ShareThisHere we go again: The pharmaceutical maker Merck is seeking approval from the FDA for boys as young as 9 to get the Gardasil vaccine, which prevents some strains of the Human Papilloma Virus (or HPV), a virus spread during sex which, in turn, can cause cervical cancer in women.
Follow?
This is not a case against giving kids of either sex the vaccine for reasons of principle, though such reasons might suffice. The vaccine, targeted to children and very young teens, is new. (We don't even know if it will be effective beyond 5 years or so.) So, giving it to my child? No.
And doesn't giving kids the vaccine -- hard to do "secretly" since it takes three separate doses during a time kids are not being routinely vaccinated -- communicate that we expect our kids to behave sexually? Could a child easily think, despite a parent's best efforts to communicate otherwise, that he's protected in ways he is not after having "the vaccine"?
Of course. These are kids.
But what really outrages me is that encouraging the routine vaccination of children and very young teens with Gardasil, a push happening now, makes no sense from a public health standpoint.
Let's review:
There are about 40 different strains of sexually transmitted HPV, and while the Gardasil vaccine protects against some of the most problematic ones, it does not against all of them.
Anyway, most sexually active people will get HPV at some point. And the body typically clears the virus on its own. In maybe ten to twenty percent of cases, that won't happen. And some of those cases in women will go on to become cervical cancer.
By the way, while HPV can, rarely, lead to certain genital cancers in men, circumcision greatly reduces such risks, but that's another column. (Actually "circumcision" goes on the list of "topics I will never write about" which in itself may be a column.)
Let's keep going. Cervical cancer is almost always curable when caught early, and an extremely effective, easy, and relatively inexpensive test to detect it, the pap smear, is routine. (The vaccine protects against less than 80 percent of cervical cancer cases, which is why the pap smear is still a must, even after the vaccine. Do most women know this?)
Still, cervical cancer last year afflicted more than 11,000 American women and almost four thousand died of it, because the cancer wasn't detected early. Truly a tragedy.
But now let's circle back. For starters, the series of vaccines, which may not give long-term protection, costs $360. Very expensive compared to other vaccines. No wonder Merck loves it, and would like insurance companies to pay for it. Last year alone, in targeting only half of a very young population, it generated more than $1.5 billion for Merck.
So, there are billions -- yes, billions -- of dollars to be sucked out of our health care system to pay to help prevent a disease which is relatively rare, easily detected, and almost always curable, if found early. And consider that almost certainly the same people "responsible" enough to get the vaccine for themselves or their kids will be the same ones having the annual pap tests to begin with.
Yes, any particular individual may be helped by Gardasil. Yes, young adult women and men might want to consider the vaccine, particularly before becoming sexually active.
But from a public health standpoint, to encourage expensive, widespread vaccination of children with Gardasil, as is currently the case? It makes no sense. Or cents.
How about doing something really helpful, and instead spending a fraction of those billions to get women at greatest risk, who aren't likely to be the ones getting Gardasil anyway -- the poor -- a pap test on a regular basis? Why not spend the balance to perhaps fight childhood and adult obesity, now the second leading cause of preventable death in the U.S., claiming some 300,000 lives a year?
In other words - gasp! -- can we please do a public health cost/benefit analysis here?
Apparently not. Too often in recent decades when it comes to public health issues in the U.S., and very often when it comes to public health and sex, we simply lose our senses -- and our cents.
(Betsy Hart hosts the "It Takes a Parent" radio show on WYLL-AM 1160 in Chicago. Reach her through betsysblog.com. For more stories, visit scrippsnews.com.)
FROM THE HART
Let's Get The Information Straight!
We need to get some information straight here.
Approval of Gardasil is about breaking the vectors of transmission of the disease. Simply put, if enough people are immune to the virus, it simply expires because the vast majority of people will not come in contact with an infected person.
While there are many strains of the virus, the vast majority of them are innocous and do no harm. Gardasil addresses most of the harmful ones.
The National Campaign for Cervical Cancer and HPV states that 97% of people with HPV infections will develop a natural immunity to the virus. However, while that natural immunity is developing, they are contagious. Gardasil interveins during what would be the contagious stage and stops transmission during this stage.
Circumcision *may* avert genital cancers in as many as 1 in 1 million men but that issue is cloudy. Nations with essentially zero circumcision rates have male genital cancer rates significantly lower than The US. The American Cancer Society gives male circumcision no value in preventing genital cancers. Statistics show that for each case of easily and permanently treated case of genital cancer avoided by male circumcision, 6 infants will die of the circumcision procedure. That is a poor treatment record!
Circumcision has not proven to be effective in stopping HPV infections. It is estimated that more than 80% of sexually active American men have been circumcised yet it is also estimated that 70% or more of them have had an active HPV infection at one time or the other.
The vaccine is effective. Circumcision is not. The cost is roughly equivalent. No one dies from receiving the vaccine.
While the vaccine may have generated $1.5 billion for Merck over several years, male circumcision generates almost a billion dollars in revenues *each year.*
Male circumcision "sucks" far too much money from the healthcare system for no benefit. Gardisil is an intervention that works. Like the polio vaccine, it holds the promise of wiping the HPV virus from the population in a single generation with widespread use. Remember, the polio vaccine is only 70% effective and wiped the disease from the landscape in a single generation. Gardasil can do the same thing for HPV.
Obesity is a behavorial issue and spending money to fight it is just throwing money down a black hole. There is no end point of such a campaign. Conversely, Gardisil could wipe the disease from the population permanently. Cost/benefit analyses don't work for obesity but they do work for Gardasil.
too tempting...
You're right, the same sliver of people that are at risk for cervical cancer because they do not get routine paps is not likely to utilize the vaccine.
However, I am not sold on this being a drug company push alone- I think the fascination is a vaccine that tackles cancer. When so many other efforts in cancer prevention often fail and treatment effectiveness is variable- it is too tempting to pass by a vaccine that could give cervical cancer a KO punch.