I do not think she really understands HPV

4

Category : Medical Rants

A New Vaccine for Girls, but Should It Be Compulsory?

But let’s think carefully before requiring young girls to get this vaccine, which protects against a sexually transmitted virus, in order to go to school. This isn’t polio or measles, diseases that are easily transmitted through casual contact. Infection with this virus requires intimate contact, of the kind that doesn’t occur in classrooms.

Besides, we already know how to prevent cervical cancer in this country, and we’ve done a darn good job of it. In the war against cancer, the battle against cervical cancer has been a success story.

Why, then, did federal health officials recommend the inoculation of about 30 million American girls and young women against the human papillomavirus, a sexually transmitted disease that in rare cases leads to cervical cancer?

Vaccine supporters say that some 3,700 American women die of cervical cancer each year, and close to 10,000 cases are diagnosed. Cervical cancer has a relatively high survival rate, but every death is tragic and treatment can rob women of their fertility.

Still, you have to see the numbers in context. Cervical cancer deaths have been dropping consistently in the United States — and have been for decades.

This essayist would rather allow girls to have the risk of HPV infections and possible cervical cancer. She apparently believes that PAP smears are perfect (they are not), and that early diagnosis trumps prevention. She implies (although admittedly does not say explicitly) that HPV vaccination might encourage sexual activity amongst adolescent girls. If HIV, pregnancy and other sexually transmitted diseases are not discouraging sexual activity, then I cannot understand how this vaccine could possibly change behavior. Teenage girls have become sexually active since – well since human beings evolved. Sexual activity is the natural state of affairs, only in recent society have we tried to delay the onset of such activity.

Vaccination works to prevent cervical cancer, and thus reduce suffering and death. Please leave morals out of the discussion. We have a wonderful public health opportunity here, and our best strategy is universal vaccination.

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Comments (4)

Agreed. There is no evidence that HPV vaccination, the availability of oral or emergency contraception, or the availability of condoms have increased promiscuity. What all of these can do is prevent disease and/or pregnancy. Yes, we have gotten very good at screening for cervical dysplasia. Yet many women, including someone near and dear to me, contract cervical cancer every year in this country. We’re not talking just about women who blow off their Pap smear. We’re also talking about women who have false negative results, or even cases where the clinician does not provide adequate follow-up. No screening test is perfect, nor is any vaccine. But screening combined with immunization at an early age will greatly enhance the prevention of invasive cervical CA.

And the essayist is grossly mistaken by assuming that this vaccine is being given too early, since “Infection with this virus requires intimate contact, of the kind that doesn’t occur in classrooms.” Does she really believe that since intercourse generally doesn’t occur in a classroom setting that it doesn’t happen among teens? Having managed pregnant girls as early as 10-11, I can say she is really living in a false reality.

We need to vaccinate early for this virus. We’re not only talking about genital warts, which for the most part are cosmetic and innocuous (ignoring the occasional cases that cause dystocia or are associated with verrucous carcinoma). We’re talking about squamous cell CA of the cervix, vulva and vagina, and if a woman is affected by it, it is as serious as HIV, which the author views as “more insidious” in her complete article in the NYT.

Both sides are missing the core issue here. I think that the key question is whether these decisions should be made by the parents and doctors, or should they be made by the school system. I would leave this one to the parents and the child’s doctor.

The school system’s medical decision making should be limited to those very few decisions that have a direct and substantial impact on the other children at the school, and emergency treatment of the child. If they feel that the child’s health is otherwise at risk, but this risk does not threaten the other children, report it to child protective services and let family court deal with it.

The argument that this has substantial impact on long term cancer treatment is specious. We do not tolerate school systems making other cancer treatment decisions. Those belong to parents and doctors. This vaccination belongs in that same category.

(I would similarly object to any effort by school systems to prevent parents and doctors from giving children this same vaccination. This particular case is a school system that wants to override the parents in favor of vaccination. I can think of other school systems that would want to override parents and prevent vaccination.)

I have no problems with the vaccine and agree with all of the comments made so far. There are three issues that have been touched on, but not discussed: funding, politics, and precedent.

Who will fund this nationwide vaccination program or will it become another unfunded mandate? Schools today are all facing funding issues with those in my area cutting teaching positions. You will also incur substantial back office cost as this is a multistep vaccination which will require monitoring to achieve compliance.

All politics are local and school boards are elected. My personal feeling is, that for the bulk of the country, school boards are not going to want to be involved in a politically divisive issue. School boards are just trying to get Sally through school and meet basic academic standards. They are not worried about her long term health.

Precedent. Is this first and foremost an academic or public health issue? I would have to say no. So, the issue then becomes, do we use our school systems to promote public policy involving long term personal health issues and what about the next great thing? There are any number of groups that want access to our schools for very dubious reasons, will this open the door?

My personal hope is that all insurance and health plans would cover the cost of the vaccinations. This would allow for immediate usage and cover a larger range since there would be no age target. Funding would come through reduced medical cost at some future date. This would not be a public issue so politics is removed. We have not set a precedent that may be distorted at some future date for less than honorable purposes.

Steve Lucas

[…] DB has got some commentary on the issue as well. […]

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