HPV found under the fingernails of men

An avid reader of the blog was kind enough to send me a link to this article from SeattlePI.com, which really surprised me:

"Controversy continues to plague efforts to protect young women against cervical cancer by vaccinating them against HPV, the human papillomavirus, but one leading scientist's discovery could throw a monkey wrench into the debate.

"We found HPV under the fingernails of young men," said Dr. Laura Koutsky, a University of Washington epidemiologist.

Koutsky led some of the pioneering research and clinical trials that resulted in an HPV vaccine, Merck's Gardasil, recently approved for use in girls and young women. The reason her fingernail finding is a potential bombshell has to do with why the vaccine is controversial.

HPV, which is the leading cause of most cervical cancers, is primarily a sexually transmitted disease. Opponents of HPV vaccines believe that immunizing girls against this virus sends the message that engaging in sex at a young age is acceptable behavior.

The presence of HPV under fingernails, she said, at the very least suggests another possible route of transmission. It's an additional route of infection, she said, that could explain some previous apparent anomalies such as HPV infection in infants and young girls who had not yet engaged in sexual activity.

Koutsky's not quite sure what to make of the finding, which has yet to be reported in a journal, but she said it is certainly 'a surprise.' " Read the rest of the article here.

This could turn the whole HPV vaccination debate on its head if it is confirmed that HPV can be spread through non-sexual, non-intimate contact. Not only would the debate about mandating the vaccine in schools be shifted, but this will throw a new issue to objectors on the basis of religion or other moral beliefs about sexual activity.

Cervical Cancer Vaccine: Do we need it?

By: Jenny Walters

As you watch television, you cannot go a day or even a couple hours without seeing the commercial for Gardasil, “the first ever cervical cancer vaccine.” Gardasil claims to stop cervical cancer before is starts. The Gardasil vaccine is recommended for girls ages 11 to 12, but can be used in girls as young as 9. According to an article from the Mayo Clinic, written by Bobby Gostout, MD, and entitled Cervical cancer vaccine: Who needs is, how it works, Gardasil is the newest addition to the official childhood immunization schedule.[1]

Cervical cancer affects 10,000 women a year and leads to 4,000 deaths.1 In 2005, according to the World Health Organization, there were an estimated 500,000 new cases of cervical cancer. Cervical cancer is the leading cause of death in women, even with treatment.

Various strains of the human papillomavirus (HPV), are responsible for most cases of cervical cancer.1 HPV spreads through sexual contact. Gardasil specifically blocks two cancer-causing types of HPV: types 16 and 18. Gardasil also blocks types 6 and 11, which are associated with genital warts and mild Pap test abnormalities.

The Gardasil vaccine allows young girls immune system to become “activated before their likely to encounter HPV.” Vaccinating young girls also allows for higher antibody levels, which results in greater protection against cervical cancer.1

To see earlier positive effects of the Gardasil vaccine, the Center for Disease Control (CDC) recommends a “catch-up immunization for girls and women ages 13 to 26” be administered.1 Currently, the vaccine is not required for school enrollment, but may be in the future.1 Gardasil has been proven to be “remarkably safe.”1

Common side effects include: soreness at the injection site, low-grade fever or flu-like symptoms. There were no reports of clinical trial discontinuation due to serious side effects. So what does this all mean?

As a mother and wife, HPV is not a threat I worry about now. However, during nursing school, I had a class of about 18 girls. Of those 18 girls, almost every one of them had the HPV infection. It seemed as though each week I would hear of another student having an abnormal Pap test due to HPV. HPV is non-discriminating, it can affect anyone. If the Gardasil vaccine can help block HPV infection, than maybe one day cervical cancer will no longer be the number one killer of women.

[1] Gostout B, MD. Cervical cancer vaccine: who needs it, how it works. Sep 2007. Available at: http://www.mayoclinic.com/health/cervical-cancer-vaccine/WO00120. Accessed on Jun 02, 2008.

Is GARDASIL® a responsible mandate?

If the common goals between the public and the pharmaceutical giant Merck in the controversy over compulsory HPV vaccination were long-term cost containment and public safety by reduction and prevention of widespread disease (HPV and cervical cancer, in this case), and GARDASIL is supposed to achieve both objectives; then, mandatory GARDASIL vaccinations for young women is worth investigating.

Compulsory HPV vaccination for girls before they become sexually active is said to cut long-term costs in their healthcare (especially costs related to cervical cancer). However, these costs may be outweighed by long-term costs that are unknown at this time. According to Merck's website, GARDASIL has only been tested for over a decade, which is not sufficient in considering the long-term effects of a drug on a young woman's reproductive system. Currently, GARDASIL has not been evaluated for the potential to cause carcinogenicity or genotoxicity... it is not known whether GARDASIL can affect reproductive capacity (Merck 2007). Because a little over a decade is arguably insufficient time to recognize all of the implications that the drug may have on a woman of childbearing age who received the vaccine prior to, or during puberty, we do not know the long-term costs of what may result from the use of GARDASIL. And, we cannot assume that GARDASIL is cost efficient. We cannot consider this vaccine to be an effective one in reducing or preventing long-term, perhaps costly health problems.

As the second most common cause of cancer death in women worldwide, resulting in nearly a half-million diagnoses and 240,000 deaths each year (Merck 2007), and because 6 million people in this country become infected with HPV every year, and nearly 10,000 women are diagnosed with cervical cancer (Colgrove 2006), HPV and cervical cancer are undeniably very serious threats to public health. Compulsory HPV vaccination for girls before they become sexually active is said to significantly reduce or even prevent widespread cervical cancer. Because there is some evidence of its success in preventing four types of HPV, two of which are leading causes of cervical cancer, the fact that there are at least short-term benefits to GARDASIL is undeniable. However, the vaccine should be made accessible without mandating its use. From a moral standpoint, it seems that the use of the GARDASIL should be accessible at least for those at high risk (i.e., with family history of cervical cancer, etc.). Without long-term evidence of its efficacy and safety, it seems irresponsible (on the part of government, as well as Merck) to mandate its use, but also to deny its access completely.

The best possibility at this point is to wait until further, more conclusive and long-term research has been conducted. Given more time, competition will likely increase, which will inevitably reduce the cost to the consumer (or government), as well as provide more sound evidence regarding its long-term efficacy and safety.

References:

Merck. 2007. CDC Finalizes Advisory Panel Recommendations for GARDASIL®, Merck Cervical Cancer Vaccine. http://www.merck.com/newsroom/press_releases/product/2007_0322.html (accessed September 25, 2007).

Colgrove, J. 2006. The Ethics and Politics of Compulsory HPV Vaccination. http://www.natap.org/2006/newsUpdates/121106_05.htm (accessed February 20, 2008).

Dan Savage on Media, the HPV Vaccine, and Sexism

In this week's Savage Love column*, Dan Savage tackles the link between throat cancer, oral sex, and HPV - and makes the disturbing claim that

up to now the mainstream media have refrained from calling the right's opposition to the HPV vaccine what it is—delusional, psychotic, homicidal—because up to now only women's lives were at stake.

That's about to change.

Here's the headline from my morning paper: "HPV Factors in Throat Cancer: Study Could Shift Debate About Vaccine." You bet it will. Up to now the HPV vaccine—which, again, has proven 100 percent effective against the cancer-causing strains of the virus—could merely prevent 10,000 cases of cervical cancer in American women every year, along with 4,000 deaths. But now the debate could shift—it will shift, it already has shifted—because it's no longer "just" the lives of 4,000 American women that are on the line, but the sex lives of 150 million American men.

Is Dan right? Based on the media coverage of the link between HPV, oral sex and throat cancer, he just might be. And that raises, as I said, disturbing questions. Is it just because instead of talking about 4,000 people a year, we're talking millions, or is it accurate to break it down on gender lines? And if that gender breakdown is right, what in the world does that really, truly say about our society?

*Note: Savage Love is a sexually explicit column that tackles reader questions about sex and sexuality in a no-hold's barred manner. If you are offended by or would prefer to avoid casual and explicit language, do not read Savage Love!

Adding to our collection of posts about Gardasil and the HPV vaccine is the news that HPV is one of two viral links to lung cancer. Two new studies suggest that viruses - specifically, HPV and measles - can significantly boost a smoker's already serious risk of developing non-small cell lung cancer. Almost 90% of the over 200,000 cases of lung cancer that will be diagnosed in the United States this year are typed non-small cell lung cancer, and it tends to be a highly malignant version of cancer to end up with.

Both findings were presented Friday by separate research teams attending the European Lung Cancer Conference in Geneva.

"In terms of HPV, our finding is pretty controversial," said study author Dr. Arash Rezazadeh, a fellow of medical oncology and hematology at the University of Louisville in Kentucky. "And this is just the beginning of the road. There is much more work to be done. But it's important to know that being infected with this virus does appear to increase lung cancer risk."

As for the role of measles, the second study's lead author, Dr. Samuel Ariad, from the department of oncology at Soroka Medical Center in Beer Sheva, Israel, said that infection -- perhaps even asymptomatic infection -- seems to be associated with half of the lung cancer cases he tracked.

So,... can we mandate HPV vaccinations for all, now?

(Yes, I admit it would be good to see more studies done on this, in larger numbers, and with smokers as well as ill non-smokers. But I watched someone die from non-small cell lung cancer last year, and it's not something I'd wish on anyone - if we can stop even a small handful of those cases, along with all the other types of cancer HPV has been indicated in causing, isn't it worth the unlikely chance that the vaccine itself would encourage promiscuity?)
-Kelly Hills

HPV, vaccines and women's health

A group of us associated with the Canadian Women's Health Network, with input from others, authored a commentary on "Human papillomavirus, vaccines and women's health: questions and cautions," that was given early release online by the Canadian Medical Association Journal on 1 August 2007: http://www.cmaj.ca/cgi/rapidpdf/cmaj.070944v1 This will be part of an issue of the CMAJ that will feature some other articles on HPV, due out August 28 at www.cmaj.ca There is also a larger policy paper available (19 pages) -- casting a critical lens on the HPV vaccine -- now available on the CWHN website: HPV, Vaccines, and Gender: Policy Considerations http://www.cwhn.ca/resources/cwhn/hpv-brief.html This work has (unexpectedly) gotten a fair bit of media attention in Canada, where three provinces will be offering publicly-funded vaccinations to school-aged girls starting in the fall. We hope the issues we raise will stimulate discussions that actually should have occurred prior to the announcement of these vaccination programs. Some of the details may be specific to Canada, but many cross borders.

Human Papillomavirus (HPV) Recombinant Vaccine Approved by FDA

U.S. Food and Drug Administration (FDA) today approved a Quadrivalent Human Papillomavirus Recombinant Vaccine. It is the first and only vaccine to prevent cervical cancer and vulvar and vaginal pre-cancers caused by HPV types 16 and 18 and to prevent low-grade and pre-cancerous lesions and genital warts caused by HPV types 6, 11, 16 and 18 and is developed by Merck and will be marketed under trade name Gardasil.

Arthur Allen does a nice job of discussing some things we should be thinking about in his Slate article: And Now, the HPV Vaccine: Warts and all (http://www.slate.com/id/2143304/) :

"...how to get the vaccine to the women and girls who need it most—poor, uneducated women and those in the developing world. "None of us are going to be happy if the only women who get the vaccine are the same women who are already getting regular screens for cervical cancer," John Schiller, one of the vaccine's inventors, told me at his National Institutes of Health laboratory. The Vaccines for Children program, a Clinton-era entitlement, will probably make the vaccine available for free to poor children in the United States. But social conservatives like Focus on the Family leader James Dobson have opposed making vaccination mandatory, believing vaccination might lower barriers to teen sex.In a roundabout way, this prudery may keep the vaccine out of reach of poor girls. Research and experience have shown that only mandatory-vaccination laws—which typically increase vaccination rates by 10 to 15 percent—get even cheap vaccines to the poor. Given the politics, state legislatures and public health boards may shy from requiring HPV vaccine for middle-school entry."

Virginia considers requiring girls to get HPV vaccine

A bill has been introduced in Virginia that would require girls to receive their first vaccination against HPV prior to their entry into middle school, or have parents apply for an exemption after reading the literature on and being educated about the vaccine. The bill would add HPV to the list of immunizations needed for school attendance, and make the state one of the first to require the vaccine.

On the face of this, it sounds good - but digging a bit further in to it, a few questions are raised. While I initially wanted to cheer to see that a Republican was sponsoring the bill, it turned to dismay and, well, suspicion as I read the following:

Hamilton said pharmaceutical company representatives approached him about submitting the bill, probably because he chairs the House Committee on Health, Welfare and Institutions. Drug companies have been among the largest contributors to Hamilton's election campaigns.

So the companies that have financed most of his campaigns now want him to make a vaccine, which is not covered by all insurance companies (and runs around $350), mandatory for all girls?

Hmm. Strikes me as a bit ethically questionable.

Of course, one thing that many people are saying is ethically questionable is vaccinating girls against a sexually transmitted disease, something that doesn't raise any questions for me. Why? Here are a couple of reasons:

• 1) At the age people are talking about (9-13), most kids aren't being given specific and detailed information about what the shots they're receiving do - it's just part of the evils of going to the doctor. It's not like anyone is sitting down saying "alright, now you won't get measles, mumps, or cervical cancer so you can be sexually promiscuous now!"


• 2) Hepatitis B is a required immunization, and is sexually transmitted (among other ways)


• 3) We're talking something that kills. There are 10,000 new cervical cancer cases diagnosed every year, and something like 3500 women die every year. Given that we know most people do not abstain from sex until marriage (and we know this has been true for a long time), safety really seems like it should trump anything else. Or put another way: do you want to be the parent whose daughter tells you she has cervical cancer, knowing you could have prevented it through three simple shots?

I know parents hope that their children will adhere to their morals, and I support teaching your children your values and beliefs. But I also think there's the necessity to be realistic; if you can prevent disease via a combination of teaching morals and actual protection, why would you choose otherwise?

I remain skeptical of Hamilton's motivations for proposing this bill, but I suppose that sometimes, the ends do justify the means.

HPV debate: Virginity or Death?

Merck and GlaxoSmithKline have the answer to the threat of human papilloma virus in women; that is new vaccines that can help prevent it before it infects a system. HPV is an STD that can often lead to cancer in women and has diagnosed 10,000 American women a year. This new vaccine that can be administered to preteens before they become active is the cause of great controversy for Christian groups. They assume that this type of vaccine will allow children to engage in sexual activity before marriage. The article is in opposition of such a notion. The author argues that the real issue for Christian Conservatives is this debate is women’s virginity, just as it was in the original debate over abortion. HPV can be used as a great scare tactic for Christian conservatives because is it not prevented through the use of condoms. However, opponents of this vaccine are essentially holding that having sex before marriage is worse than having cancer later. The conservatives use the example of a 13 year old pregnant girl in Florida who had a child when she was a child herself. The article explains that she was too young to be having sex or an abortion, but it fails to explain why wasn’t too young to be forced to go through childbirth. Right- wing Christians consider that women should abstain from sexual activity. They try to achieve this through the use of fear. This is why people who are pro-life will not join with pro-choicers to lessen numbers of abortions by making birth control available. This has little to do with protecting human life and it is more focused on making sure women are tied to marriage. Read more here.

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Posted by Ana Lita to Women's Bioethics Blog at 6/02/2006 12:52:00 PM

Governor Spitzer--in this Blog?

While the current political trials of Governor Spitzer may at first appear to have no place in this Blog, a small item in the news, which is being discussed in the Feminist Law Professors Blog, caught my eye as well. Apparantly one of things caught on tape is a conversation with the woman, "Kristen", who met with Client 9--allegedly Gov. Spitzer. The New York Times reports that "After her encounter with Client 9, the prostitute told the booker for the agency that it had gone well, and the booker told her that he, in an apparent reference to Client 9, sometimes asked the women “to do things that, like, you might not think were safe.” (Link here)


While this could mean many things, it most likely means he didn't want to wear a condom. As a result, he exposed Kristen, and any other women he slept with, to the full range of STI's (including HIV and HPV) as well as unwanted pregnancy. In an interesting example of perhaps unintended coordination, another story on the NY Times' front page reports a study that 25% of U.S. teenagers (including 50% of African American teenagers) test positive for sex infections which is leading to the conclusion that treatment of boys (including vaccination against HPV) and men must be part of an effective public health strategy.

I do not believe that prostitution should be legalized. However, if there are situations where it is a transaction between consenting adults, and therefore ethically unobjectionable, there is no information here that indicates this is one of those situations. First, we only assume that Kristen is a U.S. citizen who can voluntarily leave this line of work. This is often untrue of sex workers in the U.S. There are increasing reports of foreign women lured to this country with the promise of jobs and then finding themselves forced to be sex workers. Moreover, the link between prostitution and drug addiction has been shown again and again. Is this a sound foundation for informed consent?

Moreover, whether or not it would ever be ethical to allow a sex worker to consent to exposure to an STI could there ever be informed consent by the spouse, or other partners, of a man who engages in this high risk behavior without her knowledge? (and all arguments hold the same however you would like to shuffle around the genders of the parties involved--there is quite a bit of male prostitution and it carries with it the same stigma of STI's and drug addiction).

Prostitution is a health risk for everyone, especially women, and just as we have ethical limits on the risks any individual can take, whether in the context of a drug trial or a risky surgery, we must consider them when the danger is not just to an individual woman who may or may not have consented but to all women who sleep with people who sleep with sex workers.
So is there a link between Governor Spitzer and women's bioethics? Absolutely there is and to the best of our knowledge, her name is Kristen.

Gardasil, Assumptions, and Men

I was speaking with someone this morning about the Gardasil vaccine, and she made a very interesting point. Everything around the vaccine is very heteronormative. There's an assumption that everyone is going to be straight! So vaccinate the women, protect them.

But what about the gay men? Anal cancer is caused by the same strains of HPV that cause cervical cancer, yet we don't see people flocking out to advocate vaccinating boys. Because there is an inherent undercurrent that the boys don't need it, they don't develop HPV-related cancers, only [straight] girls get that.

If we are going to act on the presumption that children will become sexually active when they're older, regardless of the morals their parents try to institute, shouldn't we also avoid the presumption of heterosexuality and vaccinate both genders equally, to confer to both protection?

While the vaccine is currently limited by the FDA to women, why are we not discussing the broader implications and potentials of vaccinating everyone?

Embracing the HPV Vaccine -- Warts and All?

We've posted before here and here about the HPV vaccine and debated whether or not it should be 'mandated' for girls; today in the NY Times an article in the Fashion and Style section (??) asks whether or not the parents would encourage their boys to get the vaccine. Currently, Gardasil is only FDA approved for girls and is marketed as preventing cervical cancer; but boys could benefit too, because the vaccine also protects against genital warts. Currently the vaccine is already approved for boys in Australia, Mexico and countries in the European Union; Merck will seek FDA approval for boys later this year. The question is, will the parents of young boys and girls in the USA buy it? Full article accessible here.

A disturbing prediction on cervical cancer deaths ...

Today's New York Times has an article summarizing the disturbing results of a new study looking at trends in cervical cancer morbidity and mortality in Latin America.

In an era in which most cases of cervical cancer can be prevented or detected early and treated, the study – sponsored by the Sabin Vaccine Institute, the Pan American Health Organization, and the US CDC, among others – concluded that cervical cancer-related deaths are likely to double in Latin America in the next 20 years. Fewer than five per cent of women in Africa, Asia and Latin America are screened for cervical cancer, as compared to 70% of women in North America and Europe. Most of these women also lack access to newly-approved HPV vaccines.

Does this truly have to be the case? Must we continue to needlessly condemn 250,000 poor women to death every year? Even if we accept the argument that current screening and treatment technologies – Pap smears and the HPV vaccine – are too costly to be used widely in resource-poor countries like Haiti and Nicaragua, what about lower cost screening technologies like VIA (visual inspection of the cervix using acetic acid)?

For almost a decade, it has been known that clinicians, usually nurse-midwives, can detect more than three-fourths of pre-cancerous and cancerous cervical lesions simply by wiping a patient's cervix with acetic acid (white vinegar) and examining it visually. That this method is not more widely used, particularly in light of a recent Lancet study showing that VIA is as effective as traditional screening methods in India, is shameful.

It's time to wake up and smell the vinegar ...

Should The HPV Vaccine Be Mandated?

We've discussed the HPV vaccine and why we think it should (or should not) be a mandatory vaccination - for both women and men (an argument we were making long before last week's study showed definitive proof of the need to vaccinate men). And on Tuesday night, when most of us were eying the results of Super Tuesday, our own Linda MacDonald Glenn was on a panel discussion hosted by Vanderbilt, on the same debate.

The video was streamed live, but for those of you who missed it, Vanderbilt should have the archived film up some time this week. The panel format makes it especially useful for people in teaching situations, who'd like to show their students a range of opinions in a civil debate.
-Kelly

More evidence for a mandate?: FDA approves Gardasil For Prevention Of Vulvar, Vaginal Cancers

We and other blogger friends have blogged about Gardasil before here and there -- and in a quick and dirty drive-by post, we thought we'd update you on the latest developments:

The AP press reports that federal health officials approved expanding the use of Gardasil, the cervical cancer vaccine, to prevent cancers of the vagina and vulva:

"The Food and Drug Administration first approved Gardasil in 2006 for the prevention of cervical cancer in girls and women ages 9 to 26. The vaccine works by protecting against strains of the human papillomavirus, or HPV, that cause about 70 percent of cervical cancers. The HPV virus, transmitted by sexual contact, causes genital warts that sometimes develop into cancer.

'There is now strong evidence showing that this vaccine can help prevent vulvar and vaginal cancers due to the same virus for which it also helps protect against cervical cancer' said Dr. Jesse Goodman, director of the FDA center that oversees vaccines."

Full Story can be accessed here.

A Little Dab Will Do Ya ...

[cross-posted from GCM News ... sign up for the Global Campaign for Microbicides newsletter at http://global-campaign.org]

A simple technique using nothing more than cotton swabs and vinegar could help prevent the deaths of more than 250,000 women a year. Cervical cancer – a sexually transmitted disease caused by the human papilloma virus (HPV) – is the leading cause of cancer-related mortality in the developing world. Early diagnosis and treatment is key, but current screening and treatment technologies, such as Pap smears and the newly approved HPV vaccine, are too costly to be used widely in resource-poor countries. Fewer than five per cent of women in Africa, Asia and Latin America are screened for cervical cancer, as compared to 70% of women in North America and Europe.

In 1999, researchers in the U.S. and Zimbabwe showed that trained nurse-midwives who wiped a patient's cervix with acetic acid (white vinegar) accurately detected more than three-fourths of pre-cancerous and cancerous lesions; tissue harboring such lesions turned white when exposed to vinegar, and could be easily seen during a visual inspection of the cervix.

In a study recently published in the British medical journal The Lancet, researchers in India and France have built upon that finding to show that this method – visual inspection of the cervix using acetic acid (VIA) – is as effective as Pap smears for detection of cervical cancer and dysplasia. In the study, 49,311 sexually active women in Tamil Nadu were randomized to receive VIA or existing cervical screening and care. Women who were VIA-positive were offered further treatment, including cryotherapy to remove any lesions, or a referral if they had invasive cancer. Women who underwent VIA had a 25 percent reduction in cervical cancer incidence and a 35 percent reduction in deaths compared with the women who received standard screening and care.

As promising as these results are, however, it is important to note that the Lancet study was performed at a clinic with dedicated staff and in an area where treatment for cervical cancer was readily available. The VIA screening method is simple and cheap, but many women in resource-poor countries still lack access to basic medical services, let alone treatment and care for cervical dysplasia or cancer. As always, technologies are only useful if they are not only effective but also available, affordable and acceptable to the people who need them.

The painful irony is that cervical cancer screening is of no use to women who cannot access treatment to prevent the onset of cancer. This breakthrough only underscores the need to advocate relentlessly for adequate access to the full spectrum of reproductive health care options, including (and especially) treatment for life threatening conditions. This is surely a case in which half a loaf really isn’t better than no loaf at all.

Should Children be Vaccinated against Addiction?

blog.bioethics.net points to an article in Time on the new "cocaine vaccine" and asks whether it should be given preemptively to children.

Basically, the "cocaine vaccine" works by stimulating the body to produce antibodies that bind to cocaine molecules, preventing them from binding to the receptors in the brain that, when activated, produce the "high" from the drug. As a result, the "high" is negated or greatly reduced, which removes the incentive to continue to use the drug.

While I see the potential for this treatment to help addicts overcome cocaine addiction, the talk of giving this preemptively to children worries me. Beyond the issues of informed consent mentioned, I have concerns about using any treatments that could affect brain receptors in children unless it is medically indicated. Psychoactive drugs affect us because our brains have receptors that respond to particular drug molecules; these receptors probably have some other function in normal life. Stimulating the body to produce antibodies that bind to drug molecules to inhibit them from binding to our receptors could have adverse impacts on the natural auto-stimulation and regulation from our bodies. In children whose brains are still developing (and will go into overdrive during puberty), we cannot safely anticipate what the long-term effects on neurotransmitters and brain activity could be.

Because the vaccine has been show to be effective on adults, and because there is usually sufficient time to respond to cocaine addiction, I do not feel that vaccinating children in this case is justified.

And because I still am bitter about the controversy over the HPV vaccine: aren't moralists worried that giving the cocaine vaccine to children will tell them it's okay to start doing drugs?

Politics, Parents, and Prophylaxis Podcast

Kudos to the New England Journal of Medicine for publishing this fascinating podcast interview with bioethics law professor R. Alta Charo on how cancer prevention (the HPV vaccine) has fallen victim to the culture wars. Dr. Charo describes how sexual politics are distorting public health concerns, the political landscape at the federal and state levels, and how this politicalization diverts us from vital ethical considerations such as the current high price for the vaccine and how to make sure it is available to all who might benefit (boys as well as girls.) Best 8:33 minutes you'll spend this week.

(Hat tip to Peggy Danziger for bringing it to our attention.)

Texas Governor Orders STD Vaccine For All Girls

From MSNBC:

Bypassing the Legislature altogether, Republican Gov. Rick Perry issued an order Friday making Texas the first state to require that schoolgirls get vaccinated against the sexually transmitted virus that causes cervical cancer.

Perry also directed state health authorities to make the vaccine available free to girls 9 to 18 who are uninsured or whose insurance does not cover vaccines. In addition, he ordered that Medicaid offer Gardasil to women ages 19 to 21.

Beginning in September 2008, girls entering the sixth grade — meaning, generally, girls ages 11 and 12 — will have to receive Gardasil, Merck & Co.’s new vaccine against strains of the human papillomavirus, or HPV.

And for those of you wondering how Gov. Perry has the authority to issue such an order:

By employing an executive order, Perry sidestepped opposition in the Legislature from conservatives and parents’ rights groups...

The order is effective until Perry or a successor changes it, and the Legislature has no authority to repeal it, said Perry spokeswoman Krista Moody. Moody said the Texas Constitution permits the governor, as head of the executive branch, to order other members of the executive branch to adopt rules like this one.

It'll be interesting to see how this plays out in the media, with the public, and I'm sure, eventually a courtroom. Bravo to Gov. Perry for taking the lead on this issue.

See previous WBP posts here.

Is prettiness your best standard?

There is a pretty spirited debate about male circumcision going on at a NYT blog.

This was partially inspired by a recent blog post supporting female genital mutilation.

Your opinion on whether these are reasonably comparable issues will depend on your moral/ethical framework - comparative harms, consent, cultural relativism, aesthetics, etc. Personally, I subscribe to consent as the paramount value in this situation up until urgent, life-threatening conditions require immediate action. The supposed benefits in STI prevention are not compelling enough to me to justify permanent prophylactic removal of a part of an organ, and the aesthetic concerns expressed by people (especially women) are downright appalling.

One thing I do find interesting is that nary an anti-HPV-vaccination brawler has made a move to oppose circumcision because of the purported benefits in preventing STI transmission. If it is a priority to prevent our girls from turning into wanton harlots because of a vaccine against one STI given at a young age, shouldn't we also be concerned about our boys turning into the same thanks to the magical disease-defying benefits of circumcision, provided at *gasp* infancy?