The Scientific Activist

This week’s New England Journal of Medicine is a virtual smorgasbord of articles on HPV (human papilloma virus) vaccination. Although HPV also causes unsightly genital warts, HPV is more or less the sole cause of cervical cancer. I’ve written quite a bit here about Merck’s HPV vaccine, Gardasil, since a February 2007 executive order by Texas governor Rick Perry made the vaccine mandatory for sixth grade girls in the state but was subsequently overturned by the state legislature (and Perry announced just this Tuesday that he would not veto the bill, which had been passed by a veto-proof majority).

Not surprisingly, ScienceBlogs has been all abuzz since the NEJM issue came out. Here’s the rundown of the issue:

  • An editorial in the NEJM summarizes the issue and the relevant articles.
  • A clinical trial finds the HPV vaccine 100% effective at blocking disease caused by the four strains of HPV it protects against, and it finds the vaccine 20% and 34% effective at preventing all cervical and vulvar/vaginal lesions, respectively, caused by HPV in general.
  • Another clinical trial found the vaccine 98% successful at blocking disease from these four strains and 17% effective overall at preventing the precursor to cervical cancer.
  • An epidemiological study establishes a strong link between HPV infection and oropharyngeal (throat) cancer.
  • A letter to the editor outlines the legal justification for mandatory HPV vaccination.
  • Another article makes a more in-depth case for mandatory HPV vaccination.
  • An editorial takes a more nuanced approach.
  • A final article discusses HPV vaccination in developing countries.

In short, the vaccine is safe, and it is effective. It’s no surprise that it’s not 100% effective at preventing cervical cancer, given its limited scope. The fact that it prevents at least 17% of cases of cervical cancer should make its distribution a major public health priority. Given that its effectiveness decreases dramatically if there has been prior exposure to HPV, mandating it for sixth grade females is entirely justified. Also, given that HPV is so strongly linked to throat cancer, and given that males transmit HPV to females, vaccination in males as well should be a priority in the near future. All of this once again highlights the misguided nature of the Texas legislature’s decision to overturn mandatory HPV vaccination, and interested parties should continue to pressure the Texas legislature to reverse course.

Comments

  1. #1 roseindigo
    May 11, 2007

    Sorry, but mandatory vaccination is NOT OK in this case. HPV is a sexually transmitted disease, and it seems to me that sexual abstinence for boys and girls that young ought to be tackled before subjecting them to mandatory vaccination. Unlike smallpox and other diseases for which we require mandatory vaccinations, those diseases are not a choice exposure, whereas sexual activity is a choice. So the Texas legislature is quite right. When are we, as a society, going to grow up and take responsibility for our own actions, especially our sexual CHOICES. I take responsibility for my actions, and I am SICK AND TIRED of my choices or NON-choices being legislated by the government—any government.

  2. #2 Nick Anthis
    May 11, 2007

    Yes, and it’s also your “choice” if you want to live in a fantasy world where abstinence-only sex education actually works. In the real world, though, it doesn’t, and it’s absurd to allow a major public health problem to continue–when we could easily act on it–because of the hand-waving and moralizing coming from people in your camp.

  3. #3 Rich
    May 11, 2007

    It also dependent upon the sexual practices of the woman’s partner. Even if a woman abstained until marriage if her husband did not abstain himself she is at risk. So, here we have a case where the woman is responsible and she ends up dying from cervical cancer due to no fault of her own. Note the first editorial, “it appears necessary to vaccinate young women before they are infected with these two serotypes”. In other words the vaccine doesn’t work unless women are vaccinated before they are sexually active.

    If you are really worried that some girls will become sexually active because they are now protected from most HPV infections you are dealing with teenagers that are much more forward-looking than I know. It’s likely that these are the ones who would abstain anyway because there are plenty of other risks of being sexually active than just HPV infections. These are also the ones who deserve to be protected. I know my teenage daughter is getting vaccinated. I guess some fathers are more responsible than others.

  4. #4 Diana
    May 11, 2007

    You may do anything you like with your daughter…please keep your hands off mine. She will not be getting her executive order shots and it has nothing to do with making her horny. We are opting out for reasons of conscience. Thank you for calling it a moralizing decision, because that is exactly what it is. There is a reason why the Texas State House voted 135-2 and the Texas State Senate voted 30-1 to pass the legislation that rescinds Perry’s executive order mandating HPV vaccine For Texas middle school girls.

    State Rep. Dennis Bonnen (R), author of the bill, said, “The governor has missed the point (as have you Nick),” adding, “Just because you don’t want to offer up 165,000 11-year-old girls to be Merck’s study group doesn’t mean you don’t care about women’s health, doesn’t mean you don’t care about young girls”

  5. #5 Diana
    May 11, 2007

    So much for the free flow of ideas. Like Perry, the Scientific Activist apparently wants the mandate without discussion.

  6. #6 Jackie
    May 12, 2007

    @roseindigo

    Would you and your cohorts please stop it with the preaching? Not everyone agrees with your point of view. Teens have sex. I have sex. We all have sex! (Except maybe yourself.) Get over it. Now, please let’s vaccinate the little kiddies so they don’t get warts or cancer later in life. Thanks.

    P.S. – Nick, that’s a good point that males should get vaccinated, too.

  7. #7 Nick Anthis
    May 12, 2007

    Diana,

    I will point out here, once again, that Rick Perry’s executive order gave parents the option to opt their daughters out of the vaccination at any point. The vaccine would certainly not have been forced on anything. Honestly, then, I can’t see what the problem would be.

  8. #8 Joseph j7uy5
    May 13, 2007

    Sexual choice has nothing to do with the vaccine. With or without the vaccine, people’s sexual choices will be the same.

    The other angle is this: if this vaccine works as hoped, then every year it will save a number of lives comparable to those lost in the attacks of 9/11/2001. We seem willing to accept compromises in our civil rights in order to protect against another terrorist attack, and the odds of that are unknown. Why not make compromises to protect against disease, when the odds are known to be unfavorable?

  9. #9 Chelsea
    May 22, 2007

    “whereas sexual activity is a choice.”

    First, that’s amazingly naive. Sexual activity is not always a choice, especially for women.

    Second, should your daughter get a deadly cancer as a result of her engaging in sexual activity, even if it’s willing and you don’t approve of it? Personally, that seems a pretty twisted punishment to wish on one’s offspring.

  10. #10 Elizabeth
    May 23, 2007

    Excellent point, Chelsea. While the Guv’s motivation for the inital mandate (unfunded though it was) may have been monetary, it was the right thing to do. Abstinence edumacation is a joke whose punchline is confusion, pregnancy, and STI’s.

  11. #11 Axel
    May 28, 2007

    While I disagree totally with roseindigo and somewhat with Diana, I have to wonder about a situation – any situation – where the law obliges people to let a substance enter their bodies. The issue is not resentment of Merck, much less resentment of sex, but whether expert opinion trumps an individual’s ownership of his or her body.

  12. #12 Bill
    June 8, 2007

    I must say I was surprised to read that Gardasil prevents as little as 17% of cervical cancer cases, (if I havent misunderstood something). I thought it was far more effective than that.
    If it isnt all that effective, why should it actually be compulsory? Cervical cancer is not all that common and Gardasil, (I presume), is quite expensive. People like Nick have some pretty authoritarian tendencies about whatever he thinks is good for us.

  13. #13 Nick Anthis
    June 8, 2007

    Cervical cancer is in fact fairly common, so the real question is why wouldn’t you want a vaccine that can prevent 17% of cervical cancers?

  14. #14 ?????
    October 18, 2007

    Excellent point, Chelsea. While the Guv’s motivation for the inital mandate (unfunded though it was) may have been monetary, it was the right thing to do. Abstinence edumacation is a joke whose punchline is confusion, pregnancy, and STI’s

  15. #15 العاب
    October 16, 2009

    great article thanks for that… but its prevent at least 17% little one..but its good one thanks again…http://games.m5zn
    i love it

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.