I recently told you about the shameful appearance on Oprah of a gynecologist who openly denied the connection between human papillomavirus (HPV) and cervical cancer, and spoke out to young women against the vaccine. I have no idea what her motivations were: was it crankery? Ignorance? Morality? Who can say? What I can say is that she is dead wrong, and using her mantle of authority to spread incorrect information is irresponsible and shameful. She is very much alone in her beliefs. Medical science knows (not believes) that HPV is the cause of most cervical cancers, and that the Gardasil vaccine prevents most of these cancers…
Since the advent of Pap smears, cervical cancer deaths in the developed world have dropped dramatically. In the developing world, where Pap smears are not always readily available, rates continue to be high. In the U.S., there are many barriers to compliance with Pap smears and appropriate follow up. A better way to prevent cancer (or any disease, for that matter) is to remove the exposure that causes it. Not smoking dramatically reduces the risk of lung cancer. We don’t just tell people to take their chances, and hopefully we’ll catch it before it’s too late. Safe and effective vaccines are always the best prevention.
The same goes for HPV. Some idiots would have you believe that not only is the vaccine problematic, but the idea that HPV causes cancer is part of some vast conspiracy. Let them wear their tin foil jock straps, but please realize that they are considered insane by the entire scientific community.
There are many legitimate questions about HPV vaccines—should they be mandatory? At what age should they be given? Should they be given to males?
In the early 1970’s, it was believed by many scientists that viruses would be found to cause most cancers. This was based on ground-breaking research on, among other things, human retroviruses.
This has not turned out to be the case, but this did lead to tremendous breakthroughs in HIV, and in other viruses that do cause cancers, such as HPV and Epstein-Barr virus.
I urge you to read the excellent articles below. One of the great scientific successes of the modern era is the discovery of the cause of cervical cancer, and its prevention. If anyone tells you otherwise they are either crazy, trying to sell you something, or both.
References:
Future II Study Group, . (2007). Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical LesionsNew England Journal of Medicine, 356(19), 1915-1927. http://content.nejm.org/cgi/content/full/356/19/1915
Ho, G.Y., Bierman, R., et al, . (2007). Natural History of Cervicovaginal Papillomavirus Infection in Young WomenNew England Journal of Medicine, 338(7), 423-428. http://content.nejm.org/cgi/content/full/338/7/423
Kumar, Robbins, and Cotran. Pathologic Basis of Disease, 7th ed., Chapter 22. Elsevier, Inc.
January 29, 2008 at 3:57 pm
When an MD holds themselves out as an MD and spouts off dangerous nonsense, isn’t that professional misconduct? Isn’t that malpractice?
If it isn’t, it should be. There is room for professional disagreements, but denialism isn’t within the realm of professional disagreement.
An MD can privately hold any foolish idea that they want to. But if they hold themselves out as an MD and publicly state and try to promote opinions that are counter to what is considered the “standard of care”, they are doing malpractice (in my opinion) and should have their medical license revoked.
As I see it, an MD talking in public as an MD on a show like Oprah, is doing “public health education”. If they do it counter to what is the “standard of care”, they are doing malpractice. Even if an MD is doing work pro bono, they are still required to conform to what is the “standard of care”. In my opinion that includes “public health education”.
January 29, 2008 at 5:05 pm
Some HPV can cause cancer - but we still need prove that vaccination against those couple of HPV subtypes prevents cancer in the long run.
There are those other HPVs, there will be a replacement effect as we have seen with the pneumococcal vacination… it’s all not that easy!
Please, do NOT cite “biological plausability” - that has kill too many people!
January 29, 2008 at 6:06 pm
I’m not precisely sure what your point is, but read the linked articles first.
January 30, 2008 at 3:31 pm
I suppose the point is that haven’t yet directly demonstrated that Gardisil reduces the rate of invasive cervical cancer in vaccinees. The Future II Study Group acknowledges that in their Conclusions, saying “[P]revention of invasive cervical cancer is the main goal of prophylactic HPV vaccination, [but] it is ethically unacceptable to use invasive cancer as the end point in efficacy trials.”
The Future II study shows that Gardisil reduces the incidence of earlier stage cervical lesions, and we know that such earlier stage lesions can progress to invasive cervial cancer. Technically, one could argue that Gardisil might do that and still not reduce invasive cervical cancer rates. But that would require additional ad hoc assumptions. E.g., if all the earlier stage lesions would have been caught and prevented from progressing anyway, or if the particular lesions that Gardisil prevented wouldn’t have ever progressed, or if prevention of HIV-16/18 infection just allows other procarcinogenic infections instead.
That seems to be what mager is arguing. In an abstract sense, I see his point, but I don’t agree it’s an adequate criticism. The case that Gardisil will reduce invasive cervical cancer is not based on biological plausibility. On the contrary, any arguments against it are biologically implausible.
January 30, 2008 at 3:53 pm
Should they be given to males?
Yes, if studies indicate that the vaccine is safe and effective in males. Cervical cancer is not the only cancer that is HPV related. Head and neck cancers (those not provoked by smoking and drinking) can be caused by HPV, as can anal cancers and possibly some skin cancers (in conjunction with UV exposure). Men need HPV protection too. Besides, IIRC, humans are the only hosts of HPV. We might be able to get rid of the thing entirely with a little work and organization.
January 30, 2008 at 10:40 pm
Indeed- denying the link between HPV and cervical cancer is crazy and the conspiracy speculation yet another reason why I shake my head frustrated that the masses will believe anything and have no analytical frame of reference for “truth”.
February 2, 2008 at 5:45 pm
As this blog has discussed extensively, there is a fringe crowd of crazies who are against vaccination of any kind. And of course, there’s a noisy and belligerent minority of people in this country who believe that anything that reduces a woman’s chance of either pregnancy or death after sex is deeply immoral. So, when you’ve got a vaccine that prevents a sexually-transmitted virus that could otherwise cause illness and/or death, the forces of woo multiply exponentially.
There is a 300-year old history of hatred and suspicion of innoculation and vaccination, and the arguments made in the eighteenth-century against innoculation sound suspiciously familiar to those of the anti-vaccination crowd. (Although, to be fair, the anti-innoculators did have more to worry about–innoculation was only a privilege of the elite, and could be dangerous for the servants who cared for people who were innocuated, and for others in their neighborhood who hadn’t been innoculated.) I wonder if these transhistorical fears are rooted in a primitive fear of boundaries being violated (something from the outside penetrating inside the body, etc.) which also meshes with the fear of women’s sexuality (i.e. women controlling what goes inside their bodies, and when.)
February 2, 2008 at 9:52 pm
@Historiann
I admit this is a largely unfounded assertion, but I think that if HPV caused more cancers in straight men (it does some), and was marketed first for men, there would be less hullabaloo.
February 2, 2008 at 11:59 pm
I think it’s a matter of choice and personal opinion. I do agree that HPV can cause cervical cancer but I don’t believe there has been enough studies done to say Gardasil is the best choice. We have to remember this vaccine protects only against 4 out of 30 strains that are sexually transmitted.
I feel the government should NOT mandate that girls X years old are required to have the vaccine. There is a preventive measure, Abstinence. It’s not like the chicken pox or measles. The health care industry and government are crossing the line.
If the vaccine does become a requirement then the government needs to pay the $400 for the series of shots. Someone is making the bucks.
February 3, 2008 at 12:25 am
Leslie, you are somewhat underinformed on the medical end, however I completely agree that a system of payment should be set up for vaccines. Anyone who cannot clearly afford it should be subsidized.
Your position contains a bit of an inconsistency, in that you say it should not be mandated, but that the gov’t should pay for it, but I think I see what you mean.
Gardasil, as you said, does not protect against all strains of HPV–it doesn’t need to. It protects against the strains that cause about 70 percent of cervical cancer cases. That’s pretty darn good.
February 3, 2008 at 11:29 am
Pal,
I’m with you on the gender issue completely (as articulated in comment #8.) Witness the success of Viagra/Levitra/Cialis–not only are they non-controversial, but they’re covered by insurance, whereas many insurance plans don’t cover contraception for women (whether on their own account or at the behest of an employer, like a Catholic university or hospital.) Let’s count the boner pills advertised today on the Superbowl broadcast, okay?
Historiann.com
February 5, 2008 at 7:17 am
I’m not a gynecologist but it seems to me that if Gardasil protects against 70% of cervical cancer cases, then there will still need to be routine pap smears to catch the other 30%. Shouldn’t those be subsidized as well?
February 5, 2008 at 8:30 am
certainly
February 11, 2008 at 2:45 pm
HPV is also linked as a risk factor for oral cancer. It’s very close to becoming the leading cause of oral cancers in men. By reaching men w/ a vaccine is it possible to reduce the rates of cervical cancer due to HPV? We’ll see.
http://www.msnbc.msn.com/id/22956090/
February 11, 2008 at 3:12 pm
Not just oral cancers, but anal cancers and some penile cancers. Also, men often serve as the vector to transmit it to women. Hopefully, male vaccination isn’t too far away.