(no subject)
Like a lot of women, I have been considering getting Gardasil, Merck's HPV vaccine. My insurance will not cover the vaccine, because I am over 26 years of age. The awesome Heather advised me to look into alternate sources of funding- she thought there might be programs funding vaccination for women in my age group, or at lease giving us a break on price (out of pocket, the vaccine costs more than $600 total.)
While I was researching this, I started learning a lot about the Gardasil vaccine. And what I learned raised my eyebrows. I should say here that I am not anti-vaccine: I think children should, in general, receive the standard childhood vaccinations (you know, measles, mumps, etc) and I myself have had a tetanus booster within the last ten years. I also usually get a seasonal flu shot, as a)being sick is very hard on me, possibly due to my neuro-immune issues; b)there is ample evidence that the seasonal flu vax can prevent flu infection or reduce its intensity; and c)the worst reaction I've ever had was the bad fibro flare I had post-vax this year. And for some years now, I have been pro-Gardasil (and I still scoff at the people who would forego vaccinating their daughters because they are afraid of encouraging promiscuity.) So please be assured, I am not the sort of person to decry all vaccines. Gardasil is different.
Gardasil has a higher incidence of adverse reaction, including death, than any comparable vaccine. The adverse reactions are serious, too: neurological problems including seizure and paralysis, as well as immune system disorders. There have been more than 30 deaths associated with Gardasil. In addition, women and girls being given Gardasil are not routinely tested for prior HPV infection, but Merck itself has admitted that Gardasil has the potential to "enhance cervical disease" in those with a pre-existing HPV infection. (In spite of this, Merck still encourages women who have been infected with HPV to get the vaccine, on the grounds that it may protect them against strains they don't have.)
In addition to all this, I object to the way Gardasil is marketed. It is marketed as an anti-cancer vaccine, when in fact it only protects against the 2 varieties of HPV that together cause 70% of cervical cancers. To quote Erin Brockovitch, would you use a contraceptive that only prevented 70% of pregnancies? It also protects against 2 types of HPV that cause 90% of genital wart cases. Gardasil is marketed to children as an anti-cancer vaccine, because Merck knows there's more money in making people think they are protecting their kids, than there is in marketing an anti-STI vaccine. Genital HPV is a STI. Sexually active people are much more at risk of contracting HPV. Because Gardasil is promoted as a childhood vaccine, the people who need it most may not be getting it.
When it comes to preventing cervical cancer, regular pap smears and pelvic exams are much more effective in preventing cervical cancer. Why do I say "preventing"? Because in the majority of cases, abnormal cells are found and removed before they become cancerous. Sometimes the abnormal areas are so small that just taking a sample removes them all. The key is in having regular exams, which is of course a health care funding issue: many women cannot afford regular exams. If every woman could receive an annual pap smear (and while she's at it, a thorough STI screen) cervical cancer could be whipped. (To be fair, HPV is also associated with penile cancer, anal cancer, throat cancer, and mouth cancers. A truly comprehensive health care system would take these into account and provide regular exams of all these areas. Anal pap smears are pretty standard in MSM sexual health care, and oral brush biopsies are available; that they are not widely used is largely due to reluctance on the part of physicians.)
Okay, so what about warts? Recently HPV came up in a thread in polyamory. In that thread, I said that the majority of strains of genital HPV are harmless. Someone disagreed with me, saying that the majority of strains cause either cancer or warts. My response was that warts are harmless. They really are, in the grand scheme of things: yes, they can be painful, and yes, removing them can be painful, but a wart does not damage you. Yes, we are socially conditioned to freak out about weird stuff on our junk- a wart on the finger is no big deal, but a wart on the junk is unclean and horrible and scary, right? But before Merck began its huge HPV media campaign for Gardasil, most of us simply accepted the possibility of warts as a risk that comes with being a sexually active person. The idea among most sexually active people was that hey, we protect ourselves as best we can (with condoms) and we get good medical care for the rest. Post-Gardasil, Merck's campaign has more people aware of HPV risks, but it also has more people panicking and over-stating those risks. I'm not saying that we shouldn't get tested or shouldn't use condoms. And cancer is scary. But many people with HPV are entirely asymptomatic, and therefore will not know they are infected, nor will their partners. We have to acknowledge that the only way to prevent HPV infection 100% is to not have sex. Sex is messy, and sex is risky.
Other things to know: the majority of people infected with HPV clear the viral infection within 5 years. That's right, it's not forever! Unfortunately, many of them are reinfected. 70% of women infected with HPV do not develop lesions. (Results from this study.) Half of all men, and 3 our of 4 women, will contract HPV at some point in their lives. Some strains of HPV are more dangerous than others, and a DNA test can determine if a high-risk strain is present. Condoms do not entirely prevent transmission of HPV, but they do reduce transmission rates by 70% when used consistently and correctly. I'd rather trust in condoms, communication, and pap smears, than in Gardasil.
While I was researching this, I started learning a lot about the Gardasil vaccine. And what I learned raised my eyebrows. I should say here that I am not anti-vaccine: I think children should, in general, receive the standard childhood vaccinations (you know, measles, mumps, etc) and I myself have had a tetanus booster within the last ten years. I also usually get a seasonal flu shot, as a)being sick is very hard on me, possibly due to my neuro-immune issues; b)there is ample evidence that the seasonal flu vax can prevent flu infection or reduce its intensity; and c)the worst reaction I've ever had was the bad fibro flare I had post-vax this year. And for some years now, I have been pro-Gardasil (and I still scoff at the people who would forego vaccinating their daughters because they are afraid of encouraging promiscuity.) So please be assured, I am not the sort of person to decry all vaccines. Gardasil is different.
Gardasil has a higher incidence of adverse reaction, including death, than any comparable vaccine. The adverse reactions are serious, too: neurological problems including seizure and paralysis, as well as immune system disorders. There have been more than 30 deaths associated with Gardasil. In addition, women and girls being given Gardasil are not routinely tested for prior HPV infection, but Merck itself has admitted that Gardasil has the potential to "enhance cervical disease" in those with a pre-existing HPV infection. (In spite of this, Merck still encourages women who have been infected with HPV to get the vaccine, on the grounds that it may protect them against strains they don't have.)
In addition to all this, I object to the way Gardasil is marketed. It is marketed as an anti-cancer vaccine, when in fact it only protects against the 2 varieties of HPV that together cause 70% of cervical cancers. To quote Erin Brockovitch, would you use a contraceptive that only prevented 70% of pregnancies? It also protects against 2 types of HPV that cause 90% of genital wart cases. Gardasil is marketed to children as an anti-cancer vaccine, because Merck knows there's more money in making people think they are protecting their kids, than there is in marketing an anti-STI vaccine. Genital HPV is a STI. Sexually active people are much more at risk of contracting HPV. Because Gardasil is promoted as a childhood vaccine, the people who need it most may not be getting it.
When it comes to preventing cervical cancer, regular pap smears and pelvic exams are much more effective in preventing cervical cancer. Why do I say "preventing"? Because in the majority of cases, abnormal cells are found and removed before they become cancerous. Sometimes the abnormal areas are so small that just taking a sample removes them all. The key is in having regular exams, which is of course a health care funding issue: many women cannot afford regular exams. If every woman could receive an annual pap smear (and while she's at it, a thorough STI screen) cervical cancer could be whipped. (To be fair, HPV is also associated with penile cancer, anal cancer, throat cancer, and mouth cancers. A truly comprehensive health care system would take these into account and provide regular exams of all these areas. Anal pap smears are pretty standard in MSM sexual health care, and oral brush biopsies are available; that they are not widely used is largely due to reluctance on the part of physicians.)
Okay, so what about warts? Recently HPV came up in a thread in polyamory. In that thread, I said that the majority of strains of genital HPV are harmless. Someone disagreed with me, saying that the majority of strains cause either cancer or warts. My response was that warts are harmless. They really are, in the grand scheme of things: yes, they can be painful, and yes, removing them can be painful, but a wart does not damage you. Yes, we are socially conditioned to freak out about weird stuff on our junk- a wart on the finger is no big deal, but a wart on the junk is unclean and horrible and scary, right? But before Merck began its huge HPV media campaign for Gardasil, most of us simply accepted the possibility of warts as a risk that comes with being a sexually active person. The idea among most sexually active people was that hey, we protect ourselves as best we can (with condoms) and we get good medical care for the rest. Post-Gardasil, Merck's campaign has more people aware of HPV risks, but it also has more people panicking and over-stating those risks. I'm not saying that we shouldn't get tested or shouldn't use condoms. And cancer is scary. But many people with HPV are entirely asymptomatic, and therefore will not know they are infected, nor will their partners. We have to acknowledge that the only way to prevent HPV infection 100% is to not have sex. Sex is messy, and sex is risky.
Other things to know: the majority of people infected with HPV clear the viral infection within 5 years. That's right, it's not forever! Unfortunately, many of them are reinfected. 70% of women infected with HPV do not develop lesions. (Results from this study.) Half of all men, and 3 our of 4 women, will contract HPV at some point in their lives. Some strains of HPV are more dangerous than others, and a DNA test can determine if a high-risk strain is present. Condoms do not entirely prevent transmission of HPV, but they do reduce transmission rates by 70% when used consistently and correctly. I'd rather trust in condoms, communication, and pap smears, than in Gardasil.