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Fear-Mongering on Gardasil

By Rachel Walden, Our Bodies, Ourselves; Women's Health News

July 14, 2008 - 7:00am

Rachel Walden's picture

Combine girls, vaccines, and sex, and you apparently get a recipe for sensationalism and poor reporting. CNN last week featured a piece, "Should parents worry about HPV vaccine?" which notes that "Gardasil has been the subject of 7,802 'adverse event' reports from the time the Food and Drug Administration approved its use two years ago."

What the article doesn't explain is how the Vaccine Adverse Event Reporting System (VAERS) system works. Reports to VAERS can be submitted by anyone, and are not verified or definitively linked to the vaccine without further investigation. This understanding was not demonstrated by the piece, which simply conceded,

"The company said in a statement that an adverse event report 'does not mean that a causal relationship between an event and vaccination has been established -- just that the event occurred after vaccination.'"
This phrasing makes it seem as though it's just the company (that stands to make money) that believes that reports don't indicate a causal relationship - it seems designed to make the average reader believe that this characterization is just the vaccine maker protecting its financial interests. While Our Bodies, Ourselves often points out ways in which pharmaceutical companies and medical device companies prioritize their own financial interests above people's health, in this instance the company is simply explaining how the reporting system works.
 
The piece also doesn't address how this figure compares to anticipated adverse events estimated from the original studies, how it compares to the rates of adverse events for other vaccines, or that, due to the current system, there are always

more/different side effects reported after a drug is approved (in the "post-marketing" period) due to the numbers of individuals involved. For example, if a drug causes death in 1 in 500,000 people, and was tested in 2,000, the possibility of the drug causing death is not likely to be realized until it is on the market and prescribed to a large population.

On the other hand (and unmentioned in the CNN article), many adverse events may occur that are not reported. "Post-marketing surveillance" - including analysis of reports from those who have received the drug or vaccine after it has been approved - is a crucial aspect of safeguarding the public from dangerous drugs. Because individuals and physicians may not associate an outcome with the vaccine, and many individuals may not realize that they are allowed to submit reports directly, underreporting of effects is both possible and likely. The FDA uses this surveillance system to make changes to labels, educate physicians about risks, and re-evaluate their approval of a drug or vaccine, so it remains important that adverse outcomes are reported, despite the cautions about making judgments based on raw numbers of reports and difficulties in later determining which of those outcomes were directly linked to a specific drug, vaccine, or other product.

Habladora at Feministe has an excellent summary of how CNN's piece omitted crucial information in favor of drumming up parental anxiety, touching on many of these same issues. She notes:

"Finally, CNN presents us with the terrifying story of a teenager who developed pancreatitis not long after taking the vaccine. While I am not insensible to how horrifying such a serious illness would be for a young girl and her family, it should be CNN’s responsibility to verify whether or not her fear that it was related to the vaccine could be founded - by researching how many of those incident reports dealt with pancreatitis, for example, or other autoimmune diseases. This type of reporting is important, after all, since it could impact women’s decisions and, consequently, their health."

This approach is not limited to CNN - Judicial Watch is currently featuring the large, bolded headline, "Judicial Watch Uncovers New FDA Records Detailing Ten New Deaths & 140 'Serious' Adverse Events Related to Gardasil." However, the CDC has reported that of the 10 deaths they have analyzed, they could not establish a causal relationship between the vaccine and the deaths, and notes that "While Gardasil was being tested in the U.S. before it was licensed, 10 people in the group that received the HPV vaccine and 7 people in the placebo group died during the trials. None of the deaths was considered vaccine-related."

In their report, Judicial Watch also suggests that Gardasil wasn't adequately tested for adverse effects because the comparison placebo vaccine contained an aluminum "reactive, potentially harmful substance." Without reading the original studies, this probably makes the comparison more valid instead of less, because the real vaccine also contains an aluminum compound (as do many other vaccines), and omitting it from the placebo vaccine would have skewed the comparison by confusing adverse effects of the aluminum with adverse effects of the actual vaccine substance.

I have to wonder if we'd be seeing the same level of fear-mongering if this were another vaccine, if opponents hadn't suggested that it would cause young girls to become sexually active and that girls from "good homes" don't get HPV. Yes, of course we should keep watch when a new drug, vaccine or product is approved and is targeted to women. Of course we should attempt to tease out real and serious side effects that didn't appear in the smaller trials, and be wary of the financial motives companies have to put the best light on their product. Of course we should be aware of mandates for vaccination and ensure that adequate information and opt-out provisions are available. It may still turn out that there are serious issues with Gardasil that warrant a different assessment of the risks and benefits. However, incomplete and inaccurate reporting and misrepresentation of the science does nothing to assist women and families in making decisions about vaccination and safety.

For further discussion, see Gardasil: What you need to know about the HPV vaccine and this previous OBOS blog post.

This post originally appeared on Our Bodies, Our Blog


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7 comments
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I am just a guy,so I don't pretend to know everything,but the FDA has had budget cuts,there has been cuts in the number of scientist throughout the federal government.I wonder if the research has been adequate and if women should not be worried.All kinds of foods and drugs have been allowed to enter this country and aren't or can't be kept track of because there not enough,competent people to keep an eye on everything because of budget cuts and the increased volume of products coming into this country.I understand these are kind of two different areas,but let's just extrapolate what is common in one area to this area of observation.Not enough people to check imports and not enough people to adequately check on food and drugs issues inside the country either.But that's ok yes?We need the money we save NOT protecting the people so that we can fight the illegal war and give tax breaks to the wealthy and Big Business,so that makes it o.k..

Submitted by eddiemyboy1 on July 14, 2008 - 6:42am.

and I can tell you that there are TONS of Serious Adverse Event reports and Investigational New Drug reports that come in every single day and less than 5% of them the investigators that submit them think are related to the drug. MOST of them use the non-commital phrase "Possibly related". Mostly because there are so many other medications that patients in studies are on and also because it's very difficult to trace with any degree of accuracy whether a certain drug in particular caused a reaction or exacerbated a disease that the patient already had or even reacted badly with herbal supplements or vitamins the patient took.
Add into that body chemistry that varies from individual to individual and it's a wonder drugs get approved at all.

But- I'm certain that because this vaccine is what it is that it is more sensationalized tht most other drugs are (how often do you hear about the serious adverse events that happen when a patient is taking viagara and blood thinners? those reactions are far more common than any adverse reaction to this vaccine I'd bet and yet the fearmongering is certainly less.

Submitted by BBCaddict on July 14, 2008 - 11:38am.

It sure is dangerous to say there's no proof it's poison yet... it's all fear-mongering... so we should be fine with continuing to give it to our daughters until we're told otherwise.

Submitted by Cranky Catholic on July 14, 2008 - 4:41pm.

Memo to Cranky Catholic: it sure is dangerous to say that there's no proof that penicillin is poison yet. Or that there's no proof that bell peppers are poison yet. (For some people they are; I happily cooked some for dinner tonight.)

Submitted by Vicki on July 14, 2008 - 10:07pm.

When 7,802 people get sick from tomatoes, I'm not going to wait for the FDA to do its research and release a statement that tomatoes are poison. If the bell pepper was invented two years ago and 7,802 people have had horrible side effects to bell peppers, I'm not going to ingest bell peppers, duh! In the meantime you believe 3000 women a year should continue to get sick because, well, the FDA hasn't told them they're sick, yet.

Submitted by Cranky Catholic on July 16, 2008 - 7:40am.

Cranky Catholic, it doesn't help people make informed decisions, though, when the media leaves out important information about the vaccine and portrays those reports of adverse effects in a way that is not accurate. I'm all for getting facts out there, but the CNN piece did not do that in a responsible way.

Submitted by Rachel Walden, Our Bodies, Ourselves; Women's Health News on July 21, 2008 - 3:02pm.

The point is it is impossible to say "x number of people got sick from Gardasil"....because that is NOT what the reporting system is designed to prove. A striking example: Of the 18 deaths that the media says were "Attributed" to Gardasil, it breaks down as follows:
3 are still under review
7 had no proof of autopsy or death certificate
1 was a suicide
1 was a drug overdose
2 were related to influenza
1 was related to diabetes
2 were related to blood clots
1 inconclusive in an oral contraceptive user (blood clot risk)

So you can see how warped the report of "18 Gardasil deaths" would be.

Submitted by Laura J. on July 30, 2008 - 2:06am.