Stop Playing Politics with Girls' Health
August 10, 2007 - 6:38am (Print)
By now, the new Human Papillomavirus vaccine has been widely discussed, but I still find that no one is clearly stating the obvious. Gender bias has infiltrated this debate and, once again, anxiety surrounding s-e-x may be preventing American citizens from obtaining needed healthcare.
Human Papillomavirus (HPV) is a sexually transmitted disease that has infected women for decades. Most frightening about the condition is the rarity of signs or symptoms; both women and men may be carriers of the illness for years without any evidence. Although exact figures are unknown, estimates suggest that as many as seventy-five percent of women may become infected with a strand of HPV at some point in their lives. Various types of HPV may cause cell changes in the cervical lining that lead to cervical cancer. In addition, one can contract HPV through any sexual contact -- not necessarily through intercourse.
At that rate, one would think that if we had a safe and proven method to prevent this cancer-causing virus, we would take full advantage of its benefits. Yet now that the Gardasil® vaccine is available, there is debate over its regulated and routine use.
Sure, there has been controversy over mandated vaccination before, but never with such fervency. Why shouldn't we require the vaccine for girls in a school environment? While some feel the government should not regulate our children's health care, we have had no trouble with laws imposing medical decisions when we see them as public health responsibilities. There are times when the benefit to the community trumps the choice of the individual and this is rarely disputed in our school vaccination design -- although an opt-out alternative will not be denied. Vaccination programs in schools have been one of the most effective ways of curbing disease and have comprehensive benefits to the individual as well as the community. In addition, the very reputable Advisory Committee on Immunization Practices (ACIP) recommends the vaccine for all girls age 9-26 in the United States.
There also seem to be various concerns about the safety and research conducted on Gardasil®. Yet research was conducted with over 11,000 women, exhibiting very few adverse reactions. I am having a hard time believing that this same controversy would exist if we were discussing a method of prostate cancer prevention. Accessible reproductive health is something for which we are constantly fighting. Let's be clear -- this is directly related to the fact that reproductive health affects women -- a population historically without power, and consequently without power over medical decisions or agency over their own bodies. This is about gender discrimination.
Concerns have surfaced about sexual safety and abstinence. Does providing a vaccine for a cancer-causing virus encourage sexual behavior in youth? Does it promote sex without protection? The ideal of abstinence remains, but research has repeatedly shown that there is most value in comprehensive education, informing youth about risks, and how to prevent effectively if they should choose to engage in sexual behavior.
Now that we know that the vaccine is safe and effective, the question remains: How do we make it accessible for young girls and women? Gardasil® is currently produced by only one manufacturer and is extremely expensive -- running approximately $360 for the entire course of treatment. Keeping the vaccine as elective -- available to only those who seek treatment through private healthcare environments -- has serious implications for class and inequality of health services. There are many who will not have the economic or educational access to have their children vaccinated. Many uninsured or underinsured families may not be seeking routine care with providers who can educate them on the availability and benefits of vaccination. Yet we do have a method of access to their children. They almost all attend school.
The solution seems clear. We as a nation need to put more investment in preventative care. If we want to make sure that our girls are protected, it's time to stop playing politics. We owe this protection to our nation's children.
Ms. Schwartz,
I applaud your article and echo your sentiment. I am a social worker who works in middle schools in poor neighborhoods such as East New York and the South Bronx. Sadly, many of my students cannot afford health care and are not educated about these matters. We must reach these children through the school system. It is imperative.
Well done. We need more active people like you. You, in all honesty, are the type of person that will change this world.
Truly,
Elizabeth Lasky
of course the nation should put their efforts into preventive care - as in pap smears. it is not clear at all how safe gardasil is. Perhaps what is happening with Prevnar - serotype replacement - will happen with gardasil. Let's hope the strains not covered by the vaccine don't turn out to be more lethal than the strains they are knocking out. To be sure of this, true long-term studies need to be done. Until then, leave the mandates out of it and funnel the money saved on Gardasil into pap smears for all.
You are absolutely right, the first step in cervical cancer prevention should always be the provision of regular pap smears, education about their importance as well as funding to support those services. However, I want people who are reading this to be aware that pap smears are not always effective. In addition, pap smears are methods of detecting HPV, not preventing it.
It is very difficult to compare Prevnar- which is meant to work in protection of Pneumococcus in early childhood- to Gardasil. Even the adverse reactions noted in initial trials were vastly different. Components of the vaccine have not been thoroughly researched. It is controversial but parents and other caregivers, please research thoroughly before deciding on vaccination for your children.
Ms. Schwartz, you are having a hard time believing that this same controversy would exist if we were discussing a method of prostate cancer prevention? You could not have chosen a worse analogy! Please refrain from making casual statements when obviously you are totally unaware of the situation surrounding the FDA and prostate cancer. The FDA is being sued right now by a group called Care to Live for their blatant disregard for the plight of prostate cancer victims. Only one drug has been approved by the FDA which showed some survival benefits in the treatment of late stage androgen independent prostate cancer in over 42 years! Last May, Dendreon's Provenge was denied approval even tho the FDA advisory panel voted unananimously that the drug was safe. They then voted 13-4 to say there is substantial evidence that the drug worked in treating advanced prostate cancer that no longer responds to hormone treatment. Provenge was DENIED and it was later determined 2 of those voting against have financial conflicts of interests, one doctor heading Novacea's efforts to bring Asentar, a rival drug, to market! These doctors are also named in the lawsuit. Likewise, Satraplatin joined the growing list of prostate cancer drugs being given the FDA thumbs down. The FDA has denied dying prostate cancer patients access to drugs that have been through phase III trials. The FDA has approved many drugs for breast cancer and for AIDS, a relatively new disease, turning it into a chronic condition, but men are denied access to every promising therapy for advanced prostate cancer. Prostate cancer, #2 cause of death in men behind lung cancer, is the "neglected" cancer in terms of research dollars as well. The only access to promising new drugs is through clinical trials, and despite crying for recruits, they are very difficult to qualify for and get into, and require that a patient go off all hormone and radiation therapy for months preceding the trial, and can thereafter be denied access to the trial, while the disease has progressed. My father died of prostate cancer 25 years ago, and now my brother is in the same position, with virtually no better treatment options. He has applied to 5 trials and so far accepted into only one, a Phase I toxicity trial with no therapeutic benefit, which cost him valuable time and benefited only the researchers, as Phase I trials do. Like most advanced prostate cancer patients, he is running out of time. Please go to caretolive.com and educate yourself. A future column on prostate cancer might redeem you after your careless analogy.
S. Florence-
Perhaps you are not understanding the analogy. The purpose was comparison of the possible use of an FDA APPROVED vaccine for prostate cancer. Gardasil is approved... we're not talking phase I trials. I'm sorry you lost family to prostate cancer, yet it seems you are using my blog to push your own agenda. I encourage you to write your own, as I agree that as health professionals we all need to educate ourselves about ongoing research. Good luck.
Andrea Schwartz
I was referred to your blog by a woman who wanted me to be informed about this important topic. Too bad you had to spoil your cause with your incredibly insensitive flame against S. Florence. I read the comment with the thought that I had gained a twofer of information from this blog and was thinking of adding it to my list to watch. Then your response made me realize that your view is "how dare you interupt MY lecture with information on a related topic that can help inform the debate." What a shame. I will be sure to note this to my friend as well in hopes that she can find more compassionate and understanding less self-centered sources in future for information. Congratultaions, you also made me question the validity of your arguments and the issue at hand. How can I trust the information from a source such as yours when you treat people like this?
James-
Not only was my intention not to be insensitive, but I was not trying to keep comments off the page, nor do I think it's fair to say I implied that and I am lacking in compassion as a result. I am thankful for opportunities to learn from my collegues in the field and appreciative for readers who are engaging in this debate- in agreement with my position or not. I found the comment to be condescending but still welcome... yours, however, seems "incredibly insensitive" to me. There is no need to attack personalities. We are writing about these topics with understanding and compassion to make effective change in reproductive health, not for personal attacks. Let us focus on the issue at hand- the quality of women's health care- and leave personal comments out of it.
This article is BS. The issue is actually the government and vaccine maker are taking advantage of young girls. HPV is rare and primarily a problem of middle aged women. So why the aim at young girls? Because you can't make adult vaccines mandatory.
The CDC has already demanded that Merck stop stop campaiging state governments to make it mandatory because it's not an infectious disease and therefore not a public threat. Yet they continue to push this for teenagers, even though they only studied 1200 girls for two weeks (see their own package insert).
Follow up reports of side effects are horrifying, including loss of conciousness, paralysis, and death. This is an absolute disaster that has nothing to do with sex.
http://www.nvic.org/Diseases/HPV/HPV_Vaccine_Safety_Report_-_Part_III_(081507_revised)[1].pdf
I am concluding a nursing research paper on Gardasil. I find that Ms. Schwartz information confirms what I have found. Ms. Terry's claims that the CDC demanded the manufacturer, Merck Co., Inc., to stop campaigning the state governments because of the side effects is inaccurate. The CDC claims the only side effect is an occasional brief skin irritation at the site of the injection.
I think parents who are against this vaccine believe abstinence is the answer to teenage pregnancy.
Parents who face the realities in life will find Ms. Schwartz article accurate and informative. It will assist them in their research to educate themselves and their sons/daughters about these STD's.
Thank you to Professor Elizabeth Lasky for her dedication to East New York and the Couth Bronx.
Respectfully,
Sarah G
