White Coat Underground

I used to teach at a hospital downtown. While on rounds, I’d often ask my residents and students where they were born, and get answers such as, “Alabama”, “Kerala, India”, “Damascus, Syria”. Inevitably, they’d ask me where I was born, and I’d point to the floor and say, “Right here”.

“You mean in Michigan?”

“No,” I’d explain, “I mean right here in this hospital.”

So I have a certain pride about my hometown. I like Detroit, and although I, like many others born there, don’t live in the city, I always hope for a recovery. So it saddens me whenever I see news stories that paint my natal city in a poor light. Whether it’s a focus on the execrable city government that’s never met a bad decision it didn’t take, or the crime, or the sexting ex-mayor, these stories dominate the headlines. We see less often stories of citizens who take over vacant properties and create neighborhood gardens, or neighborhoods where average house prices of less that 10K are bringing artists back into the city. Still, sometimes, our hometown media are our own worst enemy.

I’ve lived in a lot of different cities and watching the local news often gives you a feel for the sophistication of a place. In San Fran, in Chicago, the local TV news reports were very different from each other, matching the west coast and third coast sensibilities, but both often broadcast well-produced stories of local relevance.

And since Detroit has plenty of goings-on of local relevance, it’s just a wonder to me that WXYZ-TV would broadcast another horrid medical scare-piece. (H/T Orac)

It’s nominally about Gardasil, the HPV-cervical cancer vaccine, and entitled (perhaps predictably), “Are You or Your Daughter at Risk?” Rather than exploring the risk of HPV-related diseases…well, let the reporter tell you:

When it was first released in 2006, it sounded like a real medical breakthrough. Gardasil has the potential to prevent 70% of cervical cancers. But the question is: Does it cause problems that are just as serious?

The answer is clearly “no”, but there are still reasonable controversies surrounding the vaccine, such as whether or not it should be mandatory. Still, this report is even more horrible because of some important demographics. The city of Detroit is about 82% African American (and depending on whom you believe, perhaps more). Cervical cancer, the disease that the vaccine is intended to prevent, is much more common among Black women than White women (12..6 vs 8.4 per 100K). Combine that with the fact that Detroit has a spectacularly high rate of sexually transmitted diseases (STDs)*, and this report is more than wrong, it’s irresponsible and dangerous.

Combine idiotic “both side-ism” reporting with foolish “abstinence programs”, and pour that over an impoverished minority population with unemployment rate in the 20% range, and channel 7 is simply pouring gasoline on tinder.

Our highest risk populations deserve our best public health and public health education. If a reporter wants to help “save” Detroit and do a story on STDs, maybe she should focus her energy on finding ways to combat STD’s in Detroit through providing real information in prevention. But that’s probably too much to hope for.

_________________________

*For example, national syphilis rates in 2007 were 13.7 per 100K. In Detroit the rate was about 29 per 100K.

Comments

  1. #1 The Blind Watchmaker
    April 25, 2009

    Where are the experts who actually can interpret data? They should be on T.V.

    Why is it that people who actually know what they are talking about are the one’s the public is least likely to hear?

    I guess we can expect more of this B.S. soon. May is “sweeps”.

  2. #2 Eric Jackson
    April 25, 2009

    This has become something of a pet peeve of mine: the Gardasil hysteria.

    Much of this seems to stem from material initially put forth by a group called Judicial Watch, an extreme religious right organization I can’t quite characterize properly. While it promotes itself as being devoted to an open government, uncovering corruption and the like, it acts like a muckraking service that digs up dirt and harasses anyone to the left of Mussolini. Their report on Gardasil (http://www.judicialwatch.org/documents/2008/JWReportFDAhpvVaccineRecords.pdf) reads like something put out of Generation Rescue’s wet dreams. Statements and claims range from grandiose to outright false, such as claiming that the New England Journal of Medicine disapproves of the vaccine. The NEJM was the journal that published the FUTURE II study of 11,000 women over four years with which the vaccine was approved, and has published a great deal of discussion that praises the vaccine and discusses implications in how to use it (PMID: 17494925).

    The central theme of the document and subsequent material posted is that the organization acquired all the documents through the Freedom of Information Act, and while they certainly did acquire some material such as internal documents related to approval, they also present VAERS data. The VAERS data is presented in such a way as to imply that it was release through an FOIA request, and the implication being that there is some vast conspiracy to approve the vaccine and distribute it while covering up the horrific baby-killing side effects. The incidents of death are presented as being directly caused by the vaccine, including several that are obviously not, contain hearsay and speculation, or flat out no information at all.

    When the CDC investigated the reports of deaths they found that none of them were related to the vaccine, and all had conditions prior to vaccination, such as insufficiency of multiple heart valves, unmedicated epilepsy etc that caused such deaths. Unfortunately the CDC just redid their pages on Gardasil and my bookmarks are no longer valid. If someone can find this info and post a link, it’d be appreciated.

    Most of the media paranoia comes directly from the above material. It’s been reposted and recirculated, and some newspapers have printed stories of single cases of medical trainwrecks that people are claiming were caused by the vaccine. Their evidence for the vaccine causing such cases is always the statement of a parent, placing the full blame of a variety of illnesses solely on the vaccine.

    There are few things uglier than cervical cancer. It’s neither one of the nice cancers, nor one that there is a spectacular success rate in treating. It doesn’t use easy chemo, if often requires hysterectomies. And yet the causative infection is almost exclusively transmitted by sexual contact. Given that Judicial Watch, and other organizations relate to it such as the American Family Association have spent most of the last few decades fighting anything that makes sex safer, from condoms, to the Plan B pill, to birth control, going to the point of spreading outright misinformation, lies and propaganda, I find the idea that these organizations are foaming on this issue in the name of purely health and safety somewhat suspect.

  3. #3 RMM Barrie
    April 26, 2009

    Unfortunately the CDC just redid their pages on Gardasil and my bookmarks are no longer valid. If someone can find this info and post a link, it’d be appreciated.

    Try here and here

  4. #4 RMM Barrie
    April 26, 2009

    In 3, just checked the link and did not work. Back to the old fashioned way which still does not embed, but it can be copied and pasted:

    http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm

    http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct08/12-3-hpv.pdf

  5. #5 Karen
    April 26, 2009

    I’m curious. Do you believe that medical science is 100% right 100% of the time, and that we learn nothing over time and experience, and that all people react in precisely the same way to any medication or vaccine?

  6. #6 Eric Jackson
    April 27, 2009

    Karen: Of course not. Science takes time, repetition and continual work to improve upon. Relatively small changes in dosing, indication, or monitoring can have quite a bit of impact on the success and usefulness of any medication or procedure. Doxil, or Emsam are two wonderful examples where mediocre or difficult to use drugs have been changed in formulation or route of administration to great end, despite the both of them being rather old. This of course, takes time and repeated experimentation.

    That said, the amount of research that’s been, for lack of a better word, lavished on the Gardasil HPV4 and Cervarix HPV2 vaccines is pretty breathtaking. At its release, clinical data was available from double blind placebo controlled studies with over twenty thousand participants. A followup study (PMID: 17544766) incorporated another sum 20,000 women. While of course the entire population doesn’t respond the same way to the same medications at the same dose, an extraordinary level of safety testing is required for vaccines, because they are administered to healthy people on a wide scale. Thus far, the safety data has been completely consistent from animal trials, through all three phases of human clinical trials (PMID: 18586311), and continued monitoring by VAERS and the CDC (thank you RMM for the links! Those are perfect.) agree with that as well.

    The criticism that it’s unstudied (see the above 40,000, and that was two years ago), or untested is groundless. The criticism that it’s ‘too new’ also falls rather flat. There’s been preclinical development of these going on since the early 1990s, and the vaccines themselves are nothing spectacular or revolutionary. They’re both recombinant virus-like proteins produced in a human cell line and purified using standard downstream processing. While they may be ‘new’ in the public eye, at the core they’ve been created by the same technology as the Hepatitis B vaccine in the 1980s. There’s nothing crazy involved like using transgenic herpes virus particles to deliver engineered peptides to MHC molecules.

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!