Completely freaking irresponsible

This is why people who don't know science shouldn't write about it as if they do. I don't care how much she's "mulled it over"-the author of the recent New York Times opinion piece about compulsory vaccination of girls with the vaccine against HPV makes some dangerous assertions here based on totally unscientific thinking and some seriously lame perspective.

And if this lady is SERIOUSLY going to suggest that in the face of other preventive options, we choose to rely on the often-imperfectly-used condom for prevention of STD's, especially among adolescents whose access to them is determined by how much their school districts' chieftains love Jesus, then she is just insane. And if this lady is SERIOUSLY going to suggest that in the face of other preventive options, we choose to rely on the often-imperfectly-used condom for prevention of STD's, especially among adolescents whose access to them is determined by how much their school districts' chieftains love Jesus, then she is just insane.
First of all, has this woman ever had an abnormal pap smear? A LEEP excision? No? Well, neither of them is much fun. Also? Cervical cancer may not be on the top 10 cancer list in the U.S., but it still exists, and it still kills 3,700 people each year. I haven't done a statistical analysis, but I'd guess that the number of adverse events expected from the vaccine is outweighed by the number of cases of cervical cancer that would be prevented by the vaccine, even in our pristine American cervices.

And if this lady is SERIOUSLY going to suggest that in the face of other preventive options, we choose to rely on the often-imperfectly-used condom for prevention of STD's, especially among adolescents whose access to them is determined by how much their school districts' chieftains love Jesus, then she is just insane.

There is at least one fact she got right: Cervical cancer causes far less death than it used to due to the early detection capabilities of the Pap smear. OK, and she's also right that vaccines carry risks. But those risks are teensy tiny, and often exaggerated by media reports.

Her great example of risky vaccines is RotaShield. Her proof of its riskiness? It was pulled from the shelves! Sorry, lady, but that is not data. RotaShield was, in fact, pulled from the shelves because eight of several thousand recipients developed intussusception, an involution of the bowel that can kill a child if it's not caught in time. At the time, everyone panicked about the possible linkage between the cases of intussisception and RotaShield.

Now, intussusception happens in kids at a certain baseline rate. The question after the vaccine was pulled was, how many of the new cases of intussusception were due to the vaccine? Meaning, how many cases above the baseline rate occurred in kids who got the vaccine? The answer: not many. The estimated increased risk among kids getting the vaccine was 1 in 11,000-16,000 kids. (1)

(Slightly tangential, but good for completing the thought: the risk above is already a pretty low risk. It seems even lower when you consider that about 440,000 kids die each year worldwide from rotavirus diarrhea, the disease against which RotaShield was active.)

(Even more tangentially: the author conspicuously avoids naming one of the most popular "debates" about vaccine-associated morbidity. I'll help her out: the mercury-containing vaccine preservative thimerosal does not cause autism. [2] Her entire article smacks of the same vague, clueless doubt that shapes the ethic of a lot of people who insist the above association exists.)

My point is that although most vaccines have some side effect-some more pronounced than others-those side effects are almost always greatly outweighed by the benefits. Although I appreciate the spirit of inquiry that provokes evaluation of risk-benefit ratios with respect to medical interventions, it is completely freaking irresponsible to suggest that we reconsider all vaccinations because "we don't know what the long-term effects are."

In most cases, we DO know what the long-term effects are: massive reductions in morbidity and mortality. The risks associated with the vaccines we routinely offer are so greatly outweighed by their benefits that they are not worth considering in deciding whether to vaccinate children. If she wants to argue otherwise, a weak "but" isn't good enough-she needs to present some data. Otherwise, her New York Times essay is no better than an emailed chain letter.

And another thing. Has this author given any thought to the impact that HPV vaccination could have on countries outside the U.S.? Cervical cancer is the number one cause of cancer deaths in the developing world. Maybe, in between sips of her shade-grown, fair-traded, half-caf latte (on skim), she could consider that domestic vaccination might be the first step toward a global vaccination strategy.

It wouldn't bother me so much if she'd have discussed vaccine risk-benefit from an informed perspective. What steams my rice is the nonchalance with which she makes sweeping statements, and the fact that it's not even data she's misinterpreting. This might be the way that your average schmuck on the street formulates an opinion, but it's not the way an opinion should be presented in a major U.S. newspaper, where it could influence so many others. Vaccines, and the kids who need them, deserve better.

1. Simonsen L, et al. More on RotaShield and intussusception: the role of age at the time of vaccination. Journal of Infectious Diseases. 2005 Sep 1;192 Suppl 1:S36-43.

2. Hviid A, et al. Association between thimerosal-containing vaccine and autism. JAMA. 2003 Oct 1;290(13):1763-6.