"Its hard to debate this because its not grounded in evidence or rationality"

File this under 'Religion has nothing to do with morality'--

Some religions have a problem with a vaccine that, when dosed appropriately early enough, virtually eliminates risk of cervical cancer, as virtually all cervical cancer is caused by HPV.  Its even better if males get the vaccine as well, not only because if fewer males get HPV, fewer males can transmit HPV to females-- but also because the HPV vaccine might protect against non-cervical HPV cancers (which males can get).

I wish I was making this up, but some religions reject the HPV vaccine because it will turn little girls (its better to get the vaccine when you are young) into sluts:

“If we don’t attempt to change sexual behaviour that is responsible for transmission of the HPV, but attempt to solve the problem by getting a series of shots, then we don’t have to exercise self-control, nor develop virtue, but can use medicine to palliate our vices,” he [Bishop Frederick Henry] said in an email.

I assume The Bishop is also against cholesterol/blood-pressure medication, liver/lung transplants, treating colon or skin cancers, you know, medicine that 'palliates' vices like over eating, drinking, smoking, and getting a sunburn.

Well professional Catholics are entirely out of touch with reality-- who cares what some bishop thinks, right?

This 'some bishop' has been whispering in the ears of the educational board of the Catholic schools in Calgary.  I dont know much about Canadian schools, but I guess there are a series of religious schools in Canada that run off of public money.

Most of these schools have bucked the 'Catholic' rules and provided HPV shots for their students (kids are more likely to get all of the shots they need if theyre done at school-- Mom/Dad doesnt have to take off work, they dont have to have a car or get a taxi or ride a bus or get an appointment-- kid just has to show up at school).

Not Calgary.  Cause of The Bishop:

“In the letters from the physicians to the trustees, the word ‘children’ is used three times at least per letter. In the letters of response from the trustees they use the word ‘bishop’ three times per letter,” said Juliet Guichon, an assistant professor in community health sciences at the University of Calgary.

Thats just a roundabout way of saying the healthcare providers care about the children, and the school trustees care about The Bishop.  More:

“They have delegated their decision making to a non-elected official without expertise in evidence-based medicine or public health.”

...

Vaccination advocates said studies have found no correlation between the HPV vaccine and increased promiscuity.

“What we see anecdotally is that the children don’t jump into bed, they go out for recess. It’s hard to debate this because it’s not grounded in evidence or rationality,” Ms. Guichon said.

Guichon from a different article:

Dr. Juliet Guichon, whose family has been part of the Catholic system for decades, said the board’s stand is unconscionable.

When asked recently which school board she would fund, “I said don’t send my taxes to the Catholic system — I can’t support this, I’ve seen what do to a family without a mother,” said Guichon, who counts a close friend who attended the system who died from cervical cancer.

She said the worst medical consequences of the trustees’ opposition likely wouldn’t be seen for 15 years “and where will Bishop Henry be then?”

What is The Bishops response to this?

He [The Bishop] also suggested criticizing the decision [his decision] is a waste of time.

“Why don’t they spend their time trying to figure out an alternate way and site to vaccinate children?” he said. “Instead they would rather demonize those who don’t agree with their approach.”

He is in a position of influence, against the HPV vaccine (but not other medical interventions for other 'vices') for other people/their children, and he just doesnt understand why-oh-why these healthcare professionals are 'demonizing' him. 'Just go someplace else' he says to families that might not be able to go someplace else.

Id say he was a vicious, clueless, little man, but hes a Catholic Bishop, so...

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My father-in-law (when we were still on speaking terms) made this same argument. He actually went one further, though, and had the gonads to outright say that the risk of getting HPV and cervical cancer were a good deterrent to promiscuity.

You can't reason with folks like that.

By Optimus Primate (not verified) on 26 Jun 2012 #permalink

Unfortunately several Canadian provinces have publicly funded Catholic schools, http://www.onessn.org/
They have a history of discrimination against non-catholics, both when accepting students and hiring teachers and other staff. They have blocked any attempt at having gay straight alliances and still teach that homosexuality is sin, and have a much higher rate of suicide among gay teens, and now this. Looks like following the faith is more important, so who cares if a few kids die. Oh and that thing about being funded by only catholic tax dollars - you can specify non-catholic schools on your taxes, but it doesn't matter, they get the same per-student funding as everyone else, sometimes more. Canada has been called on to change this system by the UN and other countries, but there is no political will in the legislature. Any attempt at improvement is fought tooth and nail by the church, as they always quickly play the persecution card. So yes, Canada does have this backward discriminatory waste of money still in effect in some provinces.

The Canadian education system is a product of our history - the uniting of French and English colonies. As part of that process, our constitution ensures that in areas where French/Catholic are the majority there is an English/protestant secondary school system and vice-versa (both publicly funded; other religions get/got left in the dust). This has morphed into a system where the majority schools have become the public/secular system, but where the minority boards (where they still exist) retain their religious identity.

I grew up in Calgary, and this isn't all that surprising. The cathlolic board there was one of the more "conservative" in the country, and that hasn't changed. Hopefully, events like this will lead the province to do away with the separate board, but I'm not going to hold my breath.

His argument is, of course, idiotic. The idea that getting vaccinated predicates you towards high-risk activities is bogus. Tetanus shots don't lead us to jump on rusty nails. . .

Uh, I am not catholic but am having difficulty finding the evidence base for this vaccine that shows its efficacy matches up with the marketing.

By buckthetrend (not verified) on 26 Jun 2012 #permalink

Expanding on Bryan's comment @1354: Calgary is the primary commercial center of Alberta, which in terms of political and religious outlook is the closest thing Canada has to Texas. Alberta is also, not coincidentally, the center of Canada's fossil fuel industry, and home to Prime Minister Stephen Harper, whom a substantial minority of Albertans (so I hear) consider not right-wing enough. So I'm not the least bit surprised to see something like this pop up in Calgary.

By Eric Lund (not verified) on 26 Jun 2012 #permalink

Looking at it from a cultural perspective, I'm thinking this is another example of a religious figure representing an authority status quo. Biology disrupts that status quo, whether it be the reality of our sexuality or evolution or what have you. And that's a good thing! It's a good thing for all of us who believe that we should always look for a better way or that which is right! If this Bishop assumes he already has the answers, he won't change. It is up to the rest of us to take the cultural power away from such individuals.

A candle in the dark, indeed.

Please check your sources. When I went to the doctor, the information I was given for this specific HPV vaccine specifically stated that it only protects against ONLY 2 particular HPV strain s and eliminates cervical cancer caused by those 2 particular strains. In no way does it "virtually eliminates risk of cervical cancer". The church people are overstating the moral implications of this drug, but you are way over-stating the health effect of this drug as well. And to be honest, if you did just a little bit of research on the vaccine, you will know not all doctors/nations approve of its medical efficacy.

By Sleepy Cat (not verified) on 26 Jun 2012 #permalink

Optimus #1 - food poisoning is a good deterrent to eating, and bronchitis is a good deterrent to breathing.

Sleepy Cat
There are two popular HPV vaccines out there, one that protects against the top two HPV strains associated with cervical cancer, and one that protects against those plus the top two HPV strains that do not cause cancer, but do still cause the most genital warts. The vast majority (roughly 85% - PMID: 19115209) of HPV-associated cervical cancers [keeping in mind that there are very few instances of cervical cancer not associated with HPV] are caused by these top two strains of HPV, which is why there are "only" 2 strains included in the vaccine. (The remaining cancers are caused by a large number of other strains with very little predominance, and thus far we aren't able to make a vaccine to cover so many different strains of the virus.)
I would also challenge you to carefully evaluate the motives and background of those doctors and nations that you've encountered who do not approve of its medical efficacy.

Sannica, there is an issue though with being given the vaccine if you have a pre existing HPV infection because it puts the cervical cancer risk up. Why is there no pre testing being done.

Surely if we were being balanced with scientific enquiry we would be evaluating the motives and backgrounds of those promoting this vaccine considering the huge financial factors and usually public money.

By buckthetrend (not verified) on 26 Jun 2012 #permalink

Uh Primate, the study you quoted followed women aged 15 to 25 for 6.4 years. considering the average age of diagnosis of cervical cancer is 48 years and it is well known that even the most virilent strains are normally naturally eliminated in 2 to 3 menstrual cycles I fail to see how pubmed is my friend or this study has anything meaningful in it.

Surely the only way we will know if the vaccine works is to vaccinate a large number of girls way before they are sexually active and wait until they are 60! So I am still haven't read any current research that provides an EBM for this vaccine.

http://seer.cancer.gov/statfacts/html/cervix.htm

From 2005-2009, the median age at diagnosis for cancer of the cervix uteri is 48 years of age.

By buckthetrend (not verified) on 26 Jun 2012 #permalink

I think the god issue is a distraction to somehow try and stick this on anyone who is asking logical questions about efficacy.

Again I don't believe in gods, medical or otherwise.

By buckthetrend (not verified) on 26 Jun 2012 #permalink

"the risk of getting HPV and cervical cancer were a good deterrent to promiscuity. "

Beat the snot out of him and tell him that this is a good deterrent for being a pillock.

followed women aged 15 to 25 for 6.4 years. considering the average age of diagnosis of cervical cancer is 48 years and it is well known that even the most virilent strains are normally naturally eliminated in 2 to 3 menstrual cycles I fail to see how pubmed is my friend or this study has anything meaningful in it
2-3 menstrual cycles is 2-4 months; a 6.4 year follow-up, of people of a sexually active age is more than sufficient to determine if a vaccine reduces the incidence of chronic HPV infection in a vaccinated vs. control population. Since infection is a pre-requisite for development of HPV-associated cancer, we don't need to wait 20+ years to determine if there is a decrease in the infection-related cancers. Moreover, there are very early changes in the cervical epithelium which occur within months of infection, and are considered the preliminary steps in developing cancer.

But I think we can conclude that pubmed is your enemy, as it is providing data that runs counter to your beliefs.

being balanced with scientific enquiry we would be evaluating the motives and backgrounds of those promoting this vaccine considering the huge financial factors and usually public money
What "huge financial factors"? Vaccines are notoriously low-profit products, which is why most pharma companies have stopped producing them. It is far more profitable to treat the disease once it forms - the average cost for treating an average case of cervical cancer runs runs ~$50K, largely in drug costs. Severe (metastatic) cases can run well into the hundreds of thousands of dollars range. In contrast, vaccination runs about $300. Even taking into account the incidence rate of cervical cancer, you're still saving a lot of money using the vaccine.

And lest we forget - ~1 in 4 cervical cancer patients die as a result of their cancer (its 1:2 in developing nations).

What is the value of a human life?

Surely more than $300...

"What is the value of a human life?

Surely more than $300…"

For libertarians, if it's not their life but is "their" money, then no.

Of course, if it's THEIR life, then they damn well DESERVE all that free health care because they've "paid in to it".

Oops, where I wrote: And lest we forget – ~1 in 4 cervical cancer patients die as a result of their cancer (its 1:2 in developing nations).

cancer needs to be replaced with "cervical cancer"; other cancers have vastly different survival rates - from far better, to far worse...

Hi Bryan

I think the problem is the souce of the evidence. To imply that vaccines don't make bucks is a bit off beam really. The billions spent on fallacious swine flu vaccine were paid for by the public purse in most countries, also the research you sent me too was paid for by the company that made the drug so you are asking lots of blind faith there.

Are you aware also that Merck is being sued by former employee scientists over falsifying MMR efficacy and I just don't have the blind faith you have in this circular proving vat.

When we see a fall in the 48 plus age of cervical cancer I'll be interested, as for now believing in Pubmed as some kind of irrefutable truth just seems a bit unscientific really.

http://www.rescuepost.com/files/june-mumps-suit.pdf

By buckthetrend (not verified) on 27 Jun 2012 #permalink

Bryan, excellent post until the last line. You dont spend $300 to save a life-- you spend $300 for that life plus $300 for all the women who got the shot but would not have gotten the disease anyway. Incidence of cervical cancer is about 10 in 100,00 women per year (CDC). I am not sure how that translates into individual risk but If, say, 1 in 200 women would get cervical cancer and 1 in 4 would die of it and the vaccine is 85% effective, you would need to immunize approximately 940 people to save each life, at a cost of about $280,000 per life saved.

In evidence-based medicine, this is referred to as the NNT, the "number needed to treat" to see a benefit or harm. You can quibble with my arithmetic because I guessed at some of the numbers, but you should understand it's not really fair to argue public health policy as if your intervention saved everyone to whom it was given.

By john smith (not verified) on 27 Jun 2012 #permalink

Most pharmceutical companies have stopped producing vaccines because of the controversy about their value Bryan.

"Since infection is a pre-requisite for development of HPV-associated cancer," Bryan

Sorry Bryan this is not a statement of fact, it is a statement of belief, this pathway is not a cast in stone fact.

By buckthetrend (not verified) on 27 Jun 2012 #permalink

"Sorry Bryan this is not a statement of fact, it is a statement of belief"
No, both are statements of fact. In the 1970's there were ~20 companies producing vaccines in the developed world, we're now down to about 1/4 that number. A study in Health Affairs assessed the reason for this decline, and the answer was simple - the profit margins were simply too small and the R&D/production costs too high. As in those were the stated reasons, by the companies, why they ceased vaccine production. Not opinion, but stated (and quantified) fact.

Likewise, by definition an HPV-induced cancer can only exist in the presence of HPV. That is a fact. The key there is HPV-induced cancer; obviously other cancers exist, and the HPV vaccine would be unlikely to have a significant effect.
---------------------------------------------------
John, your numbers are not exactly right, but you did put into numbers what I was trying to put into words. The lifetime risk of cervical cancer is 1:134 (UK numbers), of which 70% are caused by HPV. So ~1:190 women will develop an HPV-associated cervical cancer in their lifetime, plus whatever the incidence of non-cervical HPV-caused cancers is (which I don't think we have accurate numbers for). Of those ~1:190 women, 1:4 will die with modern treatment. The CDC's 2011 estimate for cost-per-QALY (considered more reflective that simple NNT #'s) is $3k-$45K. My treatment cost numbers were incorrect - they were only drug costs. I couldn't find US numbers, but Canadian & French numbers put total cost at ~$105,000USD. Probably more in the US. Even assuming basic drug costs, the worst-case vax number is still cheaper. When considering full cost-of-treatment , the vaccine wins all around.

QALY numbers: http://www.cdc.gov/VACCINES/RECS/acip/downloads/mtg-slides-jun11/07-5-h…

The PubMed citation does not, in fact, answer the question most people would be interested in, which is "What is the absolute chance that this vaccine will eventually prevent my daughter from getting cervical cancer?" The abstract, I note, does not provide absolute numbers for the endpoint of persistent infection; still, the vaccine is in the short term (6 years) clearly quite efficacious for that indication. That does not guarantee that the eventual percentage reduction in HPV-associated cervical cancer would be equally high, assuming no further exposures to HPV (for example, some of the people with persistent infection now may lose it over time). It also does not guarantee that the vaccine will not lose efficacy over decades, assuming further exposures do occur.

It's reasonable to ask what the NNT (number needed to treat) is for an intervention that, while it surely can reduce the risk of a life-threatening disease some decades in the future, is financially costly and not totally harmless today. We are increasingly getting to the point where real or alleged prophylaxes for every possible cause of death are being developed and marketed. If that trend continues, will it be most rational for a family of average means and health to subject their children to all of them (e.g., statinizing 12-year-olds), to none of them, or to selected ones, and if the latter, how selected?

Jane, I'm entirely with you. Indeed, I'm glad that reasonable people were curious about the NNT with respect to polio vaccinations. I'm happier that smarter people were interested in stopping polio.

I mean, you know, these 'real' prophylaxes for stopping every possible cause of death ideologues had their way about things, we'd wind up living longer and shit. And, well, that means I'd have to put up with many, many more years of stupid people on the internet.

Just imagine the horror if like our medical ideologues stupidly invented lots and lots of ways to prevent death so that we lived for hundreds of years. The fucking horror.

ReGreta virus attacks mid-debunking of Thunderf00t. Damn, that disease is fucking inconvenient (get Judy Mikotits on it):

There is so much wrong packed into this one post, I could write an entire novel-length systematically dismantling everything that’s wrong with it. But I don’t have time or energy for that today… and I can’t imagine anyone having it in them to read it anyway. So I’m going to look at one piece of this wrong at a time, until I get bored or otherwise sick of it.

The PubMed citation does not, in fact, answer the question most people would be interested in
But, short of inventing time machines, the paper provides the only meaningful readout we have. Other studies have found equivalent decreases in pre-cancerous lesions as well.

That does not guarantee that the eventual percentage reduction in HPV-associated cervical cancer would be equally high, assuming no further exposures to HPV (for example, some of the people with persistent infection now may lose it over time).
I've lost your point here - we want to vax girls before they are exposed to HPV; meaning "no further" exposures would equal no exposures. In the later case, the risk of HIV-associated cancer is zero. You need to be exposed to encounter the risk.

It also does not guarantee that the vaccine will not lose efficacy over decades, assuming further exposures do occur
In all likelihood efficacy will decrease over time - that is normal for both vaccines and "natural" immunity. If that occurs boosters may be necessary. But even reduced efficacy is of benefit; preventing 95%, 90%, 85%, etc, of infection still dramatically reduces the later incidence of cancer.

It’s reasonable to ask what the NNT (number needed to treat) is for an intervention that, while it surely can reduce the risk of a life-threatening disease some decades in the future, is financially costly and not totally harmless today
Absolutely - especially when gov money is involved, ensuring that the money's not being wasted is important. The later part of this comment is a different issue - cost vs. benefit analysis. The known rate of adverse reactions to vaccines is known - minor issues (pain, fever) run <1-6%, severe issues are much rarer (<1:10,000). Compared to 1:190 (~0.5%) risk of developing cancer, the risk is much smaller than the benefit.

Justicar - Did I question the cost-benefit ratio of polio vaccination? For that matter, I'm not really opposed to vaccinating teenagers for HPV - though I am opposed to statinizing them, and they are nearly two orders of magnitude more likely to die of heart disease in their old age. I only pointed out that parents who question the value of a brand shiny new intervention for a relatively uncommon disease may not be eeevil stooopid religious nuts, but asking reasonable questions. Responding with a shrieky tantrum does not do much to convince me that those questions are unreasonable.

Bryan - Thank you for your civil response. Exposure is not equivalent to infection; it's merely a chance to be infected. The purpose of a vaccine is to reduce the risk of infection if you are exposed. During the six-year follow-up, some of the vaccinated girls in the study did have to be exposed to HPV, because some of them, and (if the claims made are legitimate) more of the placebo group, had incident infections. Will all of those with persistent infections in the placebo group be infected for life (whether they are ever harmed by it or not)? Probably not, as some will clear the virus later. At the same time, some fraction of the vaccine group who initially enjoyed 95% efficacy against incident infection and 100% efficacy against persistent infection will, if they do continue to be exposed, become infected later in life, as, of course, will some of the uninfected placebo group. You might expect new infections to be more common in the placebo group, but that presumes that the vaccine remains effective, which may not happen. The gap in incidence between the two groups therefore may increase, diminish or remain the same over time; we don't know.

Ignoring the rate of severe complications, because it is indeed far lower than the rate of cervical cancer, there are still reasonable questions about the cost-benefit ratio. $300 smackers is a lot to many families, and - assuming you adopt the belief system that says extending life expectancy should be our most important concern - there are many ways that $300 might be spent to make a larger statistical improvement to a girl's lifetime health. You might, for example, provide early dental care, or buy several months' worth of fruits, nuts, and vegetables to develop healthy eating habits, or heck, even send her to karate classes to encourage her to live an active life and thereby reduce her risk of breast cancer and heart disease, either of which kills enormously more women than cervical cancer. And if a parent believes that her daughter is being raised in such a way that she will likely end up with fewer lifetime sex partners than average, it's reasonable to presume that the likelihood her daughter will someday benefit from the HPV vaccine is smaller than the population-wide estimates being quoted to her. If you say "why, you should do all of those things together," you are not taking into account the financial constraints of many parents who genuinely can't do it all. As ever more preventive interventions are marketed, more Americans are having to choose between the recommended medical interventions and healthful (or sometimes ANY) food, never mind other things that may make for a good life.
.

It actually makes perfect sense given the priorities of the Catholic Church.

What did they do about priests sexually abusing children? Hide it so that the priests would have to develop self-control and virtue.

I fixed the Bishop's quote for him.

“If we don’t attempt to change sexual behaviour that is responsible for transmission of the HPV, the raping of children by priests but attempt to solve the problem by getting a series of shots, putting the perpetrators in prison then we don’t have to exercise self-control, nor develop virtue, but can use medicine the Criminal Justice System to palliate our vices, ('wink wink')” he [Bishop Frederick Henry] said in an email.

By daedalus2u (not verified) on 27 Jun 2012 #permalink

I have difficulty with this claim of 95% efficacy Bryan. The recent law suits by previous Merck scientists over 95% claims for mumps in MMR are being shown to be fraudulent.

If the same companies making the drug are then funding research how do we know this is not biased too.

If we look at claims for flu jab efficacy and actual efficacy we also see massive descrepancies between what is claimed and what is clinically true.

To argue there is a pro and anti seems bonkers when the pro evidence seems to be so open to bias it is down to producing papers that in many cases are being shown to be downright lies.

By buckthetrend (not verified) on 27 Jun 2012 #permalink

Buckthetrend,

So based on allegations that Merck lied and the produced vaccine was less effective you would advocate a solution with zero effect? For the record I don't support Merck at all - if they lied they should be punished.

By Niche Geek (not verified) on 27 Jun 2012 #permalink

I looked up the lawsuit that buckthetrend referenced. Other than the lawsuit filing itself, there is absolutely no news about this on anything but hilariously unreliable anti-vax sites like Natural News and Age of Autism. I'd hold off on taking it seriously until someone that actually has taken a biology course writes about it.

I also was unable to find any published articles by either of the principals in the lawsuit, which makes me question their position as "scientists" working for Merck.

As for buckthetrend, I think that he would be better off relying on pubmed for scientific evidence of efficacy rather than Mark Blaxill

By G. cuvier (not verified) on 27 Jun 2012 #permalink

With regard to 95% efficacy: 70 of the women in the placebo group had an incident infection vs. 4 of the women in the vaccine group, so an initial 95% protection from infection sounds legitimate. 20 of the placebo group and 0 of the vaccine group had an infection that persisted for at least 12 months. (One would not expect all of those to be permanent.) Since almost 3/4 of infected women clear the virus within 12 months anyway and there were only 4 infected women in the vaccine group, we can assume that the "100% efficacy against persistent infection" will not hold up at the population level. But it's still pretty good. If cervical cancer is one of your big health fears, there's little doubt this vaccine is worth it (assuming you have it to spend).

But I still wonder how you pick and choose among diseases. I saw an article recently in which some guys who had invented (and stood to profit mightily from) a small endoscope were declaring that every American should be screened for esophageal cancer. This, like cervical cancer, is a relatively uncommon disease. Admittedly, the cases aren't comparable in that there's no evidence at all that screening and pretreating for esophageal cancer would offer a net benefit, whereas there is good reason to hope that preventing HPV will reduce cervical cancer burden. But for the average consumer, who only knows that he's being offered a menu of risk reductions far longer than he can endure or pay for, how do you decide which uncommon outcomes you are supposed to fear most? The fact that one is caused by a virus does not automatically elevate it to the top of the list.

G. Cuvier,

Good point - the suit against The Oatmeal is ample evidence that the plaintiff in a civil action should not be taken at face value.

By Niche Geek (not verified) on 27 Jun 2012 #permalink

It's been said before: Alberta is the Texas of Canada.

What I find more disturbing is the lack of balance here. No one files a law suit against a big coporation without grounding. The lack of scientific enquiry here is to be honest more akin to some East block sensorship.

What is the problem? I am neither anti or pro vaccination that is an artificial construct, either there is evidence for efficacy or there is not.

The evidence sources you cite have dubious credibility by their track record. If we look at the swine flu scam all of them from the CDC, the NIH to the WHO to all the pharmas and government dept. tried to fool us into believing them. Poland was the only European country to officially reject the swine flu pandemic scam and spent no public money on bogus vaccine. They made an informed decision based on the facts opted out of the madhouse and were totally right. I don't know anyone who had the vaccine or died from swine flu either.

Edge of bananas, why do you think there is no reporting on the Merck lawsuit! It's not rocket science, but it is medical science.

"So based on allegations that Merck lied and the produced vaccine was less effective you would advocate a solution with zero effect?" Niche

I don't know how you come to the conclusion that the only option to stay well is to vaccinate, I mean they may drum that into us in the US and use stereotyped marketing to blackmail us into compliance but allegence to the flag, I shit you not, has nothing to do with informed choice.

I don't believe in conspiracy theories either, it's no conspiracy, it's happening! It is always the problem with money, dorks like the gates with pots of cash can buy almost anything and pay for any result they like.

Most septic sites seem to diss any critique of the value of vaccination automatically with no inquiry, that alone shines as an example of 'anti science' and gives away this false debate as a fishing expedition as part of a PR war that quite frankly you are losing.

By buckthetrend (not verified) on 27 Jun 2012 #permalink

denemeden bilemezsin

Will all of those with persistent infections in the placebo group be infected for life (whether they are ever harmed by it or not)? Probably not, as some will clear the virus later.
Actually, in all likelyhood, they will be infected for their whole lives. I am unaware of any evidence showing clerance of persistant HPV infections. Basically, you get one shot - at the time of infection - or it becomes latent.

$300 smackers is a lot to many families...there are many ways that $300 might be spent to make a larger statistical improvement to a girl’s lifetime health
These are totally legit concerns, but living in Canada, I have the advantage that my daughters (and hopefully soon, sons) will have the vax covered under our universal system. That said, in the medical world $300 is a pittance; aside from other vaccines I cannot think of anything that would be as effective - even some sort of organized sport/exercise (by far the best thing we can do to prevent long-term disease) will cost far more than that over a kids teenaged years. Or, your example of a good diet - also will cost far more than $300 (per year, never mind per lifetime).

And if a parent believes that her daughter is being raised in such a way that she will likely end up with fewer lifetime sex partners than average, it’s reasonable to presume that the likelihood her daughter will someday benefit from the HPV vaccine is smaller than the population-wide estimates being quoted to her.
To the contrary, people raised in this fashion (i.e. typically a religious upbringing) typically have higher incidence of STI's, including HPV infection, than those raised in less traditional environments.

we can assume that the “100% efficacy against persistent infection” will not hold up at the population level
No, we cannot assume such a thing. Why would you presume so?

I have difficulty with this claim of 95% efficacy Bryan. The recent law suits by previous Merck scientists over 95% claims for mumps in MMR are being shown to be fraudulent.
Spare me the conspiracy mongering. Reality is that in older individuals, MMR has a >95% efficacy. It is only in children - who were not part of the original studies assessing efficacy - where the rate is lower. Merck didn't hide a damned thing; they just didn't look in the right place. The largest systemic review of MMR vaccination, looking at MMR produced by Merck and others, concluded "Based on the available evidence, one MMR vaccine dose is at least 95% effective in preventing clinical measles and 92% effective in preventing secondary cases among household contacts"

http://www.ncbi.nlm.nih.gov/pubmed/22336803

What I find more disturbing is the lack of balance here. No one files a law suit against a big coporation without grounding. The lack of scientific enquiry here is to be honest more akin to some East block sensorship.
Oh please, frivolous lawsuits against large companies are common. As for the evidence, as of today there are over 100 studies listed in pubmed that address MMR efficacy, Some, like the one I linked to above, assessed efficacy and safety in a combined 14.7 MILLION people. Just because you ignore them, doesn't mean they don't exist.

Bryan - Go to Pubmed and search "HPV clearance"; you will find a number of studies that demonstrate substantial rates of clearance over time even for people who already have HPV-associated lesions. Even in the Glaxo vaccine study we've been discussing, 34 women in the placebo group had at least one 6-month persistent infection but only 20 had at least one 12-month persistent infection.

$300, used carefully by someone who doesn't live in a food desert, will buy enough unprocessed plant foods to give someone a relatively healthy diet for at least several months. And we cannot only compare the cost of a single medical intervention vs. the lifetime cost of eating healthfully; if we compare the lifetime costs of every intervention and screening that might be recommended to us vs. the lifetime costs of eating healthfully, the former exceeds the latter - and I highly doubt that it has a greater impact on quality-adjusted life expectancy. Fortunately, it's not for most people an all-or-nothing proposition; they can selectively utilize a portion of the interventions and still eat and live well. The question is how they are supposed to select that portion, when every single intervention is marketed as urgent and lifesaving. They lack the information needed to calculate how many QALYs might be gained from this vaccine vs. some other intervention vs. six months of good food, say, so it comes down to emotional judgements about what you fear most and what you trust most.

I dunno if we're talking about the same kind of upbringing or not. I never set a toe in a church in my entire childhood but I was not raised to be comfortable with casual sex, and as a result had fewer partners than many people I know. Do you have a citation for the supposed higher HPV rates in such people, or in people from religious homes for that matter? Even if that turns out to be the case, I find it totally understandable that parents would not presume it to be so.

The vaccine greatly reduces the risk of initial infection upon exposure to HPV. Most people who get infected later clear the virus naturally, as is the case in the placebo group of this study. The vaccine does not perfectly protect against infection, as incident infection was noted in four of the vaccine group. The fact that 4/4 rather than 3/4 of them cleared it naturally within the study period is well within the play of chance. I see no reason to presume that the vaccine, once it has failed to prevent infection, will magically cause 100% clearance rates. Surely the immune system after infection would be reacting to the real virus at least as much as to the vaccine.

"Actually, in all likelyhood, they will be infected for their whole lives. I am unaware of any evidence showing clerance of persistant HPV infections. Basically, you get one shot – at the time of infection – or it becomes latent." Bryan

This is mythology, look around you, if everyone was infected for life we would all be dying from cervical cancer and we are not.

"I cannot think of anything that would be as effective – even some sort of organized sport/exercise (by far the best thing we can do to prevent long-term disease) " more Bryan wisdom.

How rediculous Bryan, has it ever occured to you that sport for a start is probably the worst way to get fit, look at all those 'atheletes' dropping dead in marathons, cycle races and on football pitches, this sport=health myth is LOL. Has it ever occured to you that eating proper food instead of the standard US corn syrup infested jet junk is more important than jogging? Probably not. If one eats a processed diet and goes to the gym that's like putting sand in your car sump and driving fast down the highway!

The idea you can spray everyone with 'disinfectant' and eat crap and join a gym and vaccinate is the only way to promote health is laughable. Look at Polio in India, no input by Bill on sanitation Bryan, because no shares for his vaccine investment and a better solution that is more permanent. Failed vaccine campaign better give it another name. There is no conspiracy theory Bryan, it's happening now!

Wake up and smell the sewage Bryan.

"people raised in this fashion (i.e. typically a religious upbringing) typically have higher incidence of STI’s, including HPV infection, than those raised in less traditional environments. " Bryan, the stand up comic! no reference for this gem either!

Sorry Bryan but Merck studying Merck and pubmed 'reporting' is no different to homeopaths studying homeopathy and publishing in their journals.

If the ex editor of the NEJM and BMJ have both gone on record saying 'nothing published in peer reviewed medical journals can be believed due to funding bias' and remember Bryan all you have is those articles to tell you the 'truth' then none of your citations are worth the bytes they are typed on.

It's not about belief Bryan it's about facts and reality, both factors are largely missing from all you can quote.

Funny that clinical obs are not part of EBM. wonder why that is?

By buckthetrend (not verified) on 28 Jun 2012 #permalink

Hi Chat
Üçe kadar sayacağım; üç deyince koşabildiğiniz kadar hızlı koşun.

By buckthetrend (not verified) on 28 Jun 2012 #permalink

Or maybe more appropriate to this whole site:

Hata yapmak, hata için özür dilemenin sadece yarısı kadar kötüdür.

By buckthetrend (not verified) on 28 Jun 2012 #permalink

"This is mythology, look around you, if everyone was infected for life we would all be dying from cervical cancer and we are not."

Well, actually, you can be infected for your whole life and never get cancer. OTOH, if they were really confident that the vaccine would cause a vast reduction in cancer, you'd think they wouldn't be telling vaccinated women to keep getting Pap smears on the same schedule.

I agree, in the medical science world it always depends on what paper you read, material facts and reality have no bearing on the conclusions to most medical research.

Apparently not everyone with 'the gene' for breast cancer gets cancer. Why then do they always study those who get it, has it ever occured to these 'researchers' that this might be more useful? Probably not.

Baba z wozu koniom lżej

By buckthetrend (not verified) on 28 Jun 2012 #permalink

This is mythology, look around you, if everyone was infected for life we would all be dying from cervical cancer and we are not.
Maybe learn a little virology before you start demanding others "educate" themselves.
1) Not all HPV infections lead to cancer,
2) Not all of us will be exposed to HPV

Ergo, your conclusion is false, as are the premises it is based on. The rest of your reply is similarly wrong - despite your denials, vaccines are safe, effective, and cheap. They're not the only tool in the infection control toolbox, but they are a powerful one.

Bryan one plus two equals banana. Why are medical scientists studying only half the data? Surely if they studied people who didn't die they might find out something useful.

Maybe it's not sexy to discover that, for example, eating food that is naturally grownn instead of chemically altered allows bodys to live longer with less disease.

come on Bryan, where is the ref for that idea that celebate religious groups have higher STD's, I am having difficulty getting my head round the idea that someone who doesn't have sex will have more sexually transmitted disease, or is that another peer reviewed medical fact? EBM? profit fantasy generated, no reality evidence biased medicine.

By buckthetrend (not verified) on 28 Jun 2012 #permalink

Wow. I didn't think the HPV vaccine could attract more nutters than anything related to XMRV, but boy it has! At least some of the ME/CFS comment-makers listened to reason/good science and stats when they heard it.

buckthetrend - Just because someone is taught by their parents not to have sex outside marriage doesn't mean they won't do so anyway, and those who do might be less likely to know how to practice safer sex and have condoms handy. But I too would like to see a citation for the claim of *higher* rates. I am quite confident that the sort of family life one sees growing up does have an influence on one's tendency to be monogamous or promiscuous, even if the controlling factors are not what some people might assume them to be.

Jane & Buckthetrend,

I suspect that Bryan is referencing the correlation professed religiosity and prevalence of STI in a state-by-state basis in the US. While obviously not a perfect metric it does disprove the idea that greater religiosity offers some kind of protection against STI. I was unable to find similar figures for my country so I can't offer any other examples.

By Niche Geek (not verified) on 29 Jun 2012 #permalink

I agree with most of your points, but a couple of need to have to be discussed further, I will hold a small speak with my partners and maybe I will appear for you some suggestion soon.

State-by-state numbers do not "disprove" any hypothesis about the effects of individual family characteristics. Or, if they do, they have also disproven the hypotheses that ordinary domestic radon exposure causes cancer and that allowing citizens to possess weapons increases violent crime - two hypotheses that remain beloved among large segments of the allegedly pro-Science population. Mississippi is unlike Connecticut in many ways, and no study can correct for all of them. I would like to see a study with individual family religiosity (e.g., church attendance) as the independent variable, conducted among families within a single region whose children will have similar educational and recreational opportunities, and corrected for parental socioeconomic status.

Jane,

I agree that it is a poor metric. Do you have better data?

By Niche Geek (not verified) on 30 Jun 2012 #permalink

Niche Geek - I wasn't the one who made the claim. Since Bryan has argued by reason rather than ad hominems I wouldn't emulate the local habit of braying for "Evidence?" - I believe a person's got the right to mention something he's read somewhere without producing a review paper on it - but I also have the right not to accept such statements as fact without supporting data. Which state-by-state numbers are not. It is hardly implausible that residents of poorer, more rural states could have more promiscuous sex, or more unprotected sex, or less access to health care services that can reduce total STD burden, yet within each state, those who are raised with beliefs that favor monogamy have less unsafe sex. Can we agree, based on human experience, that some young adults definitely engage in more unsafe sex than others but that it's not immediately obvious what child-rearing practices best discourage it?

Jane,

I can agree in part. I agree that it id not immediately obvious. I can, however, point to some more abstract data. For example, studies consistently show that abstinence-only sex education results in more risky sexual behaviour than the alternatives. The most obvious outcome being higher rates of teen pregnancy.

By Niche Geek (not verified) on 30 Jun 2012 #permalink

Was away at the cottage for a long weekend, sorry for he delay...

Jane, there have been a huge number of studies looking at correlations between religiosity and other social factors such as STI incidence. A search on google scholar for "STI religiosity" (no quotes) will bring up a plethora of results, using a broad range of methods. Some of those studies will be cohort studies (i.e. following groups of otherwise similar individuals and looking for commonalities), others are population-based (i.e. state-to-state, or country-to-country).

I know of no good review of this literature, but they consistently show the same thing - religiosity provides no protective effect, and in many populations, increases risk, of STI infections. Project Genesis (2011). the Croatian series (1998-2008, about 6 articles) are good places to start. Gregory S. Paul has also done a series of excellent population-based studies assessing religiosity and a whole host of social factors.

Which state-by-state numbers are not
Actually, state-by-state (or country-by-country) numbers are really good for this. As you correctly mention, states (and countries) vary hugely from one another. Meaning, its easy (or, at least, easier) to find common causes for phenomena, as all of those discordant factors can be excluded. Again, the work of GS Paul is a great example of this kind of work, and how the discordant features can be used to exclude non-explanatory factors.

bucketthread wrote Why are medical scientists studying only half the data?
LOL, which half are we ignoring? I'm guessing its the imaginary half - i.e. the one that exists only in your head.

Abstinence only sex ed increases teen pregnancies.

Their effects are inverse to the one proposed.