Thursday, July 06, 2006

News

I have good news and bad news.

The good news, which you may have already heard, is that there is a new vaccine effective against the human papilloma viruses (HPV) that cause 70% of cervical cancer. It also provides immunity to two of the viruses that cause genital warts. It has the potential to save thousands of lives in the U.S. each year and should have an even greater impact in developing countries, where pap smears are not obtained as regularly and more cervical cancer presents at a later stage, resulting in a higher death rate.

The bad news is that some people don't want to give it to their kids because they think it will make them go out and have sex. I find this slightly unbelievable, although I really shouldn't be surprised, because I know full well that the efforts of such people have really hampered sex education in the U.S.

The general principle of these naysayers seems to be that any discussion of ways to make sex safer or have fewer consequences will automatically make it more likely that young people will have sex. I don't think that's true, nor do I think there is any data to support that view. (Unfortunately, this subject is more often discussed with emotion as the foundation rather than data.) Plus, it stands to reason that what is learned in the child's home and upbringing will influence them much more than any sex education in the schools.

Don't get me wrong. I don't mind if people want to teach abstinence as a way to avoid pregnancy and sexually transmitted diseases. It's a free country, and people can believe what they want. Also, I happen to think that abstinence followed by monogamy has a lot of advantages. I personally don't mind if that is taught in schools, and it certainly can be taught in the home. But we can't teach only abstinence; we have to also teach birth control and use measures like the HPV vaccine to prevent some bad consequences of sex. I think that kids are sophisticated enough to hear the twin messages of abstinence being a good thing, but that if you are not abstinent, use some protection - please! To teach only abstinence is to deny a basic reality of our world: lots of people have sex (and lots of people have venereal diseases, unintended pregnancies, and cervical cancer.)

I feel sorry for the kids of people who will deny their kids the HPV vaccine. In essence, they are increasing the chances that their children will get cancer. That just doesn't sound like good parenting to me.

24 Comments:

Anonymous Anonymous said...

As a mother of a 7 & 1 year old, I have problems with the safety of it. Is it safe? If it is, then I am all for it. But I have a bit of time before the recommended age for my 7 year old.

2:27 PM  
Blogger Kristina said...

It's funny that people don't balk at giving newborns the Hep B vax but they're worried about this one (for sex reasons)? What's the difference?

2:34 PM  
Anonymous Anonymous said...

Kristina,

There isn't much difference. It's just that doctors don't tell parents that Hep B will pretty much only be a disease that affects people who participate in certain risky behaviors. I know that our pediatrician didn't tell us anything about Hep B and how it gets acquired before our son got the vaccine. Maybe we would have done it anyway, but maybe not.

3:52 PM  
Blogger Flea said...

ND,

What is sex-education in the age of information? From surfing the net, I have learned stuff about sex that I was never taught in high school.

To me, the fact that the sexual union has health consequences is secondary to the debate over Gardasil. The primary focus is on the moral consequences.

There are consequences of sexual activity, especially early sexual activity, especially early promiscuous sexual activity, that no vaccine can prevent. The responsibility of teaching about those consequences properly belongs to parents.

best,

Flea

3:53 PM  
Anonymous Dianne said...

I don't know about this HPV vaccine=license to have sex meme. When I got my DTP I didn't immediately think "Great, now I can go out and play with rusty nails." Nor did I stop using universal precautions with blood draws after I got my hep B vaccine.

Conversely, when I first had sex, HPV was the last thing on my mind. I worried about HIV, pregnancy, syphillis: all the, if you'll pardon the expression, sexy consequences of intercourse. HPV wasn't even on the radar. I'm not entirely certain I'd even heard of it at that point.

4:01 PM  
Anonymous Dianne said...

The general principle of these naysayers seems to be that any discussion of ways to make sex safer or have fewer consequences will automatically make it more likely that young people will have sex. I don't think that's true, nor do I think there is any data to support that view.

There is at least modest data to the contrary. After about 10 minutes of looking on medline, I found several abstracts that suggest that sex ed (not abstinence only, but discussing options including abstinence and contraception) decreases or does not affect probability of sexual activity in high school and junior high students and decreases the risk of unprotected intercourse for these groups. A couple of references below:

A sex ed program associated with delayed onset of sexual activity in adolescents.

A study in which condoms were made available to students. This did not affect probability of sexual activity in this group, but increased condom usage.

An oldish study with similar results

4:16 PM  
Blogger SmartBlkWoman said...

I can understand why parents might not want to give this vaccine to their children and I'm not a religious person. Ok, you've protected the kid from a few of the multiple types of HPV. Bravo!! But what about HIV, Chlamydia, Gonnorrhea, Trichomoniasis ( sp?), etc. and the myriad other sexually transmitted diseases out there? Is the new plan to just give our children shots every 3 months until they turn 18 so that we can protect them against anything that they might catch?

HPV isn't like the plague that once wiped out half of Europe; you can't get HPV by someone breathing on or touching you.

Furthermore you don't really know all of the effects of a drug until years in the future, and by then massive damage may have already occurred to a population. Think about how mothers used to be prescribed certain drugs to prevent miscarriage and they later found out that the drugs caused sterility in children whose mothers had ingested the drugs while pregnant.

I fully suppport a parents right to not give this vaccine to their children.

6:45 PM  
Anonymous Pen said...

I think this vaccine is terrific. The consequences of HPV are fairly serious, after all, and even the pre-cancerous cell changes are extremely traumatic to experience and treat. A vaccination is rather less invasive.

This will protect young women who are abstinent until marriage as much as anyone else, just in case their partners have not been quite as 'tidy' (as Princess Diana put it).

8:34 PM  
Anonymous clobbered said...

I find the notion that there are youngsters out there that would be having sex aplenty if not for their fear of contracting an obscure disease that might lead to cervical cancer ludicrous. So ludicrous in fact, that I have to assume nobody really believes it.

Is it the case that they then believe that the mere acknowledgment, for any reason, that their children are reaching sexual maturity, will put the thought of having sex in their heads?

Or are people extrapolating from a similar argument about contraception encouraging sexual activity (which I don't believe either, but at least I can imagine why somebody would think it)?

9:10 PM  
Anonymous Anonymous said...

to SmartBlkWoman
Ok, you've protected the kid from a few of the multiple types of HPV. Bravo!! But what about HIV, Chlamydia, Gonnorrhea, Trichomoniasis ( sp?), etc. and the myriad other sexually transmitted diseases out there?

why is guarding against HPV so important compared to other STDs? because HPV is practically endemic in the sexually active population. it can be asymptomatic. Even people who have been quite sexually responsible could have it and develop cervical cancer

1:55 AM  
Anonymous Anonymous said...

Having had a friend contract HPV in HS leading to the removal of her uterus and a father with HIV I think any vaccine to prevent an STD is great. Now whether are not people should line their kids up for it is their own business. You can teach a person all the sex education you want but knowledge will not change behavior. We know that speeding can lead to a car accident or smoking can cause cancer but people continue to do these things. Still if more people would try vaccines and safe sex or abstinence maybe these STDs wouldn't be the wild fires they are today. Sadly we will never know.

3:47 AM  
Blogger Ex Utero said...

People,

I don't know how to say this except to say it.

HPV --> cervical cancer --> death.

Parents morals -X-> kids morals.

Get your girls vaccinated for HPV.

There is no hope of eradicating this disease, so no reason to vaccinate boys (since the vaccine doesn't prevent you from catching warts transiently, it prevents you from having chronic infection). Any bias against this vaccine is a bias against women and women's health. It's pretty much that simple. If it bothers you so much, think of it as protection against seducers and date rapers, but just do it. This vaccine is eventually going to make pap smears disappear, and women who aren't vaccinated will be twice as vulnerable.

7:53 AM  
Blogger Amy Tuteur, MD said...

The people pitching the HPV vaccine should come at it from another angle. They should emphasize that it protects your daughter from living with the consequences of MALE promiscuity.

At some point, virtually every daughter is going to have sex. When she "gives her virginity" to a man (perhaps her husband on her wedding night), should she receive a potentially fatal disease in return?

What if a girl is a victim of an aggressive boyfriend, a victim of date rape or stranger rape. In addition to the emotional scars, should she also carry a potentially fatal disease?

Emphasize the fact that the HPV vaccine protects girls from the irresponsible behavior of boys, not that it protects girls from their own behavior.

9:59 AM  
Blogger sailorman said...

I wrote a more detailed post on why he anti-HPV folks are insane, some time back:
http://moderatelyinsane.blogspot.com
/2006/05/hpv-insanity.html

which you may enjoy reading.

10:18 AM  
Anonymous Dianne said...

There is no hope of eradicating this disease, so no reason to vaccinate boys

Why not? Is HPV carried in any animal other than humans? If not it seems an ideal candidate for elimination, at least of the cancer causing varients.

The other reason for vaccinating boys is that they can get HPV related cancers too. Not cervical, obviously, but head and neck, penile, anal, and possibly some lung cancers have been associated with HPV infection. (I'll provide references if you're interested. Otherwise, not, since I don't want to overload the post with links and I'm already guilty of three links.)

It's probably not a good idea to vaccinate boys until the studies in men are finished and demonstrate safety and efficacy in males, but assuming they do, why not? It'd protect not just the men's female partners, but them as well.

10:45 AM  
Blogger neonataldoc said...

Thanks, everyone, for your comments. Like most of you, I remain in favor of a vaccine that can prevent cancer.

Flea, I agree that the moral and emotional consequences of sexual activity are important. What do we do when parents don't teach their kids about that?

9:10 PM  
Blogger Clark Bartram said...

In reference to the comment on Hep B being unecessary in babies because they don't have sex or shoot up, there is a little more to it than that. Young children do get blood transfusions which have a carry a small but real risk of hep B. Also, there is a small but equally real subset of children who are diagnosed with hep B where absolutely no risk factor is discovered. Children with hep b have a significantly higher risk of developing chronic disease which leads to liver failure, cancer, etc. Everyone should be immunized against hep b even infants.

9:34 AM  
Anonymous Anonymous said...

Neonatal Doc,

I completely agree with what you said.

ReneƩ

4:44 PM  
Anonymous Anonymous said...

I recently found out that I have HPV after a pap test came back positive.
I have had to undergo invasive treatment as a result of this as well as having to cope with the emotional effects and the possibility that it may at some point develop into cancer, which, in the worst case scenario, could prevent me from having children.
The fact remains that this is a very serious disease, with some very serious consequences and I fail to see why any parent would withold a vaccine.
Your kids will start to have sex at some point and with HPV being so incredibly common, it makes sense to protect them. I know there are a lot more STDs out there, but most have treatments and if caught in time, no lasting conseqences. HPV has no cure. If there was a vaccine against HIV would anyone withold that? It's not about giving anyone a licence to sleep around, it just makes good sense.

9:23 AM  
Blogger WendyLou said...

This fairly religious virgin on her wedding night was exposed to HPV by her non-virgin husband. I am religious about annual pap exams.

What other vaccine can preserve fertility, and prevent cancer. I talked my mom into having both my sisters get the shot and when my baby is old enough, she will have it as well. Like I told my mom, we don't know what their choices will be, we don't know what their partner's choices will be.

How guilty will parents feel as they bury their daughter or her cervix is removed and she can no longer bear children, because to prove a point, they did not have her have the shot.

I believe in recognizing that as parents we teach our children our values, and then they decide their own.

7:05 PM  
Blogger stockingup99 said...

How guilty does a parent of a vaccine damaged child feel?

No vaccines have been proven safe. Some vaccines have failed to prove themselves harmful, that's all.

I will not vaccinate ever again. They poisoned my firstborn with mercury, and denied thimerisol contained mercury.

11:22 AM  
Anonymous HCN said...

My 12 year old daughter is drop-dead gorgeous. She is also smart, talented and thinks boys are stupid idiots.... Though we often shop for her clothes in the Boy's section because she hates pink, cute or anything that shows any part of her body (she prefers black, baggy and with sayings from "Happy Bunny" like "I am happy... Don't wreck it by talking").

I will have her vaccinated for HPV at her next well-child visit. She will also get the new adolescent pertussis vaccine, and the meningcwhatever vaccine... because I love her very much.

Stockingup99 needs to read:
http://pediatrics.aappublications.org/cgi/content/full/118/1/e139

12:27 AM  
Anonymous Anonymous said...

I'm a mom with a 14 & 16 year old I'm not worried about "will they have sex or not" it's a matter 10 years from now will they be able to have kids? will they go into premature labor? can they carry to term?Gene mutation? There has not been enough study for my kids to get it!!! My kids doctor could not answer any of my questions!!! I had to go on line and that was VERY scary!!!

10:54 PM  
Anonymous Anonymous said...

I have read every archived blog from 2007 backward up until this one without a desire to comment until now. I'm writing to you from a bed, a bed i've been in for 2 months, with an incompetent cervix. Drs performed a rescue cercluge at 20 weeks when they saw i had 1.6 cm holding in my fetus, instead of 3 cm. Three days later at my follow up my cervix had dwindle to 1.2 cm, I said level with me what are my chances my dr. said normally they work 80 percent, I had more of a 50 percent chance. So I spent 4 wks w/ my behind high trendelomberg hoping to keep my fetus alive, feeling her move everyday. I am now 27 -close to 28- wks and this wk was told i could stand in the shower instead of being sponge bathed. How refreshing that was! Why am I telling you? Honestly I don't know... maybe a parent will read this and hope it never happens to their daughter. I have an incompetent cervix because I got hpv when I was 16. Drs. removed the severe dysplasia or abnormal cevical cells- one level away from cervical cancer.

4:49 PM  

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