Recently, there's been a lot of play in the press about the "promise" of the HPV vaccine, and a major push (at the state level) to require young women to take it. In fact, the governor of Texas has signed an Executive Order mandating its use upon unsuspecting teen and pre-teen girls.
Sounds like a good deal for Merck & Company, which manufactures (and sells) the vaccine, which can cost hundreds of dollars.
Cynical? Maybe, but pragmatic, as well. You see, I tend to look at mandated benefits (whether they require carriers or the state to pay for a particular treatment) as an added tax, because ultimately, we all end up paying for them. Now, there are certainly times where this may be appropriate, but most emphatically not when the science doesn't support the mandate.
And it goes deeper than that: as my Trusted.MD colleague Marc Kashinsky has pointed out, sometimes these posts need to be personal, too. And I take this quite personally: where the health of my daughters is concerned, I really don't think it's the state's prerogative to require me to subject them to medical procedures that are backed up by faulty science.
They are MY responsibility (and, of course, that of She Who Must Be Obeyed), and part of that responsibility is to make an informed decision. In previous 'Dispatches, I've talked a lot about personal responsibility when it comes to health care, and I would be a hypocrite if I didn't walk that walk. So let's take a look at the whole brouhaha through the lens of risk:
HPV is the Human Papillomavirus, which may cause abnormal tissue growth (warts) and is often associated with some types of cancer. The Centers for Disease Control suggest that up to one fourth of American women (ages 14 to 59) are infected with the disease. And how do they know this? Oh, very simple: by testing vaginal swab specimens from less than 2,000 women. Yup, that's right: less than 2,000 out of an estimated 100 million women in this age cohort.
Gee, what a great statistical model!
And speaking of risk, there's a real question of just how dangerous this "menace" really is: less than 3,700 American women are expected to die from HPV related cancer this year. While that's a terrible tragedy, let's keep a bit of perspective, shall we: about 4,000 people die in fires every year; almost 5,000 drown; 5,500 are hit by cars and die; heck, food poisoning kills some 6,500 folks every year (if we assume, reasonably, that half of those are women, then why aren't we outlawing food?).
And by the way, why just daughters? Dr. Eileen Dunne, the CDC's lead, um, person on this issue, says that "HPV prevalence is thought to be high in men as well, but none were studied." Gee, thanks!
But wait, it gets murkier still: "A researcher who worked on a vaccine for the human papillomavirus is warning that it hasn't been tested on young girls, is "silly" for states to mandate the vaccination, and in a worst-case scenario could even increase cervical cancer rates."
That researcher is Dartmouth professor Diane Harper, who actually worked on the study which formed the basis for the vaccine's approval, and who notes that it was tested only on women aged 15 to 25. In fact, she believes that it's most helpful for those who are at least 18. It also appears that at least one member of the Centers for Disease Control's advisory committee on immunizations has reported that "while the vaccine may be helpful, it should not be mandatory."
What really brought it home for me, though, is her assertion that "it's not been tested for effectiveness in younger girls, and administering the vaccine to girls as young as 9 may not even protect them at all. And, in the worst-case scenario, instead of serving to reduce the numbers of cervical cancers within 25 years, such a vaccination crusade actually could cause the numbers to go up." [NB: that link seems to work only sporadically]
I won't pretend to advocate that people avoid this vaccine like, well, the plague. But I darn sure can't agree that it's the role of our government to force our daughters (and again, why not our sons? Are they disposable?) to force young women to take a drug which may, at the least, do no good and, at the worst, increase their risk (there's that pesky word again!) of cancer.
Henry Stern, LUTCF, CBC is an independent insurance agent in Dayton, OH. A licensed Continuing Education instructor for Ohio and Kentucky, he has well over 20 years of experience in “the biz.” He blogs every day (or so it seems) at InsureBlog.