Wednesday, March 11, 2009

HPV, Gardasil & the Immature Cervix

I am very happy that modern medicine is moving in the direction where research funding is put towards women's health issues, such as cervical cancer.  I am very happy that we have learned that HPV is the main culprit.  But what we do with this information, I believe, is up for debate.

First of all, please see this and this about the side effects some young women are having from Gardasil.  While these stories are not conclusive enough for the medical community, I think they are pretty frightening.  

I don't want to rewrite those blogs. I wanted to add a couple of things to think about when you and I contemplate this vaccine for our children.  

First is what I learned last year while attending Miriam Grossman's talk at UVA.  She discussed (Cavalier Daily Article summary) how the immature cervix is more likely to contract HPV than the mature cervix.  The immature cervix has fewer cell layers and HPV isn't as happy to settle in when the cervix is thicker.  So that is one little piece of science.

The other thing that I hadn't realized is that if the world gets the HPV vaccine, then the need for pap-smears goes way down since virtually all cervical cancers are caused by HPV. This is of interest to me because I wonder who this benefits.  If all young women are given this vaccine, will insurance companies pay for pap smears anymore?  Especially if they are shelling out reimbursements to have every young girl in the country vaccinated?  

To truly eradicate cervical cancer, one thing that I hope evolves from medical research is a vaccine or cure that prevents men from transmitting it.  And I am a mother of boys so this comes from a personal place where I expect them to be accountable for their actions and certainly never on some receiving end of a phone call that says "I have HPV, did I get it from you?"  I have heard this is a "challenge" for medical science and they have tried.  Hmmm.  I hope they keep trying. 

I admit that I do not trust insurance companies or pharmaceutical companies with the health of my children.  I did just watch SiCKO and encourage others to check it out sometime.  As far as the personal, my insurance company paid much more for my hospital birth where I received no interventions than my homebirth which had a much lower price tag.  I, you or somebody somewhere essentially paid for drugs that I did not use.  These drugs, had I used them without needing them, would certainly not be in the best interest of my baby's health.  Epidural anesthesia, pitocin...all part of a hospital birth package deal are part of some bigger financial picture between big pharma, insurance companies, hospital revenues, AMA, ACOG and who knows who and what else.  My point is, I do not feel that pharmaceutical companies are not in it to make some money--after all, they did spend tons on research.  The faster they get any treatment, including this vaccine, out into the public, the better for them.

So, apologies for jumping around.  I hope to bring it all together.  HPV likes the young cervix.  So we want to vaccinate before the woman begins being sexually active at all because the younger she is when she starts, the higher risk she is for contracting HPV.  At the same time, if the cervix is so young and needs maturing, giving some vaccine to toughen it up (or whatever the vaccine does) before puberty even is fully on does seem to lead me to think it could cause some other problems later in life.  Sure, maybe not HPV and cervical cancer...but gosh, I have had three babies and I am pretty darn happy my cervix was good and normal for those experiences.  I can see why people might worry if it could affect fertility and so on.

So as Nature's Child discussed, parents really need the full info about this vaccine and make a choice that makes sense for their situation.  If you know your 9 and 10 year old daughter is not even close to being sexually active, then why not wait?  Let her cervix age a bit along the way.  Why is The Establishment trying to push this vaccine so early?  And then I think again to the politics of things, all of our children can have access to health care...insurance...etc. if they are in the public schools.  That means there is funding to push it on children right as they get all those other shots for school.  The older the child gets, the less likely the child will be injected with the vaccine.  For one, she goes to the doctor less, I know I did.  So there is more money to do it younger.  Ideally less cervical cancer too, but you cannot ignore the economics.  

Meanwhile will the pap smear become less routine over the next 20 years?  Might some women slip through the cracks?  And meanwhile, what about the men?  What sort of HPV testing will our country encourage for young men?  It seems like the men should have to know if they are spreading a disease that causes cervical cancer.  Would our government be inclined to fund a mandatory vaccine for young boys?  Especially if it had any scary reproductive side effect at all?  I wonder...

So all of this is to suggest the government and medical community back off on this one.  Give parents and their daughters the current information and let them make an informed decision.  I know we cannot count on all parents to be as involved with their daughters with topics such as this...but that goes into another post about how our country has such a messed up relationship with sex.  What is missing right now is the discussion about the side-effects and just how HPV works.  You don't get it from toilets, people.  It is from having sex.  Can we not educate our daughters about their bodies a little more?  I am not talking about abstinence education.  I am talking about "if you start having sex, I want you to know these things..." kind of talk.  The kind that leads women to Planned Parenthood, to Student Health, to a clinic when they cannot talk about things with other people in their lives.

Many parents of teens I know are not bloggers and are too busy to watch the evening news.  They count on getting the full story from their doctors.  Are they?  

16 comments:

Jeff said...

9 and 10? Is the CDC pushing this on 9 and 10 year olds? I have a 9 year old daughter. Oh, shucks, my mind just blew up. I'm going to go curl up in a ball in a corner now. :P

That's a seriously good point you have about boys. Does the vaccine work on males? I can't see why it wouldn't. Why NOT vaccinate the men, too?

-Jeff

teacher3rs said...

Thank you for your blog. I've commented on several sites about how my daughter has had serious side effects lasting now for more than a year. I try to read every news and blog item that comes out on the web.

I had concern that there would be even more kids with side effects if boys were vaccinated.

My daughter made a compelling statement: 'Boys (college age) aren't going to get the vaccine. They don't get cervical cancer. They rarely go to the doctor.'

Fortunately, the FDA did not approve the use of GARDASIL for boys. I wish they had never approved it for girls.

Anonymous said...

You're mistaken about the need for Pap smears going down. In fact, doctors have voiced concerns that young women will think that they are fully protected and quit getting smears regularly or even at all. Because Gardasil only protects against the 2 strains out of over 100 that MAY cause 70% of cervical cancer cases, and because HPV is not the only reason to do an annual exam, it is very important to continue going.

Also, Merck is quite desperate to get Gardasil approved for boys and men as well as older women (profits are going south because parents are becoming more suspicious of vaccine, with good reason), but the FDA wanted more data for older women and hasn't got to the boys yet. Boys may not get cervical cancer but they do get penile and anal cancer, also caused by HPV, also relatively rarely.

Cynthia said...
This comment has been removed by the author.
Cynthia said...

Thank you so much for your comments so far. I want to learn more from all sides of this story so keep them coming.

I am very relieved to hear that doctors are worried about pap smears going down and that they are voicing that concern.

Cate said...

Thanks for linking to my Gardasil blog at Nature's Child, Cynthia.

For the record, Merck is currently pushing the FDA to approve Gardasil for boys.

Didja hear the one about the pharmaceutical company that paid for it's Vioxx screw-up by giving a bunch of girls shots? Hilarious.

Oh, the real kicker? Because Gardasil hasn't been studied long-term, we're not sure if the one shot and a couple of boosters are enough for lifetime protection. Oops!

phone insurance said...

That's a seriously good point you have about boys.

teacher3rs said...

NOTE: There is a site collecting signatures for a petition to Pres Obama and Congress to inveestigate this vaccine. Please, go there and sign:

http://www.thepetitionsite.com/14/investigate-gardasil-vaccine-risks-now

Anonymous said...

FYI- there is a book on “The HPV Vaccine Controversy: Sex, Cancer, God and Politics” authored by Shobha S. Krishnan, M.D, Barnard college, Columbia University. It is available at amazon.com and Barnes and Noble .com and is written without the influence of any pharmaceutical company or special interest groups. Link to the book: http://www.greenwood.com/catalog/C35011.aspx

Anonymous said...

FYI- there is a book on “The HPV Vaccine Controversy: Sex, Cancer, God and Politics” authored by Shobha S. Krishnan, M.D, Barnard college, Columbia University. It is available at amazon.com and Barnes and Noble .com and is written without the influence of any pharmaceutical company or special interest groups. Link to the book: http://www.greenwood.com/catalog/C35011.aspx

Bird said...

The vaccine is now being marketed for boys, and look how the debate has shifted: http://www.washingtonpost.com/wp-dyn/content/article/2009/03/25/AR2009032503682.html?hpid=topnews

Naticia said...

I just read the article posted by Bird, and for me it comes down to education, yet again.

First there are all these arguments posed, yet the only answers are to list which organizations feel it is safe, the same ones that have a vested interest in either the product or not being found "wrong."

Without quality data, which it strongly appears is missing and prompting this whole dialogue in the first place, I feel it is irresponsible of our communities and our society to make blanket rules and laws.

Where is the parent education in all this? Where is the medical waiver?

Yes, one's child has to have xyz shots in order to enroll in school, but at the same time, you can claim all sorts of exemptions as a parent to say NO on behalf of one's child. How many parents know this, or is this another situation where if it passes legislation, the impoverished and uneducated are going to be the masses that utilize the drug? What if there are consequences? They are the population least able to advocate for themselves.

It disappoints me that those who are supposed to be educated and advocating on our children's behalf, namely our pediatricians, are not stepping up to the plate, and letting themselves be swayed by convincing sales pitches, and then not considering the issues from their clients perspective, but rather from a self-righteous "I am going to save society" attitude. Yet again when we are putting a LOT of money for medical advocates for our children, we are still the ones who have to go and do all the research, and understanding our own values and ethics, make decisions that effect our children.

I hope our children are able to understand that we make the best decisions we can at any given time, and if I find out that the latest and greatest that I let them have access to, sets them up to only have abnormal pregnancies, or interferes in some way with their physical/emotional/mental development, I know that I will be severely disappointed.

I want my children to be healthy emotionally and mentally way before they are healthy physically. Lets prioritize. I would like a wisdom shot, or an attitude patch, or a politeness pill :)

I love all these lifesaving devices, but there are more children starving and uneducated an unloved right this minute than there will that will die of cervical cancer in the next ten years. (Okay, so I have no statistics to actually support this!)

My kids are already living in such pollution that I would rather find a solution to skin cancer which is far more likely to happen to any child, or something.

So, I can keep talking....so give me another bone Cynthia :)

TMae said...

I have a few friends who have been diagnosed with cervical cancer. I have a few more friends who have HPV. I know most of them wouldn't think twice about vaccinating.

But then, they've been told they have cancer, or have a higher likelihood of being diagnosed with cancer.

I'm not sure where I stand. I suspect that, like every other medical "breakthrough" there will be refinements over time. It's the cost we pay in a society that wants cures and treatments for everything. America (major generalization, I know) bows to the almighty medical establishment. We want drugs for this, that and the other thing without risk, or cost to ourselves. It doesn't work like that.

HPV is an incredibly pervasive disease. It is also a potentially dangerous disease. Some estimates put the incidence of the disease at 30% of college age women. That's an epidemic.

It's a pretty complex issue. I don't know that Gardisil is the answer. But I also don't know that it isn't.

Jennifer said...

Well done. I have to say as a counterpoint, and as a mother of a teenage girl, can a young person really look at all this information and be considered "well-informed"? I don't think I would have taken the risk seriously, especially when all those places you mentioned (Planned Parenthood, Student Health, clinics) are most likely going to be hawking the vaccine as well. I don't pretend to have the answers, but the most important thing you address is that we need to encourage women to continue to get pap smears! HPV and cervical cell dysplasia are treatable! If caught early, HPV doesn't have to mean cervical cancer.
Thanks for another thoughtful, and thought-provoking, post.

Anonymous said...

The vaccine has been approved for boys. CNOW gave an excellent panel discussion on the vaccine over a year ago, and after hearing all the pros and cons, I decided that it is a good and safe vaccine. The actual incidence of dangerous side effects is extremely low and the vaccine is much safer than driving a car. No direct deaths have been attributed to the vaccine.

Anonymous said...

The vaccine was made mandatory in VA with an easy verbal opt out. This was done so that people who cannot afford the vaccine will have it covered by Medicaid or Medicare. If you don't want to protect your children, that is your choice.