What are your feelings about the HPV vaccine?

[angel03]

You're essentially correct, although remember that HBV vaccine was added to the childhood series because of mother-to-child transmission. Neonatal HBV is devastating, and easily prevented with a vaccine series, the first dose given at day 1 of life. There is also theoretical transmission of HBV through any exposure of body fluid on broken skin, and the virus is carried in the blood and saliva. This at least raises the possibility of transmission in sports, which HPV does not have.

Is Hep B required for school attendence? If it is, that's new, because I didn't get the series until I was going to college, and I went to a public school.

I live in Florida and before I was allowed to enter the 7th grade, I was required to have the Hep B series of shots. It was in a public middle school, we all had to get it. So I guess the rules out the mother to child transmission? Unless they are trying to stop it from eventually happening.

I think it is important that even though it can be transmitted other ways, I believe the main way is through intercourse/sexual contact, so then I still don't understand the difference. Of course maybe people tend to choose what to focus on and tell themselves...or maybe the sports/injuries/whatever stuff is how they sold it to parents...who knows, it all gets so political

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[Tired]

I live in Florida and before I was allowed to enter the 7th grade, I was required to have the Hep B series of shots. It was in a public middle school, we all had to get it. So I guess the rules out the mother to child transmission? Unless they are trying to stop it from eventually happening.

I think it is important that even though it can be transmitted other ways, I believe the main way is through intercourse/sexual contact, so then I still don't understand the difference. Of course maybe people tend to choose what to focus on and tell themselves...or maybe the sports/injuries/whatever stuff is how they sold it to parents...who knows, it all gets so political

My reference to the HBV vaccine was intended only to illustrate why we now give the vaccine to newborns and young children. Were mother-child transmission not an issue, we would have continued to give it to older children (as in your case).

These are essentially political decisions, not medical ones. My impression is that, as a society, we tend to associate HPV with sex, while HBV is seen differently. As much as we attempt to "logic out" the medical considerations, it is ultimately politicians and the general public who will decide what vaccination are and are not mandatory.

 

[Sol Rosenberg]

You got me there. I guess what I meant to say is that I don't think that the current vaccine has yet been shown to be effective in men.

Sign me up when efficacy has been established.

I believe that the vaccine has been shown to be somewhat effective in men, but not to the extent that it is in women. Also, there is the whole cervical cancer issue for women, which obviously isn't an issue for men.

 

[Supercluster]

I believe that the vaccine has been shown to be somewhat effective in men, but not to the extent that it is in women. Also, there is the whole cervical cancer issue for women, which obviously isn't an issue for men.

Men are susceptible to HPV, though, in the form of penile cancer and anal cancer. Granted, those are much rarer than cervical cancer.

 

[Doctor Bagel]

Men are susceptible to HPV, though, in the form of penile cancer and anal cancer. Granted, those are much rarer than cervical cancer.

But potentially a lot worse, I think. From what I gathered when we had a urologist talk to our anatomy class, removing the penis is the preferred treatment for penile cancer. While having a hysterectomy probably sucks, I think it beats losing your penis.

 

[Law2Doc]

While having a hysterectomy probably sucks, I think it beats losing your penis.

Most guys would certainly rather give up quite a few other organs first.

 

[ForbiddenComma]

Like I said... mention "penile cancer" and its surgical treatment and you'll be getting Republicans voting for this vaccine in no time.

 

[RockShox]

The real issue here is not sex but as always is money. Sure there are some insurance companies that are covering it but the reimbursement is so dismal that many primary care doctors are not even bothering carrying the vaccine. On top of that most patients can't afford it. Unfunded mandates are a pain in the tush. The push to make this mandatory is less about public health and alot about drug sales.

Here is one interesting read
"Doctors refusing to carry HPV vaccine"

http://www.cnn.com/2007/HEALTH/conditions/02/02/cancer.vaccine.ap/index.html

Also may I submit that the reason to immunize men is not to ensure that a few of them won't have to live with a stump... but because they are a vector. Just like spraying for mosquitos that carry west nile. The studies to see whether it is effective to do this are currently being conducted. Do a google search if you want to learn more.

 

[psipsina]

I think its perfectly reasonable to require vaccination against a disease that is spread socially (whether thru sexual or casual contact). If nothing else disease costs the health care system money, so why not reduce disease if its as easy as a mandatory vaccine? On a human level disease causes suffering so yet again why wouldn't you want to reduce that?
Sure we can all say we hope our daughters don't have sex untill they are married, and talk about how abstinence would prevent them from getting HPV so isn't that a better way . .. but even if little suzyQ doesn't have sex untill her honeymoon night with her new hubbie, who's to say that the new hubbie won't be carrying HPV himself and give it to her anyway? Or that new hubbie won't cheat and bring HPV into the marriage.
Life isn't a fairy tale and everyone doesn't always do what they should . . . so if we need some stupid mandate to prevent many women from getting a horrible and sometimes deadly disease that costs our system gobbs of money then I'm for it. If we're ok with preventing requiring other vaccines why not this one? Sex is about as big a part as being human as breathing, with that whole biological imperative thing, so why do we think its ok to vaccinate against airborn diseases but not those that spread via mucous membrane contact? It speaks volumes about our society's weird issues with sexuality that we would rather watch people suffer and die than confront the awful truth that people have sex and do something that would make it a safer activity for all of us.

 

[Critical Mass]

I believe that the vaccine has been shown to be somewhat effective in men, but not to the extent that it is in women. Also, there is the whole cervical cancer issue for women, which obviously isn't an issue for men.

Yes I've heard this too, and what I've also heard is that it isn't approved for men as a result. If you know different, please share with the rest of the class.

 

[etf]

I don't think there's a whole lot of controversy in the medical community, just among the lay public. I've yet to meet a physician who thought the vaccine was a bad thing. It would be interesting to hear from folks at the med schools with more religious underpinnings weighing in.

yeah the consensus among physicians is that it's a good thing. could be a way for natural selection to work and weed out ultra-religious people. but then again, their probably not engaging in "risky" behavior such as premarital sex anyway...

 

[bjackrian]

Yes I've heard this too, and what I've also heard is that it isn't approved for men as a result. If you know different, please share with the rest of the class.

Courtesy of USA Today via Google. This is from June 2006 when Merck started their PR campaign.

Q. Has anyone thought about vaccinating men and boys, too?

A. In men, HPV causes genital warts and has been linked to penile and anal cancer. Plus, of course, men can transmit HPV to women. Merck has tested Gardasil's safety and immune response in 9- to 15-year-old boys and found that they have a slightly better immune response than girls and women, Barr says. "What we don't know yet is whether the vaccine will protect against infection and disease caused by HPV in young men," he says. To answer that question, Merck is conducting a clinical trial in men as old as 26 and expects to complete it in 2008, Barr says.

 

[Sol Rosenberg]

I think its perfectly reasonable to require vaccination against a disease that is spread socially (whether thru sexual or casual contact). If nothing else disease costs the health care system money, so why not reduce disease if its as easy as a mandatory vaccine? On a human level disease causes suffering so yet again why wouldn't you want to reduce that?
Sure we can all say we hope our daughters don't have sex untill they are married, and talk about how abstinence would prevent them from getting HPV so isn't that a better way . .. but even if little suzyQ doesn't have sex untill her honeymoon night with her new hubbie, who's to say that the new hubbie won't be carrying HPV himself and give it to her anyway? Or that new hubbie won't cheat and bring HPV into the marriage.
Life isn't a fairy tale and everyone doesn't always do what they should . . . so if we need some stupid mandate to prevent many women from getting a horrible and sometimes deadly disease that costs our system gobbs of money then I'm for it. If we're ok with preventing requiring other vaccines why not this one? Sex is about as big a part as being human as breathing, with that whole biological imperative thing, so why do we think its ok to vaccinate against airborn diseases but not those that spread via mucous membrane contact? It speaks volumes about our society's weird issues with sexuality that we would rather watch people suffer and die than confront the awful truth that people have sex and do something that would make it a safer activity for all of us.

Sorry, but that is a bunch of crap (and my opinion has nothing to do with my so-called "wierd issues with sexuality" .) By not wanting to make a vaccine mandatory, it doesn't mean people are sitting around watching people die. What you are proposing is that EVERYBODY (or at least every woman) be vaccinated against a virus that:

- The spread of which can be deterred by condom use.
- Only causes cancer in a small percentage of women infected.
- Since the vaccine does not protect against all strains of HPV, annual pap smears are still required.
- Cervical cancer, IN THE US, is one of the least fatal cancers (mostly because of early diagnosis from frequent pap smears.)

This is not an epidemic where enormous numbers of people are dying in the streets, like you imply. Like I said in my previous posts, my personal opinion is that I will vaccinate my children, but I think that making this vaccine mandatory is not necessary. You seem to have the liberal "we need to protect all the stupid people from themselves" attitude, whereas mine is more libertarian and allows people to do what they want so long as it doesn't harm others. I'm bracing myself for the inevitable retort along those lines.

 

[Tired]

Yes I've heard this too, and what I've also heard is that it isn't approved for men as a result. If you know different, please share with the rest of the class.

I am aware of two studies on the vaccine, both of which were company-sponsored, and both of which were limited to women. I'd be interested if someone could point me to the ones that looked at men.

Serotypes people. The serotypes linked to penile cancer are not the serotypes covered by the vaccine.

In addition, the prevalence of penile cancer in men is so low that the requisite study to prove vaccine effectiveness would require a huge study population, making it relatively un-feasible.

 

[Jadeite]

On the HPV vaccine:

I was just in adolescent for an elective and was able to speak with attendings and residents and the drug reps about this, since it is a very hot topic. I also got to offer the vaccine to many young women, most of which accepted it.

1. Guys
- from what I've heard it was tested on guys. A quick search of pubmed (I'm not at school and thus am only reading the abstracts) does not turn up any studies that state in the abstract they included men. From what I've heard, the studies that did include men were inconclusive on benefits due to the relative rarity of penile cancer. Logic suggests that the vaccine will also help the dudes out, but even if it didn't: would it be worth the small vaccine-related risks (and here I am thinking of allergic reactions) to provide herd immunity by immunizing the potential sex partners of people with cervixes! Anyway, I think it will be approved for vaccination of men soon enough. I also predict a ****storm from the religious right about this move endorsing anal sex... But maybe I'm a cynic!

2. Vaccine refusal (makin' it mandatory)
- despite all the press about 'OMG! They are making our girls sex kittens!' Texas has a very lenient vaccine refuse policy. So if you are one of those people who believes premarital sex should result in suffering, well, by all means why don't you waive the vaccine for your kid, jackass. (We're allowed to curse here, right? I'm a 4th year and have lost the ability to communicate otherwise. Please forgive.)
- In my own work with patients the people who refused the vaccine were refusing Meningicoccal vacc (also recommended to the same age group) too because they were concerned about the risks of vaccination. I had no patient refuse (or at least tell me they were) refusing on the basis of sex morals. Of course, the clinic I rotated at was in a city where we routinely had pregnant 13-14 year olds, so maybe these parents were just keeping it real. (Vaccination requires parental consent, it is not part of the emancipation of minors around sex and drugs like birth control and pregnancy stuff - at least not in the state of Ohio.)

3. You and me!
- I made an appointment to get the vacc, I am 26. Though I may have already been exposed to one or more of the strains (I sure hope not) I will still be protected from the others once vaccinated. I called up mom who was willing to fund the series since it isn't yet covered by our student health.
- I have spoken with residents who are over 26 who have prescribed and adminstered it to themselves since 26 was only the range it was studied to, not necessarily the end of the time when you could benefit.

 

[45408]

In addition, the prevalence of penile cancer in men is so low

Irrefutable proof that there IS a God.

 

[mac_kin]

I think it's quite convenient for the Governor of Texas, considering his affiliations with Merck Co.

Personally, I believe this is a load of sexist BS. I understand that the virus may cause cervical cancer, which is obviously a women's issue, but to me this is another example of medical control over women's bodies and the medicalization of every minute problem we have. Why not start by teaching our sons and daughters not to be such who.res??

This is obviously all for the benefit of the Merck corporation - because we all know noone is going to defend women's rights.

 

[TMP-SMX]

I think it's quite convenient for the Governor of Texas, considering his affiliations with Merck Co.

Personally, I believe this is a load of sexist BS. I understand that the virus may cause cervical cancer, which is obviously a women's issue, but to me this is another example of medical control over women's bodies and the medicalization of every minute problem we have. Why not start by teaching our sons and daughters not to be such who.res??

This is obviously all for the benefit of the Merck corporation - because we all know noone is going to defend women's rights.

Isn't that what the public school systems are trying to do? It's called abstinence only and it doesn't work. Of course I don't see how any of your rant is relevant.

 

[mac_kin]

Isn't that what the public school systems are trying to do? It's called abstinence only and it doesn't work. Of course I don't see how any of your rant is relevant.

It's relevant to the fact that this is a useless effort to make more money for Merck and friends. At the expense of little girls that is. Not all teenagers have sex in high school! Little girls who are 9 or 10 years old aren't thinking about STD's. Why would you jeoparidize their future health by injecting them with chemicals?? What if they are the small few who choose not to have sex in high school or be promiscuous??

We have ditched teaching moral values in high schools because we now have these vaccines and miracle drugs to take care of all our problems. I'm not implying 'abstinence-only' education. I'm implying that we start teaching our kids early on about sexual health. Why don't we start teaching 9 year old girls about STD's and cervical cancer?? Or wait, you would rather shut them up and pump them full of chemicals for every disease imaginable and let them run wild to have sex with everyone they want. That's the american way.

I think people need to start thinking about the social and health implications of this vaccine.

 

[TMP-SMX]

It's relevant to the fact that this is a useless effort to make more money for Merck and friends. At the expense of little girls that is. Not all teenagers have sex in high school! Little girls who are 9 or 10 years old aren't thinking about STD's. Why would you jeoparidize their future health by injecting them with chemicals?? What if they are the small few who choose not to have sex in high school or be promiscuous??

We have ditched teaching moral values in high schools because we now have these vaccines and miracle drugs to take care of all our problems. I'm not implying 'abstinence-only' education. I'm implying that we start teaching our kids early on about sexual health. Why don't we start teaching 9 year old girls about STD's and cervical cancer?? Or wait, you would rather shut them up and pump them full of chemicals for every disease imaginable and let them run wild to have sex with everyone they want. That's the american way.

I think people need to start thinking about the social and health implications of this vaccine.

I disagree. No matter the risk teens are going to fool around and explore their sexuality. That's completely normal and can't be stopped. You can tell your son or daughter some of the implications of sex and the connotations to health and encourage certain behaviors, but you can't force them. I'm not saying that every teenager will have sex, but there are many different ways of contracting HPV. If not in high school, it will happen in college. Maybe you should recommend that people just don't have sex at all since it must be some evil thing that should be feared?

Since it's widespread in the population it's a serious threat that is very expensive. If pap smears could be phased out by the time that all of the disease causing strains are prevented from spreading it would save us all a lot of money.

I'm not sure I agree with making this vaccine absolutely mandatory, but I would say that with public health at risk it is important to reduce the spread of a pathogen from the levels it has in the human population now. As for the "chemicals" we pump children with, I really don't think it is a real fear. Whether or not there is a link between mercury and autism is not known fully yet, but I think it's an overstated risk.

My uncle is a biochemist and he is starting up a company that created an organism that binds heavy metals and therefore may be used in vaccines and other applications.

That's besides the point, but I think it is dangerous to not allow your child to have vaccinations. If only for the fact that diseases such as diptheria are on the rise I would say precisely for the reasoning you have. Without vaccinations, smallpox and polio would probably be just as common as they were in the past These are easily preventable diseases that were reduced or eradicated mostly for the advent of vaccinations. While hygiene is important for many water or common source infections, person to person diseases are often hard to stop because we are social animals that spread respiratory and diarrheal bacteria/viruses very quickly. Many people don't know how to wash their hands and it doesn't kill all pathogens anyway.

 

[GoodDoctor]

I think it's quite convenient for the Governor of Texas, considering his affiliations with Merck Co.

Personally, I believe this is a load of sexist BS. I understand that the virus may cause cervical cancer, which is obviously a women's issue, but to me this is another example of medical control over women's bodies and the medicalization of every minute problem we have. Why not start by teaching our sons and daughters not to be such who.res??

This is obviously all for the benefit of the Merck corporation - because we all know noone is going to defend women's rights.

There are 4 key differences between kids taught abstinence-only vs. those taught wider array of protective measures (e.g., condoms):
Abstinence Only:
- First sexual experience is about 1 year later.
- Fewer sexual partners overall.
- Higher rates of teen pregnancy.
- Higher rates of STD infection.

So, they have less sex, but having never learned to protect themselves, end up with more negative consequences.

Why do just one? Abstinence has two slight positives (fewer sex partners) and two major negatives (teen pregnancy, std's). So, teach BOTH. If you always use protection and have fewer partners, your risk is reduced more than if you just followed one method.

The most effective ways to protect from STDs are:
1) Abstinence
2) Monogomy (where both partners are monogomous)
3) Condoms, etc.

For HPV, we can now throw in vaccination at #2. A multipronged approach would be most effective.

 

[GoodDoctor]

It's relevant to the fact that this is a useless effort to make more money for Merck and friends. At the expense of little girls that is. Not all teenagers have sex in high school! Little girls who are 9 or 10 years old aren't thinking about STD's. Why would you jeoparidize their future health by injecting them with chemicals?? What if they are the small few who choose not to have sex in high school or be promiscuous??

We have ditched teaching moral values in high schools because we now have these vaccines and miracle drugs to take care of all our problems. I'm not implying 'abstinence-only' education. I'm implying that we start teaching our kids early on about sexual health. Why don't we start teaching 9 year old girls about STD's and cervical cancer?? Or wait, you would rather shut them up and pump them full of chemicals for every disease imaginable and let them run wild to have sex with everyone they want. That's the american way.

I think people need to start thinking about the social and health implications of this vaccine.

Same here. Why ONLY teach about STD's and cervical cancer? Why not also add a vaccine to the mix and further reduce the risks of contracting STD's or getting cancer?

Would you be against using a vaccine for HIV as well? Or would we just keep teaching abstinence? Even intense classes on HIV/AIDS and safer-sex practices would not be as effective as a vaccine against HIV. If we had both, though, we would be stupid/negligent not to use both.

 

[GoodDoctor]

In addition, the prevalence of penile cancer in men is so low

Irrefutable proof that there IS a God.

If there were a God, it would only proove he/she likes penises. And it makes just as good an argument for God being female as it does male. Think, would your wife prefer she lose her uterus or that you lose your penis?

 

[GoodDoctor]

Since it's widespread in the population it's a serious threat that is very expensive. If pap smears could be phased out by the time that all of the disease causing strains are prevented from spreading it would save us all a lot of money.

This is a great point. Who pays for treating all of the women with cervical cancer? I honestly don't know - I'm asking. My guess is that it would cost the nation less in healthcare costs (and lower premiums) to give out vaccinations than to give repeated paps and to treat cancer.

 

[lsumedgirl]

I think its perfectly reasonable to require vaccination against a disease that is spread socially (whether thru sexual or casual contact). If nothing else disease costs the health care system money, so why not reduce disease if its as easy as a mandatory vaccine? On a human level disease causes suffering so yet again why wouldn't you want to reduce that?
Sure we can all say we hope our daughters don't have sex untill they are married, and talk about how abstinence would prevent them from getting HPV so isn't that a better way . .. but even if little suzyQ doesn't have sex untill her honeymoon night with her new hubbie, who's to say that the new hubbie won't be carrying HPV himself and give it to her anyway? Or that new hubbie won't cheat and bring HPV into the marriage.
Life isn't a fairy tale and everyone doesn't always do what they should . . . so if we need some stupid mandate to prevent many women from getting a horrible and sometimes deadly disease that costs our system gobbs of money then I'm for it. If we're ok with preventing requiring other vaccines why not this one? Sex is about as big a part as being human as breathing, with that whole biological imperative thing, so why do we think its ok to vaccinate against airborn diseases but not those that spread via mucous membrane contact? It speaks volumes about our society's weird issues with sexuality that we would rather watch people suffer and die than confront the awful truth that people have sex and do something that would make it a safer activity for all of us.

Well said. I couldn't have put it better myself!

 

[psipsina]

Sorry, but that is a bunch of crap (and my opinion has nothing to do with my so-called "wierd issues with sexuality" .) By not wanting to make a vaccine mandatory, it doesn't mean people are sitting around watching people die. What you are proposing is that EVERYBODY (or at least every woman) be vaccinated against a virus that:

- The spread of which can be deterred by condom use.
- Only causes cancer in a small percentage of women infected.
- Since the vaccine does not protect against all strains of HPV, annual pap smears are still required.
- Cervical cancer, IN THE US, is one of the least fatal cancers (mostly because of early diagnosis from frequent pap smears.)

This is not an epidemic where enormous numbers of people are dying in the streets, like you imply. Like I said in my previous posts, my personal opinion is that I will vaccinate my children, but I think that making this vaccine mandatory is not necessary. You seem to have the liberal "we need to protect all the stupid people from themselves" attitude, whereas mine is more libertarian and allows people to do what they want so long as it doesn't harm others. I'm bracing myself for the inevitable retort along those lines.

In an ideal society I agree with you that people should be free to make their own decisions as long as their actions don't harm others. However our society is not ideal and the maldistribution of education and medicine based on socioeconomic factors has created a population that does in fact need to be protected from themselves. People born on the other side of the tracks might not have a doctor who discusses the HPV vaccine and its benefits with them, they might not have the education to understand why using a condom is so important or other ways its possible to spread STDs (i.e. oral sex), they might not have health insurance or money to go see a doctor to get the vaccine for their children.

These people may be good people who just never had opportunities that many of us take for granted, but they won't know to protect themselves with the vaccine, are less likely to understand and employ safe sex 100% of the time and are less likely go get yearly paps. And what happens when they do get cervical cancer . . . they end up unable to pay their bills burdening our health care system further. And even though cervical cancer isn't the number one killer in america it does kill people, so some of them will die. And those that are cured suffer needlessly from the disease and the chemo/rads.

I never implied that vast populations were dropping dead, but if we can prevent the suffering and death of a population of people with a simple mandatory vaccine, I believe the benefit is definitely worth stepping out of our idealistic bubbles where we like to believe in equal opportunities and freedom for everyone. I believe that these people are worth doing something that isn't the ideal way of dealing with the issue, but will help them until we can create an ideal society where they would have every opportunity to educate themselves and go to the doctor and get whatever medication and vaccines they need.

 

[Tired]

This is a great point. Who pays for treating all of the women with cervical cancer? I honestly don't know - I'm asking. My guess is that it would cost the nation less in healthcare costs (and lower premiums) to give out vaccinations than to give repeated paps and to treat cancer.

The studies that have looked at this are, of course, largely speculative, given that the actual cost of the vaccine is still relatively high, and the long-term efficacy against cervical cancer is still up in the air. However, most studies have suggested that the vaccine is probably relatively cost-effective, if we employ the standard cutoff of $50,000/life saved.

Citations available on request.

 

[Tired]

In an ideal society I agree with you that people should be free to make their own decisions as long as their actions don't harm others. However our society is not ideal and the maldistribution of education and medicine based on socioeconomic factors has created a population that does in fact need to be protected from themselves.

Are you sure you're an American? You might be much happier working in Europe, Africa, or another region with a strong tradition of fascism. In general, most Americans have been reluctant to employ your logic, since our experience has shown pretty dramatically that those who think they "know better" than the lower classes do far more harm than good.

 

[Sol Rosenberg]

I completely agree with Tired's post above, and I won't repeat his argument.

These people may be good people who just never had opportunities that many of us take for granted, but they won't know to protect themselves with the vaccine, are less likely to understand and employ safe sex 100% of the time and are less likely go get yearly paps. And what happens when they do get cervical cancer . . . they end up unable to pay their bills burdening our health care system further. And even though cervical cancer isn't the number one killer in america it does kill people, so some of them will die. And those that are cured suffer needlessly from the disease and the chemo/rads.

THEY CAN STILL GET THE VACCINE. I AM NOT ARGUING AGAINST THE VACCINE!!!!! If "these people" can't afford the non-mandatory vaccine, how will they afford the mandatory vaccine? It should be noted that here in TX, although the vaccine is mandatory, it is not covered by most insurance plans or paid for by the state per se. I don't know whether Medicaid covers it or not, but I guess in YOUR ideal world EVERYONE who can't afford insurance has Medicaid? Put the crack pipe away for a second and realize that "these people" who can't pay for their healthcare are most often the ones who "slip through the cracks" and can't afford private insurance or qualify for Medicaid (or Medicare, but the Medicare patients aren't particularly relevant to this discussion.) Therefore, I don't see how simply making this vaccine mandatory solves our current healthcare crisis, as you are implying above.

 

[psipsina]

Are you sure you're an American? You might be much happier working in Europe, Africa, or another region with a strong tradition of fascism. In general, most Americans have been reluctant to employ your logic, since our experience has shown pretty dramatically that those who think they "know better" than the lower classes do far more harm than good.

I don't understand why if I see a flaw in the american system I suddenly am somehow unamerican. We have been continuously improving our system (thus the living document concept of the constitutution and the ability to ammend it) throughout our history. I simply believe that public education funding should be the same for each child regardless of which neighborhood they come from and that every working american, child or spouse of a working american or person who is disabled and unable to be a working american has the right to access our medical system. Everyone deserves the same opportunities, what they do with those opportunities is up to them. Until this is achieved I think some small measures to ensure the public good (like all the other childhood vaccines) is a necessary evil. There is precedent for requiring vaccines, the only thing that makes this one any different is the way the disease is passed.

 

[psipsina]

I completely agree with Tired's post above, and I won't repeat his argument.



THEY CAN STILL GET THE VACCINE. I AM NOT ARGUING AGAINST THE VACCINE!!!!! If "these people" can't afford the non-mandatory vaccine, how will they afford the mandatory vaccine? It should be noted that here in TX, although the vaccine is mandatory, it is not covered by most insurance plans or paid for by the state per se. I don't know whether Medicaid covers it or not, but I guess in YOUR ideal world EVERYONE who can't afford insurance has Medicaid? Put the crack pipe away for a second and realize that "these people" who can't pay for their healthcare are most often the ones who "slip through the cracks" and can't afford private insurance or qualify for Medicaid (or Medicare, but the Medicare patients aren't particularly relevant to this discussion.) Therefore, I don't see how simply making this vaccine mandatory solves our current healthcare crisis, as you are implying above.

Along with the mandatory vaccine I would argue that it be provided for free to those who can prove that they can't afford it (i.e. look at their income). Requiring a vaccine and then not providing it is assanine.

Please don't infer that I smoke crack because I disagree with you, people can intelligently disagree without having to start this bull.

And yes, I do believe as I stated above that every member of an american family that contributes to our society or is unable to contribute (i.e. disabled war vets, schizophrenics etc) have a human right to access medical care. If you go and work 40 hours a week and pay your taxes there is no reason that you shouldn't be able to go to the doctor when you need to and yet this happens to many many americans. If we gave every working american (and their dependants) this right and we gave them equal educational opportunities then we could have a truely libertarian society in which people could be free to do what they like as long as it didn't harm anyone, and if they chose not to be productive members of society and not to take advantage of the opportunities given to them there would be no question that the blame for how their lives turned out fell entirely on them.

Finally, no, I never claimed to think this vaccine solves the health care crisis . . . but it makes a tiny dent as we try to fix some of the bigger issues that would make mandates like this unnecessary. And though that dent is tiny it is measured in human suffering and in human lives, so I think that makes it worth it.

 

[RockShox]

This is an interesting discussion. May I add that jumping in willy-nilly could be fine but could also cause problems. Economics is one thing. It is all good just to say "let them eat cake" but where its the $300 million dollars to vaccinate everyone going to come from? Especially, in light of the fact that all women who get it STILL must get a pap smear. (One, because who knows merck may have lied and two, only 70% of cervical cancer is caused by HPV there are other causes, like cheap tampons...ok just kidding about that part.)

My concern is that whenever this stuff becomes mandatory it is always the doctors that get the shaft through some low reimbursment rate. I would not be suprised if the government makes us do this and only gives Wendy's frosty coupons in return.

Remember before Gardasil this cancer was a COMPLETELY PREVENTABLE CURABLE disease. The only people who die from it were those who did not or could not get a pap. So would it be better spend the money to get them to come in for their pap and ALSO get other care/prevention advice like for diabetes, HTN etc. Or give them the vaccine and have them say "I don't need to go to the doctor I had my vaccine?" and we see the incidence of undiagnosed diabetes increase.

Let's not forget the law of unintended consequences.

BTW this is a GREAT article that looks at alot of the pros/cons

http://theoncologist.alphamedpress.org/cgi/content/full/10/7/528

I really do not have any strong opinion one way or another yet but thought I would add some other thoughts.

 

[Tired]

I don't understand why if I see a flaw in the american system I suddenly am somehow unamerican. We have been continuously improving our system (thus the living document concept of the constitutution and the ability to ammend it) throughout our history. I simply believe that public education funding should be the same for each child regardless of which neighborhood they come from and that every working american, child or spouse of a working american or person who is disabled and unable to be a working american has the right to access our medical system. Everyone deserves the same opportunities, what they do with those opportunities is up to them. Until this is achieved I think some small measures to ensure the public good (like all the other childhood vaccines) is a necessary evil. There is precedent for requiring vaccines, the only thing that makes this one any different is the way the disease is passed.

Nice turnaround, trying to make this about disparities in the public funding of education.

The issue at hand is whether or not the HPV vaccine should be mandatory for school attendence, nothing more and nothing less. You argue that the access to medical education is somehow impaired for the poor. You are right, if you were talking about adults, but we are talking about children. Children who get vaccines necessarily have Pediatricians, meaning that their parents have access to a source of medical knowledge, including information on the HPV vaccine. Since all children entering school have to have a requisite panel of vaccinations, it follows that all children in school have Pediatricians. This essentially renders your argument moot, which I'm sure you realized. It is fairly obvious that you are reaching for a "socially acceptable" reason to mandate vaccinations for children that their parents do not want.

The flaws in the delivery of medical care in America are glaring. Fortunately, that is not operative when it comes to Pediatric vaccinations.

The reason I called you un-American was your argument that you know better than the parents of the children you want to force vaccinations on. I don't think this is unreasonable; I think it is an accurate assessment of your argument, and I think my analogy to fascism was appropriate.

You blithely dismiss the "mode of transmission" of HPV, but it is precisely the mode of transmission that resulted in certain vaccines becoming compulsory in the United States. Diseases that cannot be passed via casual contact have not historically made it into the "required" vaccination panels. Forcing injections on children that their parents do not want generally requires a compelling public health interest. That is lacking in HPV.

 

[GoodDoctor]

Children who get vaccines necessarily have Pediatricians, meaning that their parents have access to a source of medical knowledge, including information on the HPV vaccine. Since all children entering school have to have a requisite panel of vaccinations, it follows that all children in school have Pediatricians.

Just wanted to point out that this part of your argument is factually incorrect. My school nurse's office did vaccinations. If you don't have the money to see a pediatrician, you can get free vaccinations at the county health office. This is from personal experience in 3 states.

 

[Lshapley]

Let's not forget the law of unintended consequences.

BTW this is a GREAT article that looks at alot of the pros/cons

http://theoncologist.alphamedpress.org/cgi/content/full/10/7/528

Wow, I am really surprised that nobody has mentioned the possibility of unintended consequences yet. This is a new vaccine. The trials have involved following women for 1.5 years on average and involved about 4,000 girls? What if there is some unseen consequence of this vaccine and we tell all the girls to take it? What if it is something that affects 1/1,000 or 1/10,000 and takes a few years (I know, most vaccine complications happen within two weeks, but what if?) We wouldn't know yet and we are making all these little girls take it. We all have heard about how terrible the smallpox vaccine is, and even the flu and polio vaccines have potential severe complications. And the threat from cervical cancer does not equal the threats from either polio or smallpox.

If the HPV vaccine is implemented on a mass scale and a couple of 12 year old girls die, the country would freak out! The vaccinations would stop and a lot of faith would be lost in both the government and the healthcare system. The loss would be much greater than the gains.

My ears perk up when I hear that a competitor vaccine will be released next year by another drug company. Like I believe was mentioned earlier, this is probably more of a motivation than any other.

I suggest not making making it mandatory until it has been in use by the general population for a few more years. I also think there should be a couple of different vaccines on the market first before we make people take one.

 

[fakin' the funk]

yeah, why worry about the longterm effects of injecting our children with foreign genetic material? pffft! why stop with the 24 mandatory vaccines we have now? why not vaccinate for everything that might possibly go wrong?

Are Luddites allowed to use computers?

 

[Coclean]

The viruses you are talking about (chlamydia and HPV) do cause pathology, although they are clinically silent. HPV results in dysplasia/metaplasia (although admittedly this reverses in most people spontaneously). Chlamydia, at least in some people, will result in low grade chronic inflammation that can cause fallopian tube scarring, eventual FHC/PID, chronic urethritis, etc.

Just in case anyone cares, chlamydia is an intracellular bacteria. And yes, it does cause significant pathology, including possible sterility, even when asymptomatic. So even if you wish not to consider it a disease (based on a definition which requires symptomology) it is still a clinically significant infection. As, most likely, is HPV (which is a virus).

The microbiologist is coming out in me I suppose. But I think it is important to make that distinction. The HPV vaccine is a unique and intriguing new medical development. It is the first vaccine for a chronic disease. It is preventative care for a chronic disease (cancer) which has in its causitive pathway an infectious agent, HPV. Whether it should be required for medical clearance in schools???? That's a social question that has nothing to do with the biology of the thing I would think. Regardless of herd immunity or preventing disease in others....its a good question as to whether we should be able to require any intervention....even isolation of TB patients (if you don't want to get TB you could just wear a mask all the time...).

However, that said. I got the vaccine (though not at high risk). If I ever had children I would suggest to them that they get the vaccine (even though I would hope they were not at high risk). And if I didn't think there was an sociology involved in administering the vaccine I would say that all little girls AND BOYS, should get the vaccine, as they saw befitting of a citizen concerned with the well-being of others.

 

[getunconcsious]

Q: What is the only way to get a Republican to vote for HPV vaccination?




A: Tell them that HPV can also cause penis cancer.




any by the way VanDerMom, are you saying that you did not vaccinate your children?

Actually, HPV can and does cause squamous cell cancer of the penis. You just don't hear about it much b/c it only happens to un-circumcised men. I'm surprised no one here has pointed out that HPV causes penis cancer, given that remark...?

 

[lsumedgirl]

Personally, I believe this is a load of sexist BS. I understand that the virus may cause cervical cancer, which is obviously a women's issue, but to me this is another example of medical control over women's bodies and the medicalization of every minute problem we have. Why not start by teaching our sons and daughters not to be such who.res??

Take this case for example... a woman saves herself for her one true love... meets him, gets married, and loses her virginity on her wedding night. Also, suppose this... what if her husband has had a tryst in his past (not making him a "who.re"... maybe it was one one-night-stand). Theoretically, he could have HPV and pass it on to his new bride. I hardly think this would be a case of HPV due to "who.ring" around. It seems to me that this poster is stating that anyone who gets HPV deserves it. That's very tacky, in my opinion.

 

[lsumedgirl]

Remember before Gardasil this cancer was a COMPLETELY PREVENTABLE CURABLE disease. The only people who die from it were those who did not or could not get a pap. So would it be better spend the money to get them to come in for their pap and ALSO get other care/prevention advice like for diabetes, HTN etc. Or give them the vaccine and have them say "I don't need to go to the doctor I had my vaccine?" and we see the incidence of undiagnosed diabetes increase.

Actually, if I remember one of the advertisements correctly, they state that it is still necessary to follow-up with your doctor for regular check-ups. They NEVER state that after receiving the vaccine, you can discontinue paps.

If there is a vaccine to combat this problem, why not use a two-pronged approach? Paps and yearly check-ups AND the vaccine to prevent new transmission! It appears that this would be the most effective approach.

 

[Sol Rosenberg]

Actually, if I remember one of the advertisements correctly, they state that it is still necessary to follow-up with your doctor for regular check-ups. They NEVER state that after receiving the vaccine, you can discontinue paps.

If there is a vaccine to combat this problem, why not use a two-pronged approach? Paps and yearly check-ups AND the vaccine to prevent new transmission! It appears that this would be the most effective approach.

Absolutely, but we hear nothing of state-mandated pap smears, which could, arguably, save more lives than the vaccine. What about mandated yearly check-ups? If we're going to make laws dictating healthcare policy like this, why not just mandate yearly checkups (not just for HPV, but yearly physicals too?)

For those who haven't been following my posts to this thread, please note that I am not seriously advocating this; I'm merely trying to illustrate a point. I think most Americans would have an issue with state mandated yearly checkups, yet we have posters in this thread advocating that that is the sort of thing that we should do (but with the HPV vaccine) because preventative care can mitigate the costs borne by our healthcare system.

 

[OncoCaP]

Absolutely, but we hear nothing of state-mandated pap smears, which could, arguably, save more lives than the vaccine. What about mandated yearly check-ups? If we're going to make laws dictating healthcare policy like this, why not just mandate yearly checkups (not just for HPV, but yearly physicals too?)

For those who haven't been following my posts to this thread, please note that I am not seriously advocating this; I'm merely trying to illustrate a point. I think most Americans would have an issue with state mandated yearly checkups, yet we have posters in this thread advocating that that is the sort of thing that we should do (but with the HPV vaccine) because preventative care can mitigate the costs borne by our healthcare system.

In a way we do have mandated checkups for students anyway. The vision test at the DMV could be loosly considered a vision checkup as well (and those vision checks are a good thing for all of us who want to stay alive on the road!). We all must have immunizations before we can attend school (unless you provide a religious or other acceptable objection). In elementary school, they do hearing and visual screenings. Schools also check for lice among elementary-age children and send them home if lice eggs are found. It comes down to striking a balance between what the experts think is best for the health of the public overall and private freedoms concerning healthcare. Given the high rate of promiscuity among teenagers and young adults, it probably makes sense to require this HPV immunization for female students unless the parents have an acceptable objection. Any balancing act like this can be taken to one extreme or the other and where exactly that balance should be struck is a political question like so many others.

 

[deleted109597]

Serotypes people. The serotypes linked to penile cancer are not the serotypes covered by the vaccine.

In addition, the prevalence of penile cancer in men is so low that the requisite study to prove vaccine effectiveness would require a huge study population, making it relatively un-feasible.

It wouldn't be to prevent the man from getting it. It would be to increase herd immunity. For the same reason that flu vaccines are preferentially given to old people, and families of those with old and very young children. Not to keep them from getting the flu, per se, but to prevent them from getting it and then giving it to someone else. Half of the HPV infections out there are men. They transmit to women. The more people get the vaccine, the more effective it is.