Thursday, February 22, 2007

The HPV Vaccine

For the first time there is a vaccine against a form of cancer. This cancer is unusual because it is caused by Human Papilloma Virus which is a sexually transmitted disease.

The impulse, fed by a major lobbying push by Merck who makes the vaccine, is to give it to every woman and to give it to them before they can possibly catch the virus. This means 10-13 year olds.

Many conservatives worry that this sends the wrong message about sex. I am not among them. I realize that, no matter what they are taught, some of these girls will grow up and have promiscuous sex.

I do have several objections.

First, the immunization is expensive - nearly $400. Currently, insurance companies will not pay for it so the parents will have to pay. That is a fair chunk of money.

Then there is the risk factor. I suspect that this is why insurance companies are unwilling to pay for the immunization. The type of cancer that the vaccine prevents is fairly rare. On a cost-justification basis, the expenditure is a poor investment. I know that some people will argue back that if it saves only one child... This is an emotional appeal. The same justification could be used to insist that everyone have an annual cat scan, just in case something shows up. In both cases, billions would be spent to save a disproportionately small number of women.

The immunization is not perfect. It is around 70% effective so the chance that girls who are immunized will be spared the cancer is only reduced by 2/3s, not eliminated. That hurts the cost justification.

There have not been any long-term clinical trials and the tests that have been made have been on grown women, not preadolescences. It wouldn't take a lot of bad reactions to make the immunizations a bigger health risk than the disease.

Finally, the effectiveness of some immunizations fades over time. Is this one of them? What if the effectiveness starts fading after a decade. Given the ages involved, that would mean that women in their early 20s who thought that they were protected would be at risk. In the absence of long-term studies there is no way to say for certain that this will not happen. [Update - I just read that it only lasts for 5 years and no booster currently exists.]

The entire issue seems like marketing being sold as public policy. Strangely, the people most suspicious of pharmaceuticals, the liberals, are for it. I suspect that this is a combination knee-jerk pro-feminist reaction fueled by the desire to do the opposite of religious conservatives.

If families think that their daughters should be protected then they should be free to have them immunized but it should not be forced on the population.

No comments: