms may work with other diseases, it is not very well suited for this one. That is why Gardasil is the highest recommendation (despite being not very useful in the long run either). But school age children shouldn't be encouraged to engage in sex. Every effort should be in delaying sex until kids are of the age to have it. For anyone who has had sex and gotten HPV, Gardasil is not nearly as effective, so the sexually assaulted, the women with adulterous mates, or the women who engaged in sex without knowing the risks do not get any more help than if the vaccine didn't exist.

2:52 AM  
Blogger T$ said...

I'm sorry, call me cynical, call me a conspiracy theorist, but I really feel like its the phama companies lobbying lawmakers for this mandate. This vaccine is EXPENSIVE. And the big pharm companies stand to make tons of money on this. I have a 6 year old daughter and I am watching and waiting to see what happens with this. I agree, we don't know the long term effects of this vaccine. My kids both had the chicken pox vaccine when they were little, and still came down with chicken pox this winter.

I am leaning toward not vaccinating my daughter.

9:14 AM  
Blogger Diane said...

All the previous manditory vaccines are to protect children from things they can catch by sitting in class with other kids. All this vaccine does is protect the manufacture's bottom line profits. Long term effects? Unknown. And some states are deciding that all girls must have this? Please stay out my by business.

9:19 AM  
Blogger p said...

You're reading too much into this. The vaccine is being used on girls and not boys because it's only been shown in clinical trials to lower the risk of HPV among girls. The studies on boys should be concluding soon and since they'll show it works on them too, vaccinations on them should be made mandatory as well.

I don't know enough about the cost/benefit analysis of this to say whether or not this makes sense. How many deaths would it prevent? What's the value of those lives vs. $300 for a vaccine for millions of people? I'd hope (and assume) someone has done the math.

Oh, yeah, a quick google search brings up: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15550200

Which, incidentally, says that including males in HPV vaccination isn't cost effective.

10:08 AM  
Blogger p said...

Ooops. busted link.

10:09 AM  
Anonymous Spincerely said...

This is a great conversation. I am going to choose for the time being to not have my children vaccinated (currently ages 12, 10, and 8). I think the vaccination needs to be proven first as something safe and truly needed and not just a way for Merck to make money. I have considered the question of what if they are assaulted, but they can be tested and screened and they will just have to be more careful to keep up with their pap smears when they get older. I think HPV will be the least of their problems if they are assaulted. Plus cervical cancer detection methods are also improving. Now what we can really use is a Lyme Disease vaccination. That I would gladly pay $300.00 for -- just to get some sleep at night!

11:59 AM  
Anonymous Nev said...

Well, arguments against the vaccine in regards to efficacy, long-term effects, big pharma, etc I don't take issue with. It's just those who argue "Increased promiscuity!" and then cover their ears to further discussion that I'm taking issue with. ;)

12:00 PM  
Anonymous naomi dagen bloom said...

here's my bottom line as a 73 year old grandmother to two girls. if you lived through the celebration of the safety of birth control pills, the IUD, and estrogen replacement, i hope you too would be guarded about this vaccine. it has hardly been tested.

what keeps american women from demanding more information, of being in charge of the agenda for their bodies?

5:35 PM  
Anonymous Anonymous said...

To offer another perspective, if this vaccine had been available during my childhood I would not have had that abnormal pap smear and subsequent colposcopy back in my twenties. While I'd have missed that load of fun, I'd also have ducked out of the resulting cervical adhesions that three days of labor, manual stretching and a hospital transfer with a pitocin cherry on top couldn't dilate past halfway. I'd have missed out on the wonderful experience last year of combining new parenthood with abdominal surgery.

I plan to vaccinate any kid of mine, regardless of gender, against HPV just like I'll vaccinate them against tetanus.

*scratches belly scar and grins*

6:09 PM  
Blogger Schmid4Brains said...

personally i'm not surprised that texas is the front-runner here. i don't really have anything else to add as it seems everyone has already made very clear and detailed points regarding this issue.

i think nev said it best with, "All that's ever discussed is promiscuity, sex before marriage, and abstinance." this is a socital issue that won't be resolved until we come to our senses and realize that sex isn't something to be ashamed of. i don't know if that furthers the discussion, but i completely lost my train of thought as my boss walked into my cube and asked what i was doing.


1:36 PM  
Anonymous Anonymous said...

Gardasil versus condoms is a completely irresponsible take on the issue. People (boys and girls/men and women) can catch HPV even if condoms are used. HPV can even be spread during activities that do not require sex/penetration. This is why it is so scary. Thank goodness Gardasil was invented. Everyone who can should be vaccinated. I can't believe the uproar about something that actually helps to prevent cancer.

5:25 PM  
Blogger doulicia said...

nev, I agree that assault is worth considering it. For that reason it seems that universal immunization would be the way to go, not just girls.

However, if what p says is true -- that it's ineffective (or just cost-ineffective?) to vaccinate boys -- then perhaps girls only is the way to go.

I just think that it's always worth considering larger societal norms, stereotypes, etc. that may factor into health policy decisions.

9:53 AM  

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