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HPV Vaccine: What Choice Will You Make?

Didn't vaccinating kids against diseases used to be a no-brainer? After all, who would want to inflict their child with the measles or the mumps when the diseases could so easily be prevented? I never recall my own mother questioning the pediatrician about vaccinations. We simply got the shots.

But now that Virginia is about to become the second state to mandate the three-dose HPV vaccine, Merck's Gardasil, for sixth grade girls, I've got my cynical hat on. (Texas's governor signed an executive order to mandate the immunizations in September 2008 and several other states are considering bills or funding for the vaccine.) Why so soon after the vaccination's approval in June 2006? Is HPV really the killer that warrants this kind of action?

Last week, a study published in the Journal of the American Medical Association estimated that there are 7.5 million girls and women ages 14 to 24 years old infected with HPV. There are about 10,000 cervical cancer cases annually in the United States. "About 40 percent of women who receive the diagnosis die. Low-income and minority women are most affected, with African American mortality rates more than twice that of whites," writes The Post's Susan Levine.

Yes, the vaccine is effective against two strains of the virus. Yes, it's the first vaccine against a form of cancer to get federal approval. Yes, it can save some lives. Regardless of whether it will encourage young girls to be sexually active sooner, which I don't believe, the numbers simply aren't there. States will be spending millions to vaccinate girls whose families are uninsured. And while Virginia and many of the states considering bills have opt-outs for parents, who is going to make sure that doctors and clinics clearly tell all parents that they have a choice?

Right now, the focus should be on giving parents of all races and income levels information and a choice, not forcing a vaccine down people's throats. What's your take?

Today's Talkers: Study Says Ibuprofen Is Best Painkiller for Children ... Helicopter Parenting: Spiraling Out of Control ... Childhood Obesity Triggers Early Puberty, Study Says

By Stacey Garfinkle |  March 5, 2007; 9:00 AM ET  | Category:  Teens , Tweens
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Comments


Make it available, cover it under health insurance plans, and let parents decide if they want it given to their daughters.

There; problem solved.

Posted by: John | March 5, 2007 10:23 AM | Report abuse

I'm all for it. 1) it will save some lives. you can't put a price on that. 2) it may lead to the extinction of HPV down the road.

i fail to see a downside.

Posted by: Anonymous | March 5, 2007 10:24 AM | Report abuse

What bothers me more about this issue is when people talk about how they fear the vaccine will encourage sexual activity. Instead, perhaps the focus should be on why this brand new vaccine is being pushed so heavily so soon. How much is truly known about this vaccine and any side effects?

As for encouraging sexual activity, if the girls are determined to have sex, they are going to do it regardless of a vaccine. The fact that there are so many young girls infected with HPV should bear witness to that.

Posted by: theoriginalmomof2 | March 5, 2007 10:24 AM | Report abuse

My take? You are wrong. If the vaccine is made optional, guess who will recieve it? Mostly children of the educated middle and upper class. The children who are most at risk will not get the vaccine. Making it mandatory takes the guess work out of it and levels the playing field.

Posted by: Barb | March 5, 2007 10:29 AM | Report abuse

Unidentified and untreated cervical cancer is a killer. As such, it affects uninsured women in much greater proportions than it does those of us who have reliable access to medical care. Frankly, the population that most needs this vaccine is the uninsured population. They will get it because the state will pay for it, while the middle class dithers about the expense (we already went through this with the chicken pox vaccine didn't we?), and parental rights to opt-out.

Posted by: cotopaxi | March 5, 2007 10:30 AM | Report abuse

"Mostly children of the educated middle and upper class. The children who are most at risk will not get the vaccine. Making it mandatory takes the guess work out of it and levels the playing field."

Will there be subsities for the poor and un/under-insured? Those most at risk are also least likely to have insurance to pay for it, and least likely to be able to come up with the estimated $350 cost. If the state makes it madatory, the state should pick up the tab for those who don't have the money.

Posted by: Ruby | March 5, 2007 10:32 AM | Report abuse

The HPV is clearly very widespread. This STD is not the product of promiscuity -- most women will have it. As such, does it not make sense to provide girls and women protection against a virus that is known to cause (some strains anyway) cervical cancer. As a woman who has had painful testing and an operation for HPV-caused dysplasia, it is difficult to imagine why anyone would not want to protect his or her daughter from this unpleasant experience.

Posted by: MontgomeryMom | March 5, 2007 10:33 AM | Report abuse

I am totally against making it mandatory. It doesn't cure cervical cancer, it doesn't eradicate your potential to contract HPV (there are over 50 different variations of HPV and this treats 2 or 3 strands of it). It is not the same as a measles, mumps vaccination. This vaccine is directed to females only...makes me think of the beginning of a bad science fiction story. Why should we trust Merck (who just came off the Vioxx case) with the sexual health of an entire generation of young females. Ridiculous.

Posted by: mem | March 5, 2007 10:37 AM | Report abuse

It is so wierd to me that we have been hoping for a cancer "vaccine" for years and now that we have one - people are pooh-poohing it (or putting on their "cynical hats"). With regard to the statistic you quote about 7.5m girls 24 & under with HPV - wouldn't a more salient statistic be how many dead women would be alive had their fatal cervical cancer be "headed off" by having an HPV vaccine? No, I think you are wrong about "Right now, the focus should be on giving parents of all races and income levels information and a choice, not forcing a vaccine down people's throats." You have set up a straw man about "forcing a vaccine down people's throats."

Posted by: sf | March 5, 2007 10:39 AM | Report abuse

Actually, it isn't the first vaccine against a strain of cancer. Hepatitis B protects against the virus of the same name, which generally leads to cirrohsis and liver cancer.

The problem with the information-only route: Most private insurers resist covering non-mandatory vaccinations (e.g., typhoid if you're traveling abroad, meningitis if you're a college student, in some jurisdictions).

In order to mandate insurance coverage for the $360 vaccine, states generally have to mandate school attendance requirements. Some states (e.g., Maryland) have requirements that private insurers cover any CDC Advisory Committee on Immunization Practices (ACIP)-recommended vaccine.

Not all the cost of the vaccine will fall on the states. The Vaccines for Children program will provide it to American Indian/Alaska Native kids, the uninsured, and to SCHIP recipients.

Posted by: Melissa | March 5, 2007 10:40 AM | Report abuse

I completely agree. The cancer numbers dont match the energy with which this vaccine is being marketed. I would not want it for my daughter.

Posted by: TJ | March 5, 2007 10:41 AM | Report abuse

Oh, and the reason why this is for women/girls only: There is no way to test for HPV in men right now.

Merck and GSK (they make Cervarix, the other vaccine in the pipeline) want to explore the possibility of vaccinating men/boys since HPV is thought to play a role in anal cancer.

Posted by: Melisa | March 5, 2007 10:42 AM | Report abuse

I think it is too soon. More testing should be done to verify the side effects of this medication before it is mandatory. It should be optional for now.

My major problem with this is that people are seeing this as a 'cure' for cervical cancer. The vaccine only prevents certain strains of HPV and, therefore, does not eliminate the need for pap smears. I'm worried that many of these girls will think it is okay to skip their annual checkups and result in a higher rate of undetected cervical cancer.

And why aren't the boys being vaccinated as well?? They carry the disease so vaccinating them would truly stop the spread of HPV.

Posted by: Liz | March 5, 2007 10:49 AM | Report abuse

While the vaccine does not protect against all strains of HPV, it protects against the strains that cause about 70% of all cervical cancer cases.

Parents should also think about other consequences of HPV aside from the ultimate "cancer." HPV is extremely common among all socio-economic classes and races; a finding of HPV through annual pap smears leads to subsequent testing and procedures that are quite uncomfortable (and depending on health insurance, expensive). On top of this, the mental anguish caused by being told you have an STD can be tough on anyone. Even though the vaccine is new, tests show no major side-effects and close to 100% effectiveness (http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm#hpvvac2)
.

My opinion is, considering these factors, why wouldn't you want your daughter to be vaccinated? As someone who has HPV and who knows many many people with HPV, I wish the vaccine had been available years ago.

Posted by: ls | March 5, 2007 10:58 AM | Report abuse

I find this debate silly. Because of our sex hang ups, little girls are going to get cancer. Nice.

Posted by: Bea | March 5, 2007 11:04 AM | Report abuse

Why would any parents not want their daughters to be vaccinated? My experience colors this tremendously - in my early 20's, I had 2 rounds with cervical dysplasia, each ending with surgery. Twenty-five years later, I'm going through my fourth (yes, fourth) round with dysplasia, this time after having a hysterectomy to elimnate round 3. My appointment to meet the consultant this time around is next Tuesday. Why mandate it? I sure wish it had been around 30 years ago. And I ask myself why any of these parents would willingly put their daughters through what I've gone through in my life. Deadly - not yet. Expensive, time-consuming, stressful - the list goes on. I care about my daughters. I'll "mandate" it for them.

Posted by: Ruth in SC | March 5, 2007 11:09 AM | Report abuse

Only in America would we turn down a vaccine to prevent cancer. I think this speaks to how very far removed from disease and suffering we are. We don't do things like this because we aren't afraid enough of it and we aren't afraid of many of these illnesses because we haven't seen them like our parents did. The irony is that the virtual erradication of these diseases is due to vaccination. For those who would refuse, I wonder how you might answer your dd if she developed cervical cancer?

For Liz, they aren't vaccinating boys yet because it wasn't tested in them and thus, not FDA approved yet. Anal cancer is also caused by HPV and there is real interest in the gay community in vaccinating men as well. I suspect it is just a matter of time!

Posted by: moxiemom | March 5, 2007 11:10 AM | Report abuse

We developed this vaccine here at Georgetown University, and have received a Bill Gates Foundation Grant to produce the vaccine more cheaply. It also is therapeutic--we hope to start clinical trials in women with cervical cancer in less than a year.

See this link: http://explore.georgetown.edu/news/?ID=3013

Posted by: JB | March 5, 2007 11:10 AM | Report abuse

"On top of that, the mental anguish caused by being told you have an STD can be tough on anyone."

What about the mental anguish caused by being promiscuous? PResumably people who don't sleep around don't get STD's.

I find that whole TV campaign ludicrous. "Anyone can get it."
Really? Can my widowed grandmother get it? How about the nuns over at the Catholic school? It's an STD, folks.
Anyone can't get it.

Posted by: Anonymous | March 5, 2007 11:10 AM | Report abuse

I simply cannot believe the outcry over this vaccine. Why would you not want your daughter to get it? And if you're afraid it's going to encourage sexual activity, won't your teachings on morals (whatever you believe) as a parent override a simple shot?

Posted by: WorkingMomX | March 5, 2007 11:14 AM | Report abuse

Yes, anyone can get it, because every woman will be sexually active at some points in their lives. Your example of nuns and widowed grandmothers aside, if we can vaccinate young girls before they engage in intercourse (at whatever age intercourse occurs) then we can protect them from cancer. It doesn't matter if they become active at 16 or at 26, statistically vaccinating them before makes sense.

Posted by: JB | March 5, 2007 11:17 AM | Report abuse

What about the mental anguish caused by being promiscuous? PResumably people who don't sleep around don't get STD's.

Tell me how exactly you would make sure that the man your dd marries will be a virgin?

Posted by: moxiemom | March 5, 2007 11:19 AM | Report abuse

I am a woman in my mid-30s. I was a virgin until age 27 and have had very few partners, always in safe and monogamous relationships. Despite being "low risk" with respect to my sexual history and behavior, a few years ago I had abnormal pap results. Further testing and biopsies revealed that I had been unlucky enough at some point in my life to contract one the few strains of HPV that is high risk for cervical cancer. These are the strains that the vaccine targets.

I would be furious if I knew that there had been a vaccine that could have prevented my anxiety and risk, but that ignorance and fear on the part of my parents or others had prevented me from receiving it. It's ten years too late for me, but do not make this mistake with your own daughters.

From what I understand, condoms are not entirely successful at preventing transmission of HPV due to the fact that it may be present on still-exposed skin. So even "safe sex" isn't safe from HPV. Now there is a way to protect against this virus. The vaccine has been tested and approved by the FDA. While it is true that we cannot yet know how long the protection will last, isn't even temporary protection worth it? Reducing the number of infections for any amount of time means slowing the exponential spread of this very common disease.

I have health insurance and can afford annual exams to make sure that any future abnormal cells don't have time to become cancerous. Extra tests and biopsies cost more than the vaccine would have. Those who argue that it is too costly to provide the vaccine to people who can't otherwise afford it are ignoring the fact that it would be more expensive to pay later for testing and treatment of cervical cancer. This is like asking how much a woman's life is worth.

I am at a loss to understand the public resistance to making this vaccine affordable (via insurance and/or public assistance) and available to all girls and young women who are lucky enough to be born at at a time when medical advancements are promising safer lives.

Posted by: 10 Years Too Late | March 5, 2007 11:21 AM | Report abuse

In the case of Virginia, I don't think it's going to be "shoved down their throats." The right to refuse would be clearly listed on consent forms. In most such cases, it's checking one box or the other, which usually requires actually reading it.

Stacey, when you say "the numbers aren't there" it appears that you mean that saving 4,000 lives a year aren't worth the hassle/expense. How many lives would make it worth it?

Posted by: Neighbor | March 5, 2007 11:22 AM | Report abuse

The first time I heard of HPV was when I was working with disabled children age birth to 5. A little 2 year old boy was infected by a male babysitter. He wasn't "sexually active", he was molested. The protection is not only for "willing" participants. If you can protect your daughter, why wouldn't you? Price is a problem but GlascoSmithCline is supposed to be coming out with a different but equally effective vaccine soon and perhaps the competition will lower the price. Mandate? I don't know but it's irreponsible not to encourage the vaccination.

Posted by: Barbara | March 5, 2007 11:23 AM | Report abuse

women who are totally monogomous can still get it if their husband sleeps around and pass it to them. tell me, do they deserve it? should they have to pay because their husbands weren't faithful or do they somehow "deserve" to get it because it's their fault that their husbands sleep around.

Posted by: quark | March 5, 2007 11:29 AM | Report abuse

My daughter will get this when she is old enough.

If 4000 people were to die in this country of flu, it would be considered an epidemic. Yet an estimated 3700 women die in this country every year from cervical cancer and that number isn't considered significant? Nearly 20 million Americans are infected with HPV. Is that number significant of an epidemic?

This vaccine costs $360. How much does cancer treatment cost? When are people going to figure out that an ounce of prevention is cheaper than a pound of cure? Our local pro-life org has come out against this vaccine. How hypocritical is that? These people claim to value life and want to protect life but apparently once life is out of the womb and capable of having sex, its' "life" is no longer worthy of protecting.

I can certainly understand the desire to have more information regarding the long-term impact of this vaccine. Perhaps this is where so many parents hang their trepidations, particularly regarding the required vaccine. For some parents, there will never be enough information. There is a significant minority of parents who don't want their children to get any vaccines, even those that have been used for decades. More information and more data will not satisfy them.

Posted by: LM in WI | March 5, 2007 11:31 AM | Report abuse

As someone pointed out, two of the strains that the vaccine prevents are responsible for 70% of cervical cancer likelihood, but it should also be noted that the other two strains prevented by the vaccine are responsible for 90% of genital-warts cases. The CDC has found no major side effects.

As for whether "anyone can get it," it's a sad truth that any woman, including virtuous teens and widowed grandmothers, could potentially be a victim of rape at some point.

http://cancer.about.com/od/hpv/p/gardasil.htm

Posted by: Tom T. | March 5, 2007 11:33 AM | Report abuse

I oppose mandatory vaccination with this vaccine because it is too soon. The vaccine just came out after being tested on 11,000 girls/women. I work in medical research and I know from experience that many drug side effects are not seen until the drug is on the market and tens of thousands of people take it. Suppose that there is a significant side effect that occurs in 1 out of 10,000 cases? With 11K tested, it may have only been seen once and considered a fluke.
The chicken pox vaccine did not become mandatory until there was more data for safety and long term efficacy. I do not think that Merck or state legistlatures should be in the business of imposing mandatory new vaccines on our children until we have a lot more data to review.

Posted by: karen | March 5, 2007 11:33 AM | Report abuse

"I simply cannot believe the outcry over this vaccine. Why would you not want your daughter to get it?"

Because until the vaccine's on the market for some time, we will have no real idea of the side effects. If you believe that every product approved by the FDA has no side effects that would outweigh the benefits, you haven't been paying attention the last 10 years. It's up to me as the parent to weigh risks and benefits of all medical intervention, and I am not prepared to cede that role to any state government.

For everyone who considers that having a right to refuse is sufficient, explain how that will work for illiterate parents or those for whom medical jargon wasn't include in their ESL class. What you really mean is that fluent English speakers and middle- and upper-middle class parents have a right to refuse, and poor parents will be led along by the nose of government - which always knows what's best for us. Right.

It's interesting to me that the same people who are concerned about medicating young children with ADD-related drugs see absolutely no problem with mandating medicating teenaged girls with a recently-approved drug with no track record. Why not aspire to some consistency and not believe everything Merck or any other pharmaceutical company tells us.

Posted by: Anonymous | March 5, 2007 11:35 AM | Report abuse

While I am very excited about the HPV vaccine and would most definitely get it for my daughters (if I had any), I am completely opposed to the idea that ANY vaccine should be mandatory. While I understand the concerns of those who have said poor people won't be able to afford it unless it is mandatory and covered by insurance, I think that is a problem that should be addressed through insurance legislation - I simply believe it is wrong to deny children something as fundamental as EDUCATION over health issues that are only tangentially-related.

Posted by: TakomaMom | March 5, 2007 11:35 AM | Report abuse

Dr Dick Schlegel and our team developed this vaccine at GU over the last 20 years. For a vaccine to reach the human population, it had to go through pre-clinical trials (in rats and mice) and then in all 3 stages of clinical trials in people.

Please see yet another link to CDC, that discusses the vaccine and may calm some fears.
http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm

Posted by: JB | March 5, 2007 11:37 AM | Report abuse

Hepatitis B is primarily a sexually transmitted disease, most young people are required to have it to attend schools. Yes there are other ways to get it, but primarily, it is spread through bodily fluids, sharing needles and SEX. As Americans, we do not like to talk about sex. Many parents will swear their children are not having sex, as a middle school teacher, I can tell you far more of your children are having sex at younger and younger ages than you think. They don't get the information from school, we are not really allowed to teach about it. They don't get it from home. Too many parents are afraid/ashamed to teach about it, or think they will wait until their children are "the right age". Sex is as natural as the curiosity that drives young people to it. Our refusal to discuss with them the consequences of the behavior, may be interpreted by them as complicity with their behavior. Immunization does not make someone more promiscuous; if that were the case, then I would seriously have to question whatever moral authority a parent was exercising that would allow a series of three shots to override 11 or 12 years of modeled behavior. The series is expensive, but will undoubtedly become less so as competition and the market drives prices. Yes, at this point it only protects women; I know this is coming as a real blow to all the men who for years had research done for them, by them, and of them and then women were forced to fit in the paradigm or die trying. Does this mean that there won't be an assay sometime soon to protect men? Probably not, if the market will bear the price or research and development, there will be a vaccine for men and boys as well. As for comments about Merck, are you also willing to trhow out, Zocor, Fosamax, Rotateq, Propecia

Many women, even women who will marry men when they are virgins, will get HPV.

We are facing many healthcare issues, perhaps mandating any vaccine is ludicrous at this point. But perhaps not.

Whether you look at the advertisements as propaganda, which in fact ALL advertising is, or as useful information, consider the impact that this vaccine may have on a young woman you know.

Posted by: Kate | March 5, 2007 11:45 AM | Report abuse

I am against mandating this drug until we have more long term effect information. 11,000 subjects is not enough to require all girls to get this vaccination. At this point, it should be a choice. Once we have more information, then it should be mandated.

Posted by: Marie | March 5, 2007 11:47 AM | Report abuse

To LM in WI:
Actually, flu kills about 36,000 people in the United States each year, according to the CDC: http://www.cdc.gov/flu/keyfacts.htm

To my knowledge, no state mandates the annual flu vaccines for their citizens -- though I think all recommend it, especially for children and the elderly.

Posted by: Anonymous | March 5, 2007 11:48 AM | Report abuse

A personal note

I have had a grand total of two sexual partners in my life. I am married to one of them and we have been monogamous the entire time we have been together. However, I am also a survivor of childhood sexual abuse. Between the one partner I had before my husband, my rapist, and my husband, I contracted HVP. I am still in treatment. This virus very nearly forced me to abort my second pregnancy because I had developed the most severe from of cervical dysplasia, carcinoma-in-situ. I was, in the words of my gynecologist, a year away from cancer.

This vaccine, had it been available when I was a child, could have prevented all of this. Note that I said "could." There are no guarantees in life. However, the vaccine would have gone a long way in stacking the odds in my favor. The cost of NOT vaccinating is dead women, motherless children, widowers, parents burying their daughters, employers hiring new workers, the list goes on. As for the cynicism about the medical community and what they have to gain, wouldn't it make more sense financially for the medical community to want us to get sick so they can charge us an arm and a leg once we do seek care?

For Anon at 11:10

Yes, anyone can get it. My grandmother in law was recently diagnosed with cervical cancer and she hasn't had sex in over 30 years. She got HPV from her philandering ex-husband who left her for another woman nearly 40 years ago.

Posted by: LM in WI | March 5, 2007 11:52 AM | Report abuse

I don't think the case against mandatory vaccination is as strong as you describe. You say, "States will be spending millions to vaccinate girls whose families are uninsured." This is true, but which costs the state more? Vaccinating those millions, or covering the cost of cancer treatment for the fraction of those millions who end up with cervical cancer? I haven't seen any data on this, but it's at least plausible that an outlay of a couple hundred dollars per person now is cheaper than the thousands of dollars in hospital stays, chemo, or surgery that the state would end up paying per uninsured person who got cancer. Preventative medicine in general tends to be cost effective.

Another thing to keep in mind: Vaccinating one girl stops her from getting the disease, but it has another positive externality. It also lowers the chance that any of her sexual partners will get the disease, and that any of theirs will get it, and so on, ad infinitum. This is exactly the kind of health issue the state should get involved in, because if enough people get vaccinated, even "vaccine freeloaders" will be significantly safer.

Posted by: sasha | March 5, 2007 12:01 PM | Report abuse

http://www.in-forum.com/articles/index.cfm?id=158525§ion=valleyrr

Fuel for the fire.

Perhaps a call for better education for better healthcare?

Posted by: LM in WI | March 5, 2007 12:04 PM | Report abuse

LM in WI, thanks for your personal story. I understand where you are coming from, and the vaccine is something for me to consider for my daughter when she is old enough. I just have a problem with it being so new and then being mandatory in a couple of states, with no knowledge really of long-term impact or side effects. I'd hate for the vaccine to someday be pulled off the market because it has been found to cause some damage, and it had been mandated in some instances.

Posted by: theoriginalmomof2 | March 5, 2007 12:05 PM | Report abuse

Sasha,

You are absolutely right! The vaccine "freeloaders" are protected by what vets call the phenomenon of "herd health"--you vaccinate enough individuals in a population, and then even the unvaccinated ones are at lower risk. It's also why people who are opposed to vaccination because of their religion don't contract polio today--enough of the rest of the population is vaccinated which protects the unvaccinated.

I wouldn't want my daughter to take the risk of not being vaccinated. Many people have made valid points about how this vaccine has nothing to do with promiscuity--all it would take is an unfaithful husband or rape to infect a girl.

Posted by: R | March 5, 2007 12:16 PM | Report abuse

Parkinson's disease affects relatively few people as well (so few that drug companies haven't invested enough for real breakthroughs in decades). But if a vaccine were invented for Parkinson's, nobody would be debating whether to get it. It's sad that a knee-jerk skepticism of government and an irrational fear (by some) of increased promiscuity may lead to some women dying horribly and unnecessarily of cervical cancer.

Posted by: Rich | March 5, 2007 12:22 PM | Report abuse

I have a daughter, and I will get her vaccinated when she reaches that age. I think the sex/promiscuity debate is ridiculous. The vaccine has nothing to do with sex. It has to do with health. I'm confused how the child is going to make the leap to 'now that I've been vaccinated I can go have sex with everyone I know'. Is that how the parent is going to explain it to the child? No. It's a vaccine that will help lower the risks of getting cancer. Sex really shouldn't be part of the discussion. SEX is a whole other discussion, but not the main point of the vaccination. Really, how many parents sat down with their child and explained all the vaccinations that they get? It was probably more like, 'you're going to be getting 4 shots at the doctor today, and then we'll get some ice cream'.

I can see the concern with how new the vaccine is and long term risks. There will be more information available by the time my daughter is in the sixth grade. But, personally I have lost way to many loved ones to cancer, and will not refuse an opportunity to take steps to help prevent it in my kids.

Also, just as an aside, does everyone really think that widowed grandmothers are not having sex? Really?

Posted by: JerseyGirl | March 5, 2007 12:23 PM | Report abuse

In regard to your statistic of 7.5 million females between 14 and 24 years old, please allow me to point out for you and your readers that is just about all of the females that age.

Posted by: bh | March 5, 2007 12:29 PM | Report abuse

Point of clarification

This vaccine is NOT a cure for cancer. It is not and should not be considered a treatment for cancer. It prevents cancer from occuring in the first place.

There are certainly legit concerns for many parents regarding this vaccine. As a parent I also have concerns anytime a doctor wants to come at my kids with a needle. As I said in my original post, more information will not satisfy all. I have a classmate who vehemently believes that vaccines caused her son's autism. I don't agree with her but she is entitled to her opinion. The question state legislatures must figure out is at what point are the legitimate opinions of a significant minority out-weighed by the benefits for small segment of the population. IMO, 20 million infections warrants mandating the vaccine.

Posted by: LM in WI | March 5, 2007 12:31 PM | Report abuse

The people that worry it will "promote" promiscuity are religious fanatics that are so afraid of their own genitals that they have to consult their Bible before going to the bathroom.

HPV is not killing enough people to warrant a MANDATORY inoculation. What is it, smallpox? No. AIDS? No.

Make it available and attempt to educate the public. Let us choose what is best for our children. Tell you what, gov't - why don't you figure out how to mandate health and dental care for Virginia's SICK children before ordering us to vaccinate HEALTHY ones??

Posted by: Pete | March 5, 2007 12:31 PM | Report abuse

LM in WI said "If 4000 people were to die in this country of flu, it would be considered an epidemic."

4,000 flu deaths a year would be a great reduction.

http://www.cbsnews.com/stories/2003/01/07/health/main535605.shtml

"The U.S. death toll surged fourfold from 16,263 in 1976-77 to 64,684 in 1998-99, the Centers for Disease Control and Prevention reported. Flu deaths now average about 36,000 a year, up from 20,000 in previous estimates, the CDC said"

Posted by: Anonymous | March 5, 2007 12:34 PM | Report abuse

to:
Posted by: | March 5, 2007 10:24 AM

Really, do you think the funds for anything in this country are unlimited? If you do, then maybe there's no way to 'put a price on' saving lives. However, funds *are* limited - so you *can* put a price on it. What if spending this money will take money away from another program that will save 10 times the number of lives, but it can't be done now because of this law?

Things are NOT so cut and dried as we make them out to be.
I think mandating this vaccine is a bad idea. It is not for a communicable disease such as polio that you can get just by being in the same room as someone else - there is something else involved. Vaccines typically for school are the type where you want to make sure that those people who are tightly in a room or building together aren't going to give a disease to others.

Posted by: atlmom | March 5, 2007 12:37 PM | Report abuse

I'm all for it.

The reason cervical cancer-death- rates are going down is NOT because people aren't getting it but because they are catching it via pap smears - and then being treated, which costs money. Also women who are uninsured and perhaps can't access pap smears are the ones most likely to die - and also the ones who won't be able to afford the vaccine if it's not on the "mandatory" list.

People who want to opt out of vaccines can the same way they can opt out of other mandatory vaccines, I believe.

Posted by: Shandra | March 5, 2007 12:41 PM | Report abuse

I am very happy that many people share my opinion on this post. As a woman who has recently been diagnosed with HPV-caused dysplasia, I am very passionate about this issue. (And, NO, I am not promiscuous, thank you very much.) The mental and physical pain of going through the biopsies and surgery has taken a toll on me. Parents, you may not be able to always make decisions for your children, so why not make the decision to protect them from this no matter what. I believe that since so many women have been affected by the virus (my Dr told me that more people in his office have it than don't have it), most parents will make the right decision and vaccinate their daughters. Although the FDA hasn't approved it for this purpose yet, the vaccine has been shown in studies to be therapeutic (treat current infections) and has shown signs of cross-immunity (will help protect you from other strains that are not directly targeted by the vaccine). Phase II testing (testing in humans) was started over a decade ago and no adverse side effects have been found yet--I'd say that's pretty convincing.

Posted by: Jane | March 5, 2007 12:43 PM | Report abuse

Opting out should not be an option, because it opens the door for the insufferable ignorance of some parents about sexuality to endanger girls' lives. Education (and now vaccinations) about sexually transmitted diseases is woefully misunderstood in our paradoxically prudish yet oversexed society, and the bottom line is this can save girls' lives. Boys are passing HPV to girls like nobody's business, and unless SOMEONE gets a clue about safe sex, the vaccination is at least a start.

Posted by: C. | March 5, 2007 12:44 PM | Report abuse

When my daughter is old enough (6 years away), we will talk to her pediatrician and discuss the pros and cons of the vaccine. I am concerned about the long-term effects (both of having the vaccine and not having the vaccine). My concern is not -- at all -- related to the sexual issue.

Posted by: Marie | March 5, 2007 12:56 PM | Report abuse

http://www.cdc.gov/pcd/issues/2007/jan/06_0058.htm

More fuel.

IMO, pretty convincing case that prevention is cheaper.

For those who will ask they question, typically a healthy woman has one Pap a year. Women with abnomal results (usually because of HVP infection) will have 2-3 tests done per year. I am not saying that the vaccine will reduce the medical costs of treating infections, but it will certainly reduce the costs of treating cancer because women won't get cancer.

Posted by: LM in WI | March 5, 2007 1:08 PM | Report abuse

As my then-boyfriend, later husband flat-out LIED to my face when asked if he had ever had an STD, and then infected me with HPV, you may rest assured that my kids (both sexes) are going to be vaccinated.

I don't care if I have to pay for it OUT OF POCKET, they will get the vaccine. I don't give a rats-@ss if my husband disagrees on this one--I notice that I'm the one who has had several colposcopies, not HIM.

If it's mandated, that would spread the costs out for all of us, not just individual health insurance plans or states.

Posted by: Anonymous | March 5, 2007 1:11 PM | Report abuse

to Anonymous at 1:11 PM:

Men/boys often do not have any symptoms of HPV infection, so it's possible that he "lied" in good faith (didn't know he had it).

Posted by: J | March 5, 2007 1:15 PM | Report abuse

I am sitting her laughing out loud by those who think if you're not "promiscuous", you won't get STDs. What a (bleeping) joke!

Three true stories . . .

A girl in college waits to have sex until well into her 20s. She finally "does it" with a guy she has been dating for quite a long time. In love with him, etc. etc. She gets an incurable STD from him.

I know another girl in the same situation.

Finally, another girl who had been with the same guy -the ONLY guy- for almost 10 years. He cheats on her. She gets incurable STD.

I assure you being "not promiscuous" does not equate to never getting an STD.

I agree with the posters who say that only in America would our freaking hang ups about sex, and our bury our heads in the sand mentality (of some parents/people) about whether our kids will have sex, get in the way of this discussion.
** Newsflash folks, if your daughters want to have sex, they will. Always have, always will.

There is a way to drastically cut down on cervical cancer. That some of you even question this on "moral" grounds boggles my mind and causes me to pity your daughters. Those poor girls.

All that being said, nothing is being forced on anyone. If your hang ups are such that you simply cannot bring yourself to vaccinate your daughter, simply opt out. Problem solved.

Posted by: JS | March 5, 2007 1:24 PM | Report abuse

I will not be giving the vaccine to my daughter: I will inform her about it so that she can make her own decision when she's older. We have no idea what the long-term side effects will be (i.e. in 20 years' time, will it render girls infertile? Cause an increase in breast cancer rates? etc), and I'm not signing my kid up to be a guinea pig. The FDA's and Merck's track records have been horrendous as of late, and the big push on a vaccine against a random cancer makes me doubt the motives of both. If you want to decrease death rates from cervical cancer, open a free clinic for PAP smears, problem solved.

Posted by: StudentMom | March 5, 2007 1:29 PM | Report abuse

Just want to point out that HPV infections go virtually undetected. There are no physical symptoms upon immediate transaction of the disease. Sometimes it takes up to 30 years before the disease manifests itself, if ever. That creates a huge gap of time where people can transmit the disease unwittingly - even to their children through child birth. It's ridiculous that you would not want a vaccine for a disease that is so easily spread, so easily undetectable, and one that kills so easily.

Posted by: Anonymous | March 5, 2007 1:29 PM | Report abuse

The promiscuity argument is absurd. I absolutely cannot believe how few people have mentioned the fact that one in six American women has been the victim of sexual assault (according to RAINN; some believe the number to be higher). As long as those statistics hold, I don't believe debate over the HPV vaccination is valid unless it centers on concerns over health problems the vaccination might create. It very much could happen to your little girl, even if she does (and you do) everything right. There are so many things you can't protect against, why pass up the opportunity to take that number down?

Posted by: RK | March 5, 2007 1:32 PM | Report abuse

J,

No, he did know about it as he had been treated (had the visible warts frozen).

The only reason he told me, when I was well-advanced in my pregnancy, was because he thought he was having a relapse and that I'd "catch him" in the lie. He didn't care about my health...

But I care about our children's health.

Posted by: Anonymous | March 5, 2007 1:33 PM | Report abuse

To Anon 1:11/1:33:

I'm sorry to hear that. I was trying to give him the benefit of the doubt, but nevermind. What an @$$.

As a previous poster mentioned, the vaccine is not yet approved for boys because it has only been tested in girls. So you may have some trouble getting your son(s) vaccinated.

Posted by: J | March 5, 2007 1:44 PM | Report abuse

It needs to be available to everyone but parents need to be able to make their own choice.

Posted by: NURSE P | March 5, 2007 1:50 PM | Report abuse

Hi J,

Well, he's young yet. I can only hope that by the time he's of the right age it will be approved for boys (after all, we presume they don't WANT to infect someone they love, right?).

Yeah. He is. But which came first, the mental illness (not diagnosed until last year) or the personality disorder (ditto) that seems to mandate lying.

Still, I hold him responsible for lying. He wasn't floridly psychotic at the time, he knew it was wrong, he did it for his perceived gain (me), and he didn't 'fess up because he had any concern for MY health or our CHILD's health, just fear of getting caught.

*sigh*

But thank you for the thought. Unfortunately...

Posted by: Anonymous | March 5, 2007 1:58 PM | Report abuse

I don't think people understand what exactly HPV is and how it is transmitted (NOT thru semen or saliva!).

1. Hand and foot warts are a strand of HPV. Only a miniscule number of carriers actually have tell-tale warts. HPV is everywhere-- one of the most ubiquitous viruses out there.
2. HPV is a skin virus so it's transmitted not thru semen but thru touch.
3. Married, monogamous women can still get HPV because the disease is passed on thru touching (shaking someone's hand, per se) and you later having sex with your husband who shook that infected hand. THIS IS WHY WE GET ANNUAL PAP SMEARS.
4. A woman can have HPV and not have cervical warts.
5. Nearly everyone is a carrier of some strain of HPV.
6. Men are not negatively affected by it even though nearly every man is a carrier of some form of HPV. Women aren't affected unless the virus makes contact with their genitals.
7. The prevalence of women, who are virgins, with HPV is 5%.
8. If you've had 1 sexual partner, even if that partner was a virgin, your chances of having HPV is 11.5%.
9. Children are vaccinated against Hep-B, an STD, so it makes sense to also vaccinate against HPV.
10. You can get HPV thru personal touching or inserting a tampon if your hands carry the virus, which again, is everywhere.

Posted by: Heidi | March 5, 2007 2:10 PM | Report abuse

If men died from HPV, the vaccine would be given to all boys AT BIRTH. so, why the friggin' debate? Give it to all girls.

Posted by: phillyfilly | March 5, 2007 2:10 PM | Report abuse

This commentary makes no sense. The writer admits that HPV and resultant cervical cancer has a greater impact on low-income women. But then she seems to have a problem with spending on the uninsured. Better to spend tax dollars on the vaccine for low-income women that treatment for HPV or cancer.

On a personal note, I was diagnosed with HPV (one of the types the vaccine prevents)and severe dysplasia in my mid-20's. It was very close to turning into cervical cancer and I ended up having a portion of my cervix removed. Luckily, I was still able to have children down the road. Now that I have daughters, they will definitely be receiving the vaccine.

I don't see the reason why this vaccine should be optional if others are not. For instance, several schools require chickenpox vaccinations. I think alot more women die from cervical cancer than the chickenpox. In terms of potential side effects, I do agree that maybe the vaccine should be optional for a few years until its safety is assured.

Posted by: EMB | March 5, 2007 2:12 PM | Report abuse

"PResumably people who don't sleep around don't get STD's."

I know no one wants to think about their precious little angels having sex, but how about considering this: Children can be and are raped and molested at an alarming rate in this country? Actually widowed grandmothers and nuns can also be raped (the other "ridiculous" examples listed by the above poster), so, yeah they can get HPV as well. Can you imagine being raped, dealing with the consequences of that, and then finding out many years later that you've developed cancer because of it? Cancer that could have been prevented had you had a couple of shots!

I won't even go into the implication that promiscuous girls deserve to get cancer!

If my baby due in 6 weeks is a girl, you can bet I'll be making sure she gets vaccinated for HPV at the soonest appropriate time! I certainly hope she waits until she's mature (say 35?) and in a commited (cross my fingers, married) relationship to have sex, but I know there is a chance that her first sexual experience will be out of her control. It's up to me, as the parent, to not flinch away from considering all possibilities and protecting her from everything I can!

I know many people have made these points already, but it makes me very upset, so I posted anyway!

Posted by: tl | March 5, 2007 2:13 PM | Report abuse

The end result of most HPV infections is not cancer. In fact, the reduction in cancer rates is only icing on the cake regarding this vaccine. Think of the millions of women who could be spared painful colposcopies and surgeries to remove abnormal cells caused by HPV. While many might be willing to risk (or risk their daughter's) chances of developing cervical cancer, please note that there are many other complications caused by the virus. In my case, I've undergone 3 painful colposcopies, two surgeries (each causing me to miss two days of work and required 6-8 weeks of recovery time) and now I must receive pap smears twice a year rather than once a year. Additionally, the surgery required to remove potentially cancerous cells puts women at a higher risk of pre-term labor when they decide to have children. While pregnant with my daughter I was on "cervix surveillance" requiring an additional 10 doctor's visits than normally required and the worry that my cervix would not hold up until I could safely deliver my baby. All in all, I'm sure my insurance company would rather have paid a $370 vaccine to save all of these subsequent expenditures and I personally would have loved to save myself from the emotional and physical pain caused by HPV. While my experience pails in comparison to the women who have died or suffered dramatically due to developing cervical cancer, my story is a common one I hear repeated by the MAJORITY of women I know in their 20's. This is not a disease that only affects 3900 cervical cancer patients a year. It affects millions of women a year. This is not a disease only promiscuous people contract so moralists can argue they somehow deserved what was coming to them. Unless you are so naïve to think that your daughter will NEVER have sex until she marries and that the man she marries will have NEVER had sex herself and she will NEVER be the victim of a sexual assault, then please do your daughters a favor and consider the vaccine. I know I will for my daughter.

Posted by: Mom with HPV | March 5, 2007 2:19 PM | Report abuse

Interesting discussion today.

Thanks for questioning whether the vaccine is the first to protect against a form of cancer. According to Sunday's story, it is the first to protect against a form of cancer that has won federal approval. I've changed the blog to reflect that.

Posted by: Stacey Garfinkle | March 5, 2007 2:22 PM | Report abuse

The author could not have more eloquently stated the true issues behind this decision. While the pharmaceutical companies surely receive some undue criticism in the face of much scientific progress, this is truly a case of overmarketing and capitalizing on the fears of parents. HPV, like almost all sexually transmitted diseases are no longer an issue when people practice safer sex. Save yourself the problem and use a condom every time.

Posted by: GW Public Health Student | March 5, 2007 2:29 PM | Report abuse

As someone way up in the chain remarked, this vaccine also prevents two strains of HPV that cause warts on hands and feet. As someone who has had to deal with a (very painful) wart on my foot, which I believe was the result of getting a small cut on that exact spot from something when I was barefoot in a TSA security line a few months before, I love knowing that if the vaccine had been available when I was a teenager or younger that I'd have been spared several months of painful limping (it's on the ball of my foot, and feels like I'm stepping on a tack every single step).

A small consequence compared to the nightmares that some are describing, but a big quality of life issue for me.

Posted by: Rebecca in AR | March 5, 2007 2:30 PM | Report abuse

Condoms do not protect against HPV 100% of the time, as the area involved is not just the genitalia, but the skin around it.

Posted by: for GW health student--study harder! | March 5, 2007 2:34 PM | Report abuse

The vaccine does not protect against 100% of HPV strains either.

Posted by: GW Public Health Student | March 5, 2007 2:41 PM | Report abuse

"The cancer numbers dont match the energy with which this vaccine is being marketed. I would not want it for my daughter. "

So you don't want to have your daughter receive it because not enough people get cervical cancer? I thought over half of all women have HPV at some time. That isn't a large enough number for you? Yes, not all get cancer for HPV, but many undergo painful and intrusive medical procedures because of it. You wouldn't want to prevent your daughter from going through this?

I just don't understand what the problem is. Do these people want their kids to develop genital warts and cervical dysplasia?

Posted by: AllisonNY | March 5, 2007 2:44 PM | Report abuse

To Rebecca in AR: try apple cider vinegar on your hand/foot warts. It works in a few days, and it's a lot less expensive than the $450 guinea pig vaccine woulda cost ya to boot!!! ;)

Posted by: StudentMom | March 5, 2007 2:45 PM | Report abuse

To AllisonNY: no, I don't want my daughter to have genital warts or cervical dysplasia. More immediately though, I also don't want her to be a guinea pig. She would DEFINITELY be a guinea pig, and she would only have a teeny tiny chance of HPV doing her harm, even in the likely scenario where she would contract it in some form or other. Therefore, she can make her own choice about it when she hits her teen years - if it's even still on the market.

Let's face facts: the only reason Merck is pushing this is that they lost their $3b/year profits from Vioxx and need a replacement for that. Conveniently enough, projected revenues from Gardasil if it's mandatory is $3b. Equally convenient, Merck was trying to beat a competitor to the finish line with this vaccine. Their motives are not to help my daughter, their motives are to help themselves ... as such, I will not trust them until TIME shows that the vaccine is safe. For all we know, this could end up being the thalidomide of our generation.

Posted by: StudentMom | March 5, 2007 2:50 PM | Report abuse

GW,

You said, and I quote:

"Save yourself the problem and use a condom every time."

Which implies that condoms are 100% effective.

If Randall Packer is your professor, he will go running around in circles, screaming and pulling out what is left of his hair. At least he would have back when I was his student.

Posted by: Anonymous | March 5, 2007 2:54 PM | Report abuse

TO GW Public Health Student:
So, if the vaccine does not protect against 100% of cervical cancer cases we should abandon it? Condoms do not protect 100% of the time and you are still keen on relying on them as your safety net. I worry about our future if this is the thinking of current Health students.

Posted by: To GW Public Health Student | March 5, 2007 2:55 PM | Report abuse

Until this vaccine has been tested thoroughly and given time to see if there are serious, long term side effects, I think mandating it be given to all girls of a certain age is definitely premature.

Let the parents decide for now if the risk is worth the benefit.

Posted by: John | March 5, 2007 2:57 PM | Report abuse

I am not saying abandoning the vaccine is an appropriate for dealing with the concerns that surround this vaccine. It is simply wise to consider what the vaccine is known to do and to consider other potential consequences that might emerge given that we have limited follow-up data at this time. Condoms are not 100% effective, but provide an important level of protection against MANY types of STD's.

Posted by: GW Public Health Student | March 5, 2007 3:00 PM | Report abuse

It is astounding to me that anyone would be opposed to giving their daughter this vaccine. As far as it being mandatory, Takoma mom, many vaccines are mandatory for any child, boy or girl, to attend school - that is the truth of it. IF I had a daughter, I would want to give her every opportunity to be as healthy as possible.
What is the downside? Yes, a certain, small percentage of girls may have an unfortunate reaction to the vaccine, but that happens with every vaccine that is out there - it is not unique to this one. We can only make the best-informed choices and decisions for any kid - the best choice is to vaccinate and the sooner the better. Yes, the cost should be covered by insurance and subsidized by the government for those without insurance.
Anyone who does not vaccinate their daughter is very short-sighted.

Posted by: star11 | March 5, 2007 3:05 PM | Report abuse

I do not think it is right to give a vaccination for an STD to young girls. I think it's a sad society when we vaccinate young girls for sexually transmitted diseases. Where are the parents? Where is the sex talk with these kids. I think we don't know what this vaccine will do to our children and trying to save everyone defeats the purpose of population control and "survial of the fittest." I was diagnosed with the HPV vaccine many years ago and it has not resurfaced. I think it's not that important of a disease to waste precious time and dollars trying to cure and if it's made mandatory, I will make sure that my daughter is not forced to get one. How ridiculous. One less. i have an idea, talk to your kids about sex and the consequences of being a promiscious teen.

Posted by: Stephanie | March 5, 2007 3:11 PM | Report abuse

20 years of testing and data just isn't "enough" for some.

If you truly don't feel like you have enough information about this vaccine to make a responsible choice, what is stopping you from getting that information? Call you OB/GYN or your pediatrician. Contact the drug makers, contact the FDA. Go get the information before reading some blurb in the newspaper and jumping to conclusions. I talked to my OB and she gave me very straightforward answers. She is NOT beholden to the drug company and she told me that she didn't feel the vaccine would do me much good because I am in a monogamous relationship. However, after answering my questions, she said she would administer it if that is what I wanted. After discussing it with my husband, we opted not to get it.

And if you don't trust your OB or your Ped to give you honest answers, get a new doc.

Posted by: LM in WI | March 5, 2007 3:18 PM | Report abuse

Measles is an airborne virus, HPV is not. It makes sense to require vaccination of students against airborne, human-to-human transmissable diseases. Since HPV is a sexually transmitted infection, it makes sense both economically and biologically to offer the vaccine to families (and offer a free or subsidized vaccine to uninsured families). Offer, not mandate.

The reality is, the vaccine has not existed long enough to know if there are severe long-term consequences of use. Additionally, the clinical trials used to gain its FDA aproval were not conducted on sixth grade girls, but rather on sexually active young women. A cornerstone of public health practice is that one does not conduct clinical trials on a population that cannot benefit from the potentially positive effects of the drug. In the case of the HPV vaccine, the immunity conferred is thought to last, at best, for 5 years. If we vaccinate 11 and 12 year old girls, by the time most will commence sexual activity, the benefit of the vaccine may have diminished. We risk creating a false sense of security in young women.

If I had a teenage daughter, I would encourage her to have the vaccine. I would also encourage her to practice abstinence until at least her early 20s, or use condoms if she was determined to be sexually active. I would also insist on annual Pap exams. These preventive measures have been demonstrated to reduce the incidence of HPV infection, and reduce mortality from cervical cancer.

And yes, as many other posters have pointed out, the notion that administering this vaccine will encourage young girls to become sexually active is ludicrous.

Posted by: Indiana | March 5, 2007 3:24 PM | Report abuse

TO Stephanie

Ask your OB how many women in that practice have HVP. Was promiscutity to blame for your infection? Where were your parents? As my mother told me when discussing STDs and preganacy, it only takes one time. Is one instance of sex promiscuous? My OB told me she has a number of patients who lost their virginity to their husbands, have been faithful to their husbands and still have HPV. Is sex with a spouse promiscuous? Again, some research into the literature would tell you the reason for giving the vaccine to young girls is because the vaccine has shown to be most effective when given to sixth grade girls. The age recommendation has nothing to do with the numbers of sexually active grade-schoolers.

'trying to save everyone defeats the purpose of population control and "survial of the fittest."'

At what point did cancer become a tool of population control? Do you really believe cancer is a way of weeding out the unfit? Seriously, do you think that?

Teaching sexual responsibility is important, but don't assume that people who have this infection are somehow irresponsible.

Posted by: LM in WI | March 5, 2007 3:30 PM | Report abuse

You can get HPV thru personal touching or inserting a tampon if your hands carry the virus, which again, is everywhere.

Posted by: is this true? | March 5, 2007 3:38 PM | Report abuse

Quote from Stephanie: "I think we don't know what this vaccine will do to our children and trying to save everyone defeats the purpose of population control and "survial of the fittest."

Wow. This comment is quite disturbing. Survival of the fittest? So would you basically reject any form of medical treatment too? Do you think that a women who has breast cancer should be left to die, based on this survival of the fittest notion? I sincerely hope not, and hope that you think about the implications of such a statement.

Modern medicine has allowed great advances in the quality of life for those that have access to medical care and treatment. This vaccine is just another advance. Unfortunately HPV sparks the morality debate as it is an STD. But as so many posters have illustrated, morals, or lack thereof, have little to do with many of the women who are infected with HPV.

Posted by: ls | March 5, 2007 3:39 PM | Report abuse

Star11, very easy for you to say since you don't have a daughter. Oh how easy it is for one to speak in the hypothetical ... if you actually had a vested interest in this, perhaps we would take your soapboxing more seriously.

Posted by: StudentMom | March 5, 2007 3:43 PM | Report abuse

I will make sure that my daughter is not forced to get one. How ridiculous. One less. i have an idea, talk to your kids about sex and the consequences of being a promiscious teen.

Posted by: Stephanie | March 5, 2007 03:11 PM

Stephanie - how about we start tagging the virgins, that way your perfect dd can pick one out easily.

Posted by: moxiemom | March 5, 2007 3:45 PM | Report abuse

I also agree that people who don't have daughters have no dog in this fight.

I am not naive, my 15 year old neice is pregnant, and I know that my daughter will one day have sex too, probably before marriage. Guess what? I did, so did many people on this board.

I am not against the vaccine, but I am worried about its safety, which is why I am not sure it shoould be mandatory.

Posted by: scarry | March 5, 2007 3:52 PM | Report abuse

TO Indiana

genuinely curious, do you have a source for your info regarding the efficacy of the vaccine over five years?

Thanks

Posted by: LM in WI | March 5, 2007 3:54 PM | Report abuse

As a Parent of a daughter 1-year away, I am kind of leery of the shot. 1st and foremost, at 11 I am not concerning myself with my daughters sex life. so I need some information as to why 11 versus 13-14-15-16-17, or stating before they become sexually active. I am not in denial but she's few years removed from sex. additionally, the vaccine only covers 2 strains of a multi-strain disease? Other vaccines are in the development process which should target or protect against the additional strains. This vaccine came out with all the markings of profit and not true public health. that's part of the hesitation. the 2nd part is now more folks understand it to be a STD and are alarmed that the recommendation is for all girls at age 11 to take shot. I was active at 13 and 14, but i cannot fathom many American girls being active at 11. if so that is a horror that i need to wake up too. Our pediatrician has told us of how the pharmacutical companies are also pushing for the flu vaccines to be a required shot for kids.

Posted by: RobGreg | March 5, 2007 3:57 PM | Report abuse

TO RobGreg

Just curious, did you ask your ped about this vaccine and if so, what was the opinion?

Distubingly, kids do seem to be sexually active at a younger and younger age. My huband sees a lot of it in his job. As a cop, he has seen more than his share of children involved in sex crimes (I classify all sex involving children a crime, even if is is "consensual" because I simply don't believe a 13 year old can consent to sex).

If you don't mind sharing, I would be interested in what pediatricians are saying. To be honest, I haven't talked to my daughter's pediatrian because our daughter is only 11 mos. old.

Posted by: LM in WI | March 5, 2007 4:04 PM | Report abuse

Most of these comments are rationally discussing the pros and cons of mandatory vaccinations, but I would like to address the few irrational people who are are judging HPV sufferers for being promiscuous.

I have HPV. I have only had sex with my husband, who has only had sex with me (we were high school sweethearts). It is unlikely that I caught HPV from my mother, since I was born via C-section. Perhaps I caught it from my husband, who caught it from his mother's cervix during birth. Perhaps there is another way for HPV to be transmitted that isn't fully documented.

My sexual history fulfills our society's strange notions of female "purity," yet I have a "sexually transmitted disease." It's absurd to turn this discussion into a judgement of HPV-sufferers' morality, and I really wish that the ignorant people who have posted here would educate themselves.

Posted by: Katherine | March 5, 2007 4:08 PM | Report abuse

To RobGreg:

Excellent question. The reason for the recommendation is that like most vaccines, it can only prevent someone from initially getting infected with the virus. If you are already infected, it cannot prevent the possibility that the latent HPV will start the process that ultimately results in cervical cancer at some point in the future. The best way to prevent getting infected is to get vaccinated before the person is sexually active. I do not know if it is more effective on an eleven year old than a seventeen year old - I have not found any evidence that was a part of the study.

Posted by: TEL | March 5, 2007 4:09 PM | Report abuse

This vaccine was fast-tracked through the approval process because of money. Making this vaccine mandatory will make many people very rich. The long-term effects of this aluminum-based vaccine are UNKNOWN. They admittedly don't know if it can cause reproductive or other health problems later in life because they don't have enough clinical trial history. Let's not forget that they touted the virtues of Vioxx just as confidently. These are little girls, not lab rats. The vaccine MAY prevent SOME forms of HPV that MIGHT lead to cancer. This vaccine should be tested for much longer than it has been.

Posted by: CW Mpls | March 5, 2007 4:15 PM | Report abuse

I also wanted to comment on labelling HPV as an STD. Current literature suggests - I used to do research on HPV - that most cases of genital HPV do appear to be caught via sexual activity, where any cause can be found.

However, because most people are unaware they have the form of HPV that results in cervical cancer until a pap smear shows dysplasia, and HPV can be latent for several years, there are many more cases where it is not known how the person caught it at all. Do not let all the hype about it being labelled an STD fool you - any researcher will tell you that too much is unknown about this disease to make such an absolute statement.

Posted by: TEL | March 5, 2007 4:23 PM | Report abuse

I am so glad to see a discussion of the merits of the vaccine in non-consensual sexual transmission, something that is absent from the majority of discussion that I have seen. The fact that the protection against non-consensual sexual transmission is hardly part of the debate in other forums, seems to support the need for the vaccine to be required. (I put aside the issue of safety with the vaccine--not because it is not important, it is very important and must be a consideration--but because I am focusing on only one aspect of the debate.)

I have followed the debate/lobbying on this issue for two very personal reasons:

My sister contracted HPV at age 3 from child sex abuse.

My college roommate was sexually assaulted in high school and contracted HPV. She was diagnosed with cervical cancer our senior of college. She spent the year puking as a result of treatment, when, we joke she should have been puking because of alcohol.

The HPV vaccine MAY have protected both of them (provided the vaccine is eventually available to younger children). But I am CERTAIN that they would have be given the vaccine only if it was mandated. Our parents and her parents would have joined the promiscuity debate and naively believed their daughters did not need the vaccine.

The protection against transmission by non-consensual sex eliminates the promiscuity line of reasoning entirely. Any parents talking to their child about (or just hoping their child will figure out) the importance of delaying sex until marriage, delaying sex for some period of time, or limiting sexual partners, can certainly explain that vaccine is a protection against transmission by non-consensual encounters. And can also use the vaccine as another discussion of how a daughter (or son) can protect herself against non-consensual violations.

The issue with this vaccine that is so difficult is that the window for getting it in time to have the greatest protection is narrow and means that parents need to make the decision for their daughters. To effectively protect against cervical cancer, a girl or woman must receive the vaccine before she contracts HPV. And, the first opportunity to protect again infection by non-consensual violations is long before a daughter is mature enough to decide for herself whether she should get the vaccine. In other words, a pre-teen girl can receive the vaccine and protect against non-consensual violations long before she would be ready to reason through the decision on her own. And probably before most parents would want their child exposed to the grittiest of details that their daughter would need to make an informed decision.

(Not to get distracted from the young girl issue, I want to make one point with regard to older girls and women able to make a decision for themselves. Most of my friends did not get their hands on birth control until at least the second or third time they had sex, regardless of whether that first time was on her prom night or her wedding night. I do not exactly think they would get to the vaccine before the birth control. And one sexual encounter could be too late for the HPV vaccine to be helpful.)

If we ensure our daughters are protected against chicken pox, we owe it to our daughters to protect them against a potential continuing violation of sexual assault, regardless of whether her parents think that getting the vaccine for her is license for her to sleep around. If we can figure out that the vaccine is safe, we owe it to every young daughter to ensure she is protected against cervical cancer to the extent possible.

Posted by: CL | March 5, 2007 4:43 PM | Report abuse

It's great that such a vaccine exists and it should be made available to anyone who *wants* it, but it really baffles me how so many feminists and pro-choice organizations are so quick to lobby for a mandatory STD vaccine. What happened to the mantra "Right to choose"? Why willingly throw more control over your private life to the government because a few key people in Congress received some handsome payouts from Merck? Especially when the Bush administration and Republican-majority state government have a history of limiting reproductive rights? Simply put HPV and cervical cancer are nowhere near the fatal epidemic proportions that warranted development and mandatory administration of the smallpox, MMR, and polio vaccines, and thus, does not require legislation. Subsidize the vaccine and make it available to all who want it, but leave up to the individual to make that decision.

Posted by: Tirade | March 5, 2007 4:43 PM | Report abuse

70 children a year die from chicken pox, but we mandate that. 5,000 women a year die from cervical cancer. Seems a reasonable expenditure.

Posted by: moxiemom | March 5, 2007 4:48 PM | Report abuse

100!

Posted by: StudentMom | March 5, 2007 4:57 PM | Report abuse

Right on StudentMom and the others that won't use their daughters to line the pockets of Merck!

The Long term effects of this vaccine aren't even known, yet so many of these caring mothers want to throw their kids under the proverbial bus.

Good luck to all of you that want to vaccinate your daughters, but to make this great unknown a mandatory thing smacks of money & kickbacks.

Posted by: guinea pig | March 5, 2007 5:16 PM | Report abuse

It should be mandatory, absolutely. I found out I had it when I was 26 and had to get a small but painful operation. I had never heard of HPV but I soon found out many of my friends had it too and had undergone the same procedure. even at 26, on my own, with health insurance, I was too embarrased to tell my parents because they would not understand the nature of the disease and would question my sexual activity as an unmarried woman. This vaccine can prevent all the strains of HPV that can lead to cervical cancer. Spare women and girls the surpise that they contracted HPV or the embarrasment that might prevent them from dealing with it. Make the vaccine mandatory and fewer women will die from cervical cancer!

Posted by: as | March 5, 2007 5:20 PM | Report abuse

Thalidomide was used too, until much too late they found that it caused birth defects.

Why the rush to mandate this when all the side effects aren't known. Plus lasting effectiveness of it beyond five years isn't proven.

We're not talking about something that has been proven rigorously by accepted scientific methods, but the initial phases of a new drug.

Making it mandatory is just a bit too Orwellian.

Posted by: Thalidomide | March 5, 2007 5:27 PM | Report abuse

This is my thought regarding vacinating young girls: As a mother, I know the morals that I am teaching my child, namely that sex should be with your life partner. However, I don't know who their potential life partner will have slept with. Because of that, their partner could easily give them HPV even if they are the only person my daughter sleeps with. For that reason, as soon as my daughter is old enough, she will get the vaccine.

Posted by: LY | March 5, 2007 5:38 PM | Report abuse

I feel sorry for the girls whose parents think that they should stay vulnerable to cancer, just to make the parents feel better about their morals. It is exactly these parents that the mandate protects these girls (and their future partners) against.

No shots, no school.

Posted by: andrew | March 5, 2007 5:48 PM | Report abuse

My 17-year-old daughter is going to get the vaccine because she asked for it.

But I think requiring it for school attendance is wrong. This is not a disease that is transmitted in school.

Posted by: kathy | March 5, 2007 6:07 PM | Report abuse

I feel sorry for the girls whose parents think that they should stay vulnerable to cancer, just to make the parents feel better about their morals. It is exactly these parents that the mandate protects these girls (and their future partners) against.

No shots, no school.

This might be the case for something that can be caught through the air, but this is not the case with this vaccine. Also, there are some children who cannot be vaccinated for anything! They rely on herd immunity to be safe from many childhood diseases. There are also exemptions for religous purposes.

I would also like to say that I am a liberal woman, but I find the idea of how quickly it passed through the trials alarming. So you can't just blame this apprehension on the bible thumpers alone.

Posted by: scarry | March 5, 2007 7:15 PM | Report abuse

My wife has HPV and two years ago, a pap smear revealed transformed cells in her cervix. She's had them removed. We worry about fertility and of course about cancer.

I noticed that "worry" didn't make your list of HPV consequences.

Vaccines save lives. The more vaccines, the better. Is your outrage that Merckx might turn a profit after investing years and billions while developing and testing the vaccine? It turns out most pharmacueticals won't produce vaccines because they can't turn a profit on them.

I doubt you're worried about the cost of vaccination. You're just another social conservative who believes in big government in everyone's bedroom.

Posted by: Annon | March 5, 2007 10:41 PM | Report abuse

Who are you talking too?

Posted by: to annon | March 6, 2007 9:00 AM | Report abuse

studentmom:

Even though I don't have a daughter, it doesn't mean that I can't see the sense of this vaccine. What is there to oppose? This vaccine is not any different than any other that children are required to get. And by the way, the 'herd mentality' doesn't always work - note the outbreak of measles in the Amish population in MN last year.
I can't imagine any instance in which a parent would object to this vaccine. Let's stop burying our heads in the sand and wake up. This has nothing to do with having sex - where is the logical connection between the two? This vaccine is about saving women from disease and pain. Its a no-brainer - and for anyone who says no to it for their daughter, I hope that one day you will not have deep regrets about doing so. Imagine your daughter calling you to say that she has been diagnosed with cervical cancer - at any age - and you knowing that you could have, very possibly, prevented it.

Posted by: star11 | March 6, 2007 9:24 AM | Report abuse

Star11, you're incorrect--'herd health ' idea DOES work, if you re-read my original post--when the majority of people in a community are vaccinated, that does protect the unvaccinated people. Trouble with the Amish is that NONE of them are vaccinated. There has to be a majority of a group vaccinated to provide the 'herd health' phenomenon.

Posted by: R | March 6, 2007 12:24 PM | Report abuse

Star11, have you even READ most of these comments? Apparently not. Most of us will not vaccinate because we are concerned that the vaccine is unsafe. And way to wish cancer on our daughters ... hope karma bites ya in the butt.

Posted by: StudentMom | March 6, 2007 12:57 PM | Report abuse

Posted by: ls | March 6, 2007 1:27 PM | Report abuse

Claiming that making the HPV vaccine widespread will encourage girls to have sex is akin to saying making the tetanus vaccine widely available will make people climb rusty fences more often or making the flu vaccine available will encourage kids to kiss each other because they think they can't get the flu anymore.

Posted by: friend | March 6, 2007 2:50 PM | Report abuse

OK, just two months ago, DD was diagnosed as high functioning autism. So yes, I do take a second thought about giving her a vaccine. But personally, I do not believe there is a link with autism and the MMR. It should be enough to make us take a second glance. So I want to see a little more about how the HPV affects people. I am a little lucky that DD is just 3. So I have a little time to see some early results of the side effects. Side effects aside, I think it is a wonderful vaccine and don't buy into any increased sexual activity due to a vaccine. Kids have sex because it feels good, peer pressure, they are young and stupid. A vaccine won't change that. It may change deaths due to cervical cancer.

Posted by: foamgnome | March 6, 2007 3:38 PM | Report abuse

Just because HPV is rampant does not mean we should turn a blind eye to the potential risks associated with this very new vaccine and make it mandatory.

This is not, as some commenters have written, a CANCER VACCINE. This vaccine protects against 4 of the 127 strains of HPV.

It is now know that Merck, the manufacturer of this vaccine, withheld information about the cardiac risks of Vioxx - another drug they fast-tracked through clinical trials. Over 100,000 heart attacks later, some fatal, the drug is no longer availalbe. Keep this information in mind as you are presented with the option of injecting your little girl with Gardasil.

Posted by: cw mpls | March 7, 2007 3:59 PM | Report abuse

I had cervical cancer at age 24...the statistic that 40% of women diagnosed with cervical cancer die is pretty terrifying. I think I would have happily taken my chances with the vaccine as I doubt 40% of people that take it will die. Obviously an exaggeration, but definitely something to think about. Every parent tries to make the best decision for their child, I know I do with mine. But as a woman who had cancer and am now a mother, I can tell you that sometimes the unknown possibility of a side effect is a much better choice than a known percentage of death when diagnosed. And just for the record, I am neither poor nor a minority, it can happen to anyone.

Posted by: JustMy2Cents | March 9, 2007 12:06 PM | Report abuse

This sounds too much to me like the "tetnus vaccine" that they were giving to women in Mexico, the Phillipines, and Nicaragua. A series of 3 shots in 3-4 months only for women ages 15 to 45. It "happened" to be contaminated with HCG, and now those women are miscarrying their babies. In other words POPULATION CONTROL!

If the flu virus needs only one shot, why does a different virus need a series of 3 shots in 6 months? And only for young females? (I don't buy the male excuse.)

Anyone else see a correlation here??

My daughter is 11 and will NEVER get this vaccine. It is not a matter of her morals, I no longer trust the morals of our government who used U.S. dollars to help sponser the "tetnus vaccine" in other countries.

Also, I am not convinced that HPV is the cause of cervical cancer, but rather that women with cervical cancer are no longer able to fight the virus, which would explain why they are found together. Cancer first, then virus. Prove me wrong!

I too had a small, very painful surgery, but my answer for my daughter is still NO, NO, NO!!!!!

Posted by: beaulah | March 12, 2007 12:15 AM | Report abuse

To respond to the person asking whether their grandmother or nuns can get HPV (On March 3rd)- Um, yes they can if they were once sexually active. Your widowed grandmother presumably had sex to have your parent, so, it is possible that she contracted it at one point in her life. 8 in 10 people are infected - and, believe me, not ALL 8 in 10 people are promiscuous. And, this is coming from someone who became sexually active at 26 and only with her husband. And not for religious reasons, either, but because of simple self-respect. Instead of teaching abstinence, try teaching kids self-respect. But, I guess it's alot easier to forbid them from something than actually putting in the time to discuss issues with them and keep them close. Abstinence is advice lazy parents give - children would be better off if we taught them how to protect themselves actively, how to think for themselves, how to respect their bodies and themselves. From my experience, people who preach abstinence where once VERY promiscuous, and are trying to over-compensate for that.
Vaccination should be mandatory. How can people believe that it will make girls embark on a sex life early or be less careful? Does a tetanus shot make us seek out rusty nails to step on?

Posted by: Anonymous | March 27, 2007 8:09 PM | Report abuse

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