Wednesday, May 24, 2006

See? We told you sex was bad. . . .

Here is an opinion piece about the new human papillomavirus (HPV) vaccine in yesterday's NYT. The vaccine, Merck's Gardasil, is fully effective against the virus that causes most cases of cervical cancer. Expected to cost between $300 and $500 for a series of three shots, use of the vaccine is expected to draw fire from the right wing as yet another practice that encourages premarital sex. (Some on the right have so far said only that they oppose mandatory vaccination for school entry, but support widespread availability of the vaccine.)

Here's the rub: the vaccine is more effective when it's given between the ages of 10 to 15 than between the ages of 16 and 23; so to maximize its usefulness, experts are recommending vaccination be completed before a person (male or female) becomes sexually active. . . which means vaccinating children against an STD.

If we can prevent cervical cancer by use of this vaccine, is it ethical to decide not to do so--because of concerns about promoting teenage sex? Will Medicaid pay for the vaccine, or will only those who can afford it be protected from cervical cancer? Stay tuned.

Nancy Berlinger has a piece on the Hastings Center's Bioethics Forum here, and Katha Pollitt has a great (year-old) piece on this issue here.


Arzhang said...

I am completely dumbfounded that fire is expected to be drawn from the Right wing. I'm not an expert in this area but I am a medical student seriously thinking about going into oncology. Studying this disease one can understand the outrage at people being hesitant against a vaccine.

Cervical cancer has been on the DECLINE because of pap smears. In the third world cervical cancer is the most common gynecological malignancy because of a lack of papsmears. The logic of the "Right" is bogus, it just doesn't pan out medically.

For example did people rush out and have more sex when pap smears came out? Because we have more advanced treatments for gynecological cancers are more people having rampant sex? Is it because of our THERAPIES that people engage in such behaviors or is it more a cultural phenomenon where morale and religion as DEFINED by the "Right" has alienated young people who have turned to nihilism at pop culture for comfort.

When we perfected heparins and clot busters did people run out and eat MORE fatty food to clog their arteries? To stop a therapy because you think it will lead to questionable behavior is appalling.

Sometimes your boxed view of the world and logic don't pan out. For instance in talking with a depressed patient aobut suicide and means to complete a suicide won't that give them ideas and lead them to committ suicide. Most might say yes however study after study shows this NOT to be the case. The point- medicine and PEOPLE are complex. It doesn't fall into this asinine logic the Right is outraged about.

Over 6000 people a year DIE from this disease. Let's not even go into how many die in the third world.

Sadly our country which has been savagely divided across political lines will have this issue merely split into an oversimplified set of superficial talking points. "Vaccine cures cancer but more people will have sex." In other words if the "Right" is going to be outraged they need to realize they are saying sex is worse than DEATH. Is this the modern day view of love the sinner?

Those ages you mentioned will fool people. My hunch is that the reasoning for it is that they happen to correspond to puberty in which you get development of the reproductive system. It is biology not a conspiracy to corrupt our kids.

I think this issue will be spun beyond all leaps and bounds. Oh my GOD we are vaccinating children against an STD! Where have we gone wrong? From a medical standpoint it is more like we are vaccinating a child against a known LINK to cancer.

So my view: of course it is unethical to withold such a vaccine! Death is worse than sex.

Jesus would NOT APPROVE.

Leah said...

For a while now I've been following the approval process for Gardasil and the conversations surrounding objections to the vaccine based on the "sex-provocater" argument; as such, while I was heartened to hear of the overall support for its approval, I was not suprised to hear followup arguments that parents should be able to withold the vaccine from their children. Unfortunately, I wasn't any less dismayed to hear the withholding argument; it's the same kind of argument that's been used to discourage education about safe sex practices. It's so dismayed me that I've been reluctant to even address the ethical implications of withholding HPV vaccines; but arzhang, you've quite clearly explicated my thoughts about it-- so thank you. :)

I just wanted to also mention that the relevance of age groups at the time of vaccination is not only related to the issue of needing to get to girls before they become sexually active (which WILL happen no matter how much abstinence is stressed- that's biology folks!), but also to the fact that it is not yet clear how long the vaccination will last, due to the fact that not enough time has passed since testing of the vaccinations began to determine that. (I believe the running estimate now is about 10 years.) Unfortunately, the ethical perspectives of vaccination cannot be circumvented by the idea of vaccination at a young age (with measles and mumps vaccinations for example) when a child's lack of understanding of STDs would likely prevent any possible influence on future sexual behavior, as it is likely that a vaccination administered at the age of 5 would no longer be effective by the onset of sexual activity. So the target group of 10-15 is crucial.

TJ said...

I whole heartedly agree with both of you. I support mandatory vaccination, because, just like measles, mumps, and rubella, HPV is a contagious disease that, until vaccination is standard practice, will continue it's rampant spread. If you look at the statistics you'll find that ~70% of the human race has contracted one of the HPV strains. But, because it's sexually transmitted, it's one of those taboo topics for conservative folks. Well, I say too bad, because it's for the greater good and, to my knowledge, there are no serious adverse events associated with this vaccine, so the only thing these conservatives have to baulk at is their contrived association with increased sexual activity. ugh!