Friday, November 13, 2009

HPV Vaccination Strategies

Ugh, it makes me sad to see that Oblivion post still sitting there at the top of the page.  It's like a testament to my inability to finish projects.  I still have half a dozen things to say about that game, but it stops seeming like a good idea when my last entry on the subject was almost a month ago.  Where does the time go?

In any case, let's talk about something else. 

Not long ago, my virology class hosted a lecture on Human Papilloma Virus (HPV) by Dr. John Schiller, the guy who pioneered the work that led to Gardasil, the HPV vaccine.  Needless to say, it was a very informative lecture.  It made me reflect on how there's such a poor spread of scientific and medical information to the masses.  Sometimes I don't think it's even just that the journalists who spread this information get things wrong, though this factors in enough, but that many laypeople don't have the patience to learn about such things.  

Anyhow, one of the misconceptions I had going into this lecture was that the carcinogenic HPV strains were mainly a female problem.  This turns out not to be the case.  While they do cause cervical cancer in women, they can also cause rectal cancer in men.  Of course, this is only a problem for men who engage in anal sex with other men, and that isn't a big portion of the population.  The number of cases of rectal cancer reported each year in men is very low.
However, when it comes to vaccination strategies, this is when it starts getting complicated. 

Right now the idea is to vaccinate young girls.  Since they stand the largest chance of getting the infection and it is easier to check for an infection in them, there is the most to gain by vaccinating them.  While the vaccine is now approved for males, its utility is unclear.  With the exception of rectal tissue transformation, men are asymptomatic as far as this disease goes.

One could argue that it would be discriminatory to spend public/insurance dollars vaccinating one sex over the other when both are just as vulnerable to the disease.  However, the actual rates of infection and cancer would make it hard to justify vaccinating both sexes with limited funds rather than just the one sex that is more likely to be affected by the infection. 

Of course, people can buy the vaccine on their own, even if insurance won't cover it.  The price will probably drop, too, now that a competitor to Gardasil is on its way.  However, we've already seen lots of opposition to this from some parents.  The idea of vaccinating their girls against an STD is distasteful, as if preparing them for a life of licentious behavior, or at least acquiescing to the idea.  How much more resistance do you think will arise for male vaccinations?  "Hey parents, vaccinate your boys just in case they turn out to be gay!"  I'm not sure that'll fly.  The age is a complication here as well.  The vaccine is being recommend, from the looks of it, for children aged 10-14.  How many gay men would have had the foresight to get vaccinated at this age?  How many would balk at getting it "just in case?"  It's quite the conundrum.

I'm not sure I have any real gems of wisdom to add in here, no grand suggestions to make all of this go away.  I simply found it interesting. 


-Murphy said...

First, the strains of HPV that are responsible for cervical cancer have been shown to be linked to penile carcinomas, which can occur from heterosexual sex. It's also linked to oral cancer resulting from oral sex (either heterosexual or homosexual) and once the infection is acquired HPV can be spread through the bloodstream, resulting in a whole host of cancers. Characterizing this as a topic that is only of concern to homosexual men is disingenuous, as all sexually active people can be affected by the high-risk strains of HPV, as even if we ignore the penile and oral cancers (and cancers in other organs), HPV can be spread through common sexual partners (so, if Girl A has high-risk HPV and gives it to Guy A, Girl B can acquire it when Guy A and Girl A call it off and Guy A moves on to Girl B). That isn't to say that gay and bisexual men might not be at a higher risk, but that risk of anal cancer is only one of the risks associated with HPV. It's further complicated by the fact that, over the course of a lifetime, 50% of sexually active men and women will acquire the disease. Cervical cancer is by far the highest risk, and as there is no HPV test for males, I see no problem in primarily giving the vaccine (which has only been approved for women) to women.

So there's that. But further, the attitude that it's reasonable that parents would not give their child the vaccine out of fear of "approving" of "licentious behavior" is absurd to me. Even without the argument that children should be vaccinated in case the individual is later raped by a carrier of the disease (and so given the virus in a situation over which they have no control), the idea that it's at all logical to prefer women to die of cancer because acknowledging that they might eventually have sex is too much of a breach of propriety seems sort of repugnant. I'm not a parent, but I like to think that if I were, I would do everything in my power to keep my child safe and living a long, happy life. "Oh, no! They might have premarital sex" is so much further down on the list of concerns than "Oh no! They might get cancer because giving them a vaccine that would have protected them from it was improper" that it's not even funny. Similarly, any parent who prefers their kid to be at risk for cancer because giving them a vaccine that would stop it acknowleges that hey, they might turn out to be gay strikes me as someone who doesn't actually care all that much about their kid. I know you're not explicitly endorsing those fears, but they've always struck me as bizarre.

As for the age thing, I think that's primarily an effort to give people the vaccine before they're sexually active. And, at 10 to 14 years of age, it's really not the kid's decision whether or not they'll get vaccinated. I'm not sure why it falls on them to have the "foresight" to get vaccinated. I know when I was 10, and my parents took me in for a shot, I had no input in the process. If I had, I likely would have run away from the guy trying to stab me. There's no other scenario in which we expect 10 year olds to make their own decisions about healthcare; why would we expect it for the HPV vaccine?

Hal said...

Let's leave aside the science for now. HPV is one of those bugs we're still learning a lot about, and I'm terribly skeptical about studies where you just look to see if X is present under Y conditions. "Oh, it's there 50% of the time? They must be related!"

As far as vaccination attitudes and strategies go, I have no disagreements with you. I think girls should be vaccinated, and boys as well if possible. I find the parents who object to the vaccine on "moral grounds" to be quite silly for any number of reasons, same as you.

I was merely commenting on what I thought might end up being the "next wave" of objections. If rectal cancer is the next prominent form of cancer HPV can be shown to cause (and the vaccine can be shown to prevent), then it would make sense to vaccinate against it. But then the same stigma against vaccinating girls against a ubiquitous STD is surely going to crop up for boys, right? You can't tell me there won't be people out there who associate the vaccine with thinking the thinking of, "Just in case he turns out to be gay."

I'll try to look at those papers, though. All I've got are abstracts, and those aren't good enough for me. At least, once I get through my class reading as well. Ugh.