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.