ENRAGED!

[joreth]

http://www.nytimes.com/2009/08/19/health/research/19vaccine.html?em

So a new study has come out studying the effects of Gardasil now that 7 million girls have had it. It turns out that out of 7 million people, only 20 have died. Out of those 20, not a single one can be conclusively connected to Gardasil and the majority of them *can* be conclusively connected to something else.

This year, 4,070 women will have died from cervical cancer.

Let me repeat that.

Over four thousand women will have died THIS YEAR of cervical cancer.

Regular pap smears keep that number as low as it is. But not everyone has access to regular health care, even with Planned Parenthood and low-income clinics. And even with screening, some cancers just can't be treated.

So let's say that Gardasil really was responsible for every single one of those deaths. You have a .0000002 chance of dying from taking the vaccine.

And yet, people are pointing towards this study and saying such stupid things as:

"no level of risk is acceptable when inoculating a healthy population against a disease that can be prevented through screening."

"I wouldn’t accept much risk of side effects at all in an 11-year-old girl, because if she gets screened when she’s older, she’ll never get cervical cancer,"

"You don’t have to die from cervical cancer if you have access to health care."

This is absolutely infuriating!  And this was from a doctor!  You ought to hear the stupid things the laypeople say about vaccines!

First of all, you are *supposed* to innoculate a healthy population.  It's what keeps them healthy.

Second, although regular screening does significantly reduce the chances of dying from cancer, and even from having pre-cancerous cells live long enough to turn into cancer, it does not, automatically, mean that you will not get cancer.  That's what vaccines do.  Screening just looks for it after you've already started developing it, hopefully in enough time to treat it.

On top of that, HPV is the cause of anal cancers, throat and mouth cancers, and has even been found in relation to skin and other cancers - none of which get screened with the regularity that pap smears are recommended.  So my number of 4 thousand women dying?  That doesn't count the numbers of people dying or suffering & surviving, from these other cancers.  

Farrah Fawcet, you know, died of HPV-related anal cancer.  I realize her death was completely overshadowed by the much more important news of Micheal Jackson's death on the same day, but that doesn't absolve this idiot doctor from making such ludicrous statements like "you don't have to die from cancer if you have access to health care".

Do you want an early-warning system that tells you when the perimeter has been breeched hopefully early enough to do something about the invaders?  Or do you want an impenetrable shield that prevents intruders from getting in at all?  Screening does not confer immunity.  Vaccines do.

Third, there is absolutely no way to predict who will have access to healthcare and regular screening services in the future.  I was raised middle-class.  I went to private school.  I grew up in the suburbs.  I lived in the 3rd most expensive city in the world to live in.  I had medical coverage under both my parent's employer-provided plans.  I had regular checkups and extensive dental work.

I am currently uninsured and unemployed.

If I want to be screened annually, I have to pay out of pocket, or I can wait, week after week, at the free clinic and hope that this week, maybe, I'll get there early enough to be seen.

Or, I could have gotten a vaccine when I had my parents' healthcare coverage (yes, I know they didn't have it when I was a kid, but this applies to kids today) and I could now spend my money on food and rent because that portion of my health has been cared for.

The US does not have the fabulous healthcare system these people want to think it does.  I don't understand why people are so opposed to giving children the opportunity to avoid, not just death by cancer, but also expensive, painful inconvenience by LEEP procedures, regular and expensive screenings, and humiliating experiences.

Even if the US *does* have fabulous healthcare, compared to other nations, not every individual has equal access to that fabulous healthcare, and there is no way to predict which children will have access to that fabulous healthcare when they need it in order to screen for the cancer that they will have to be exposed to since they weren't allowed to take a shot that gives them immunity from it.

ALL vaccines carry some risk, as do ALL treatments for ALL ailments.  Even asprin has side effects (and that was developed from a "natural" cure, let's not forget).  The reason why we continue to use any of these options is because the benefit outweighs the risk.  In some cases, the risk isn't even all that minimal, like with the case of vaccines.  Some of these treatements have SERIOUS and highly probable health risks.  Chemotherapy is no walk in the park, but the alternative is a certain death, while the therapy is a less-certain death and more certain damned-uncomfortable time.  And we continue to choose them because the benefits outweigh the risks.

The side effects from Gardasil are known, disclosed, and no different from any other vaccine.

The death toll associated with Gardasil is not only inconclusively related, but in many cases it *is* conclusively related TO OTHER THINGS.

It is utterly absurd that people continue to stand here, shouting and hand-waving and wringing their hands in fear of something that has absolutely no scientific basis in reality and, even if it were true, would STILL be far outweighed by the benefits.

Please, get vaccinated whenever possible, get educated, get screened, and get tested.

Comments

[leora.livejournal.com]

Not surprisingly, I agree with you. Although I do think it raises a good point about booster shots. Having some idea of how long the vaccine is effective for would be useful in determining who should have it. For an extreme example, if it were only useful for 5 years, it'd have been totally useless for me to get it at age 11, since I didn't engage in any behaviors that would give me a risk for HPV between the ages of 11 and 17. Now, obviously, a lot of girls will engage in such behaviors. But having an idea of how long the vaccination lasts for would be quite useful.

I don't expect we'll get that data for a while though.

It also does effect the cost-benefit analysis of the vaccination. Since how many times you need to go through the risk for how much protection is the basis of the assessment. But I would like to see the numbers on the expected numbers of deaths from HPV for seven million unvaccinated women. That's the key point of comparison.

Whether or not a vaccination is worth the risk is an important assessment. But it should be made by comparing the risk of the vaccination to the risk of not getting vaccinated rather than pretending that there is no risk to not vaccinating a healthy 11 year old. It's that lack of comparison to the risk of not vaccinating that makes me roll my eyes and sigh.

But yeah, we can't even do a good risk assessment when so many of those 20 cases were likely caused by other things. And 20 is not a large percentage out of 7 million, no matter that you can touchingly write up a heart-rending story about one of those cases and make people feel horrible about it.

[joreth]

Yes! Those are very important points and I certainly do not disagree with cost-benefit analyses or the point about what should be compared. Since HPV-caused oral cancers is second only to tobacco-caused oral cancers (and that number is dropping from smoking dropping), and since *that* has a MUCH lower survival rate due to poor screening, even without the specific numbers in front of me, I'm willing to bet that the outcome will be in favor of Gardasil in a cost-benefit analysis.

Although, in this race to find proof that Gardasil is harmful, there have been several studies now that have found children as young as 4 years old with HPV, after ruling out sexual abuse. It's just so damn easy to transmit that assessing the likelihood of being exposed to it based on behaviour trends isn't quite as useful.

Plus, much like predicting who will have healthcare in the future, predicting which children will "need" Gardasil in the event that it only has a 5 year lifespan is also going to be difficult.

But, the point still stands that 20 people is, as you say, a very small percentage out of 7 million even if you ignore the fact that the majority of them can conclusively be tied to other causes.

Hell, having a population of 7 million people AT ALL and having only 20 of them dying AT ALL is pretty damn rare!

[leora.livejournal.com]

Being bored and curious... apparently virtually all cases of cervical cancer are caused by HPV source and 4070 women will die from cervical cancer each year in the US. I'm not sure looking at the rate for one year is really the best number to compare the advantages of the vaccine, especially if the vaccine offers lifelong immunity, but I have a migraine and am not seriously researching this, so let's go with that for now. The US population is apparently 304,059,724. I'm assuming half of them are female.

If I did my math right, this means that of those 7 million vaccinated women, we would expect 187 of them to die from cervical cancer in some year or other. I'd say each year, but we're taking a narrow age range and cervical cancer tends to kill within certain ages, so when they get to the right ages, if they're representative of the larger population, about 187 per year for some number of years. Versus 20.

Now, there's a lot of fudge factor in my numbers, and I have a migraine, so I may have messed up. The vaccine does not confer 100% immunity to all strains of HPV. However, HPV kills in more ways than just cervical cancer, so that balances somewhat. A big question would be, as I said, how long the vaccine's immunity lasts for.

But it looks likely that over 100 young girl's lives were saved and many others were saved having an incredibly scary and potentially health-damaging problem. Just because you survive something doesn't mean it's good. Having cervical cancer and surviving is certainly better than having it and dying, but still not a great outcome.

Of course, those 20 deaths do occur younger, and you do have to weight that somewhat. They lost more of their life. But it's still the case that it's highly unlikely that all 20 were linked to the vaccine, and it's still more life spared than lost unless you really prefer avoiding a very small risk when you are young to have a larger risk when you are a bit older. Some people may feel that they're okay with dying any time past a certain age or whatever, but I think most people who feel that way when they are young are likely to change their minds when they get older and it becomes closer to reality.

[joreth]

That was roughly the numbers I came up with too, but, like you, I didn't really take the time to work it all out.

But yeah, just on a number of death toll, the vaccine is better than no vaccine.

When you factor in the other types of cancers, the fact that they have higher death tolls, and the fact that a far larger number of women don't die, but do have anything from a minor surgical procedure up to and including life-long damaging health problems, and also factor in the fact that not only are those 20 deaths "highly unlikely" to be linked to the vaccine, but that several of them were conclusively linked to other causes and NONE of them are even considered "possibly" linked to the vaccine, I think it's a no-brainer and it infuriates me that people are using scary anecdotal stories with falsehoods and lies to sway people away from a life-saving vaccine.

[leora.livejournal.com]

I know. I wish more people would tell the scary stories of having the diseases that we vaccinate against. I've heard about polio, since my parents lived before the vaccination and thus have memories related to it. And I've read about measles and some of the others. People just forget how scary the diseases themselves are.

I think part of it is a cultural aversion to the idea that children die. Most cultures throughout history had to be aware of this, childhood mortality was so high. But our mortality rates for kids are actually very low. And so people freak out over children dying and it seems so unnatural to them that they want someone to blame. It's unfortunate, but some kids are just going to die. We have millions of children, and we've got our mortality rates low, but out of millions of kids, some will die. As a society, we need to learn to accept that reality, because we have no way to change it.

I think the stories of a child here or there dying would have less power if we understood that sometimes kids just die.

I have tons of sympathy for the family and friends of such kids, but that's not the point. Something can be tragic and still have nobody to blame.

[joreth]

So according to Oprah's website (which I do *not* take as a credible source on vaccines, thanks to her pro-Jenny McCarthy stance, but I checked out when it showed up in my Google Alert that her site has an article on Gardasil), there are 23 million women who have taken the vaccine in the US (WAY more than the 7 million estimated above), and 4,400 women die per year of cervical cancer out of 155 million women in the US.

Then the author immediately says something stupid, which is "the odds are well against you developing cervical cancer - which is not what those statistics cite. They cite deaths.

She then goes on to say that another way to avoid cervical cancer is to just not have sex. Again, not accurate, since children of age 4 have been found to have HPV with no evidence of sexual abuse, and HPV is transmitted by mere contact, not penetration or fluid transfer, AND it ignores all the other cancers that HPV is linked to that, again, do not require sex.

And she points to the over 400 complaints against the vaccine, without reporting the result of the investigations that determine how many of those 400+ were *actually* caused by the vaccine, how many were not, how many were unknown, and the proportions of the various severity levels within that number.

I will say that the article is less stupid than I was expecting from Oprah, but she *does* make just a couple of mistakes that can skew an uninformed reader into choosing not to vaccinate.

[leora.livejournal.com]

You can just not have sex. That's true. Just as you can just avoid other risky activities such as driving a car, riding in a car, and carrying a baby to term. If you're okay with living the sort of life that implies, sure, it's an option. Of course, you still have a risk from nonconsensual activities, but if you move into a monastery or similar environment, and let's face it that's pretty much where you have to live to lead the safe lifestyle, then you can probably reduce your risks quite a bit.

Destroying your quality of life to avoid a small risk just seems incredibly stupid.

[datan0de.livejournal.com]

Just an off the wall thought: For just a moment, let's set aside the absurd religious objections that people seem to have with vaccinating children against HPV. I suspect that there's an other mechanism at work here as well.

You're familiar with the ethical thought experiment about a runaway train about to plow into a group of people standing on the railroad tracks- most people would be willing to flip a switch to divert the train to a side track, even if that means killing a single person on the track, but very few would push a large person onto the track even if they knew that doing so would save the entire group. Do you think that the people resisting Gardasil are exhibiting the same ethical "quirk", in that they consider many deaths resulting from their inaction to be morally superior to a single death resulting from their direct intervention?

Just a thought.

[joreth]

That is an interesting correlation. I do note that everyone who is in favor of things like vaccinations all say the benefits outweigh the risks, even when there are deaths, etc. and the opposition all say that not a single death is worth it. From the perspective of the first position, it is completely baffling that anyone could not see that the inaction results is significantly far more deaths (and pain and suffering) and is therefore ethically reprehensible.

But if they're not seeing the vaccines as the passive inaction, but rather the pushing of a single person to save many, that may be why it's so much harder for them to accept the consequences of vaccine side effects.

[serolynne.livejournal.com]

I wish that when folks were looking at the possible complications of HPV, that death wasn't the only consequence highlighted. 4000+ deaths a year from cervical cancer, when looked at the number of infections, is actually quite low and impressive. And that number will indeed be higher when you tally up other forms of HPV-related cancers.

It's the LEEPs and hysterectomies performed to treat it as a result of screening that are scarier numbers. And to someone who want to have children of their own, loosing your fertility can be a huge life changing negative impact. (Thankfully for me it, was just a huge a surgery and financial cost.)

[joreth]

Exactly! It's not just about the deaths, as you and everyone else says, those deaths *are* quite low, compared to other cancers.

But the suffering of the quality of life is a significant issue, and far more numerous than the death toll, compared to possibly fainting when one gets the vaccine.

For the vast majority of women, the loss of fertility as a result of HPV and/or treatment for HPV is a concern right up there with the possibility of death, if not equal.

This is why screening should not be acceptable as the only treatment when there are other options. It's great for preventing deaths, but it's an after-the-fact treatment which doesn't do a thing for preventing the procedures, it just tells us that we need one.