Regular readers keeping up on infectious disease issues might have seen Seth Mnookin's post yesterday, warning of an upcoming episode of the Katie Couric show focusing on the HPV vaccine. Even though Mnookin previously spoke with a producer at length regarding this topic, the promo for the show certainly did not look promising:
"The HPV vaccine is considered a life-saving cancer preventer … but is it a potentially deadly dose for girls? Meet a mom who claims her daughter died after getting the HPV vaccine, and hear all sides of the HPV vaccine controversy."
And indeed, reviews thus far show that unfortunately, Couric pretty much mangled the issue and allowed heart-wrenching anecdotes to trump science (reminiscent of Jenny McCarthy's appearance on Oprah). I won't cover it all (you can view it here), but basically Couric allows stories about illness and death in the weeks following administration of the vaccine to go unchallenged, and brings on Dr. Diane Harper as her HPV expert (featured prominently in the anti-vaccine documentary "The Greater Good"). Dr. Harper believes the HPV vaccine is over-hyped, and that Pap screening is "100% accurate" so no HPV vaccine is really needed. This, frankly, is hogwash. Even with emphasis on screening, here in the U.S. we have 12,000 cases and 4,000 deaths from cervical cancer alone each year. (And in Mnookin's post and in Matthew Herper's Forbes post, both note that head and neck cancers can also be caused by HPV as well--but have no good screening process).
Even when HPV cervical infections are caught via screening, the treatment ain't pretty. I've written before mentioning one such remedy--the LEEP procedure. I had this done several years ago, after a Pap smear came back with abnormal cells and positive for HPV DNA:
"Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleek, powerful, smoke-eating machine.” [And one gets to look forward to "coffee ground-like discharge" for up to several days following the procedure, due to the materials they use to stem the bleeding cervix]. After LEEP, side effects may include infection, hemorrhage and possibly cervical incompetence. These are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer."
Being currently pregnant following such a procedure, cervical incompetence was something I was carefully monitored for. Nevertheless, it's still been a huge source of stress throughout this pregnancy, as this is a significant cause of second-trimester miscarriage and there aren't great, foolproof ways to detect it, or remedy it if it does occur. Harper acts as if finding HPV via Pap smears is like rainbows and unicorns, but it too has a risk-benefit equation, and I'd so much rather have received a vaccination than to have gone through that. And, some women's treatments for HPV infections and cervical abnormalities are even more extreme than mine was.
This is why I had my now-almost-14-year-old daughter vaccinated for HPV, and why my pre-teen son will soon be getting his as well. There are multiple ways to prevent HPV-induced cancers, but the vaccine (in combination with routine Pap smears) is by far the least invasive and safest route, as multiple studies have confirmed.
Finally, the show was doubly disappointing because Couric has been such an outspoken advocate of colon cancer prevention, which was the cause of her husband's death in 1998. While realizing this is a fluff talk show and not the kind of harder journalism she's apparently now abandoned, she still failed to ask even the most basic of questions to the supposed HPV vaccine "victims" she featured on her show, nor to note during their segments that other possibilities may exist for the girls' illnesses and death besides the HPV vaccine. In the second segment, Rosemary Mathis even admits blatantly doctor-shopping until one would "listen to her" about her daughter--in other words, give her a new diagnosis (vaccine injury). Why isn't this even questioned? What did her previous doctors tell her about her daughter's condition? Couric allowed ratings and anecdotes to trump actual science, potentially causing real harm to the public health. How disappointing that this is now part of her legacy.
Dr. Smith, thank you so much for this excellent post. I really appreciate you sharing your personal experience that finding HPV by Pap smear isn't all rainbows and unicorns.
I'm equally disappointed in Couric, especially as a cancer researcher who was so impressed by her selflessness in promoting colorectal cancer screening after her husband's death. I'd submit that having a "fluff" show rather than a hard news program gives you *more* responsibility for having your information based in scientific facts.