Saturday, February 10, 2007

HPV Vaccine, Cancer, Kids and Sex

(This is something I wrote last March but since the HPV vaccine is back in the news - I thought I'd repost it.)

Instapundit brings up a subject that my wife and I have discussed recently - the HPV (human papillomavirus) vaccine. HPV is currently the cause of most cases of cervical cancer and cervical cancer is the second most common form of cancer in women (behind breast cancer). Nearly 4,000 women die of cervical cancer in the US each year. HPV also causes most cases of genital warts as well - so this isn't just a women's issue.

A vacine to cure these ills sounds great - right? There are issues, however, such as:

- In order for the vaccine to be successful it is really necessary to inoculate before a person is sexually active. In practice this means inoculating children for STDs. Most states already require a round of inoculations which include Hepatitis B, which is normally a sexually transmitted disease (you can also get it from blood - like in sharing needles but if kids are sharing needles they have worse issues then the threat of genital warts or Hep B). The point is a precedent has been set. But is it a good precedent?

- The words "with few side effects" scares the bejeebus out of some parents and rightly so. Are the odds of side effects greater than the odds of catching HPV when using a condom? I don't know the answer to that one and I think it is telling that the word "condom" does not appear at all in The New Republic article Instapundit linked to.

- Who is going to pay for these vacines and how much will they cost? Merck and GlaxoSmithKline are not non-profit companies. Steven Groopman makes a compelling return on investment argument:
But each year, 4.7 million American women require one or more follow-up appointments for an abnormal pap result, and at least 3 million of these cases result from having HPV. The cost of these appointments to the individual (and to our already overburdened health care system) quickly adds up. A 2003 Stanford study suggested that the cost of inoculating people against the disease would be far smaller than the current cost to the health care system associated with HPV.
That may be true but are taxpayers footing the bill for those follow-up pap smear tests today? Could the HPV inoculation come at the same time as the other inoculations a child has to undergo to go to school or would it require a separate trip? If it was a separate trip - wouldn't those costs equal or outweigh the saving from the reduced follow-up pap smear appointments? Many questions remain that still need to be answered about costs and who pays.

- Religious and ethical issues about the governments role in the sex lives of teenagers. Goopman's article seems to be saying that only the hysterical religious right and their cause of abstinence are against this which isn't necessarily true. The article doesn't even touch the "nanny state" issue. Like mandatory seatbelts - mandatory vaccines and other "for your own good" laws are not appealing to some people. Why not leave it up to parents and teenagers to decide?

The New Republic article should be read if for nothing else to see a comparison between abstinence and communism in print (seriously). However, I think it doesn't address many underlying issues involved and cannot be viewed as anything that even comes close to examining both sides of the argument. Hell - it doesn't even mention that GlaxoSmithKline has a similar vaccine. That leaves me wondering if Groopman's article is nothing more than a Merck PR shill in sheeps clothing.

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