Adam’s Blog

That’s my thing, keepin’ the faith, baby. –Joe Friday

An Ineffective Solution

Posted by Adam Graham on March 12, 2007

Cross-posted from WhereIStand

Merck’s HPV Vaccine is being pushed as a way to prevent Cervical Cancer. Some politicians want to make the vaccination mandatory, but there’s more than enough information to say, "Not so fast!"

The "real" reason that "[t]oo many women still die of cervical cancer" is the "lack of access to preventive medical care for low-income women and not the lack of a vaccine," Wall Street Journal columnist and Illinois-based physician Benjamin Brewer writes in an opinion piece. According to Brewer, the "decision to vaccinate a child" with a human papillomavirus vaccine, such as Merck’s HPV vaccine Gardasil, "should be made by the patient, her parents and their doctor" and not states (Brewer, Wall Street Journal, 3/8). Gardasil, approved by FDA in July 2006, has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. The vaccine, which costs $360, also is about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases (Kaiser Daily Women’s Health Policy Report, 2/28). Brewer writes that Gardasil will not stop the need for annual Pap tests, adding that the "real usefulness" of the vaccine is its protection against genital warts. Cervical cancer thus has become a "rare disease" in the U.S. in part because "newer versions of the [Pap] test have cut down on false positives and improved cancer screening," Brewer writes, adding, "There are not millions of women in the U.S. that we’re going to save with a mass vaccination program. The developing world is another story." He concludes, "[A]s a personal choice, spending $360 of disposable income on a vaccine is one thing. Mandating a vaccine with limited clinical usefulness at taxpayers’ expense … is another" (Wall Street Journal, 3/8).

Gardasil is also only been shown to be effective five years. Given that the average woman who develops cervical cancer is in her mid-50s, it would seem a tad silly to attempt to solve this problem by vaccinating thirteen year olds.

FInally, CBS published a column detailing that the people opposing the vaccine aren’t just conservative crazies:

Today, as thirty-one state legislatures consider mandating the vaccine for middle school girls, skepticism about the wisdom of embarking on this swift and widespread inoculation program has bubbled up from critics who span the political spectrum. These strange bedfellows include Christian conservatives and their abstinence-only ilk, who have long argued that safe sex encourages profligate sex; a slew of Big Pharma critics, who see how Merck (which stands to make $4 billion a year on the vaccine by most estimates) is angling to corner this huge new vaccine market; the growing antivaccine movement, which objects to all such school-entry requirements; the parental-rights folks with a libertarian strain, who bridle at any mandates regarding their children’s health; and a smattering of women’s health advocates, who worry that the pace of the vaccine’s introduction is jeopardizing its ultimate success.

Indeed, and the most unlikely skeptic of all, the Alan Guttmacher institute:

Finally, the backdrop to all these conversations is one unfurled by women’s health advocates, who insist that we set the current action in a historical context. Walking around with the DES-Thalidomide-Dalkon Shield pharmaceutical disasters in the back of their minds, some worry that Merck’s profit-driven rush to mandate this drug may prove problematic. "There’s merit to questioning industry’s motives in this case," says Heather Boonstra, public policy analyst at the Alan Guttmacher Institute, a nonprofit organization focused on sexual health research and analysis. "Because Merck itself has pushed so hard to make the vaccine mandatory, there’s a bit of skepticism about industry’s motives."

There is more than enough cause to give us pause on either having states spend $360 on a new drug, the effectiveness of which we can’t be certain of.

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