HPV & HIV Basics

[joreth]

One of the podcasts that I only sporadically listen to is called Skeptically Speaking, and is actually a real radio show (yes, they still have those) that is recorded and uploaded to iTunes as a podcast so you can listen to it even if you are out of range. It's a good show, I just didn't discover it until I was already polysaturated, so to speak, with podcasts, so I only download those episodes that have titles I am particularly interested in.

This was one such episode. It is all about HIV and AIDS, but they start the episode out with a short bit on HPV, including a description, questions-and-answers from the audience, and a discussion of the vaccines. I highly recommend you check this out:

or http://www.skepticallyspeaking.com/podcasts/Skeptically_Speaking_122_HIV_and_AIDS.mp3

I have only a quibble about the episode concerning the HPV section. In that bit, the expert talks about the cost benefit of the vaccine. Now, I don't actually have a problem with a discussion on cost-benefits. I can separate out my emotions from my ethics from the practical considerations. I believe it is the right thing, the safe thing, and the ethical thing to encourage vaccinations in men and women. But I can also see that the cost analysis of the vaccine, from both a personal decision perspective and from a governmental budgetary standpoint, might recommend that HPV vaccination is lower on the priority list than other vaccinations, or even other programs.

No, my quibble is that I think the expert left out a major factor that could affect both an individual person's and a governmental agency's decisions regarding the cost-benefit analysis. He points out that cervical cancer is almost entirely caused by HPV, and that cervical cancer is one of the most common forms of cancer in women. Therefore, it is to the benefit of both an individual and the government agencies concerned with public health issues to ensure that women get vaccinated.

But only a very small percentage of the male population get any sort of genital cancer from HPV - namely anal cancer. According to this expert (and I didn't check his facts, so I'll take it at face value for now), pretty much the only men who get anal cancer are MSM or men who have sex with men (this includes men who are not "gay", as a self-identifier). MSM is a statistically significantly small portion of the population, and of that small portion, only a small number of THEM get anal cancer.

So, from a purely cost-benefit perspective, it may not be the most efficient use of resources to make sure all men get vaccinated, and it may not be the highest priority of men who do not fit into the high risk category to spend their money on a vaccine that probably won't help them out in any way. The reason for men to get vaccinated, according to this expert, is to protect a future female partner (which is, I think, a worthy reason, but I can see why it might take a back seat due to finances).

My quibble is that this expert did not mention anything at all about oral cancers and HPV. The latest statistics (for which I don't have time to cite at the moment) now say that HPV is the leading cause of all oral cancers (mouth, tongue, throat, etc.). Not necessarily because HPV-caused oral cancers are rising (they are, but not much), but because smoking is dropping. But what that means is that now the majority of all oral cancers can be prevented by a vaccine.

It is possible that, if you add up all the numbers of oral cancers in men and women, those cancers caused by HPV, cost of the vaccine, etc., it might still be not cost-effective to encourage mass vaccination of men. I haven't added up the numbers, so that is one possible outcome. I'm disappointed that the expert didn't mention oral cancers at all. Maybe only 1% of all men in the US ever get HPV-caused anal cancer, and we can predict 99% of that 1% based on behaviour, so maybe that isn't worth it to push for mandatory male vaccination, whereas mandatory female vaccination has a much better cost-benefit analysis. But maybe enough men get HPV-caused oral cancers that the number could actually tip the balance in favor of mass male vaccination. I would have liked for him to at least mention it.

But aside for that bit, the episode is informative and fairly easy to understand, so I recommend giving it a listen.

Comments

[james-the-evil1.livejournal.com]

Yep, first thing I thought when I saw this was "what about throat cancer." I know I JUST sent you a link to the newest studies about that & the high/increasing rates a few days ago, it's serious.

[leora.livejournal.com]

I keep seeing people on the net discussing HPV and only mentioning cervical cancer, and it really annoys me. Yes, I understand that that was the first bit of news, but the info that it is a risk factor for other forms of cancer as well has been known for a while now, and it's high time people stopped only mentioning cervical cancer. At least that expert mentioned two cancers, but still, since we know about others it is important to make people aware. Also, from a personal point of view, I feel like the more cancers we know it can cause, the more a person who is considering the choice for themselves should consider the potential that it might be discovered to be linked to future cancers. We've only recently started understanding this, and one form of cancer quickly turned into findings that it is linked to many forms of cancer. So, there is the potential benefit that we may later learn it also provides protection against something we do not currently know about.

I don't expect the government to factor that into a cost-benefit analysis, but an individual very well may want to.

[joreth]

It's a particular pet peeve of mine too. By focusing only on cervical cancer, it becomes a "woman's disease", and our country is notoriously anti-women's health care at the moment. When the vaccine first came out, the backlash was all about "oh no, girls will have sex if we remove the penalty for sex that is cancer!", but when it got approved for men, we heard almost nothing about it other than "if the vaccine protects my son's future sex partner, why should I bother getting him vaccinated? Just let her get it done!" The double-standard really pissed me off, but besides that, it's NOT a "woman's disease" anyway.

I agree with your position that, if we know it's linked to more than one cancer, and we know that we're still in the early stages of learning about it, then it's likely that it's linked to more that we just haven't discovered yet. The current vaccine, Gardasil, was designed and approved for 4 strains of the virus, yet now that it's been in active use and we can study the effects, we've learned that it also has some effect on a handful of other similar strains, if not the same 98% effectiveness on the 4 it was intended for. That's HUGE, but that made barely any news too.

The reason a government might factor that into their analysis is because of the cost of prevention vs. cost of treatment using governmental resources. It's cheaper to offer vaccines for, say, polio, than to deal with an epidemic of polio (this is, of course, separating out any discussion of ethical concerns & just focusing on the costs). If we add up all the repercussions of all the cancers that are affected by HPV, such as treatment costs, unemployment benefits for people out of work due to cancer, financial aid, etc., it might be cheaper to just fund a vaccine program, which is where the government might get involved.

But I do agree that an individual would be more likely to factor the multiple cancers into their personal cost-benefit analysis, which is why it's so important to talk about these other HPV-caused cancers.

[leora.livejournal.com]

It won't necessarily save the government money, but there's a serious extent to which I don't want the government doing those cost-benefit analyses. Sure, it's likely to be cost-effective if you consider the health cost of the vaccine versus the health costs of people getting cancer treatment, but that isn't what the alternative is. Since those people who don't get cancer will run up other costs - including whatever eventually kills them. Last I heard, smoking and obesity save the government money. They tend to lead to deaths closer to retirement age, which is a much bigger financial savings for the government than any financial drawbacks from treatment. And people who live longer not only get lots of benefits from the government, but they end up sick later with other things, and often those other things are more expensive to treat, in part because it can involved longer, more drawn-out care. But I really don't want the government seeing people dying younger as a benefit and trying to encourage it.

[joreth]

I don't pretend to know what all goes into a government's cost benefit analysis of healthcare, but they already do that, and it comes out in favor of vaccines and other preventative health care treatments, including things like flouride in the water. Whatever else they're adding into the figures or leaving out, the government doesn't see people dying younger as a benefit and it doesn't try to encourage it. At worst, they just leave something alone, not trying to encourage early deaths. So I maintain that it is possible that, once you factor in all the other cancers, a governmental cost-benefit analysis could come out in favor of mass vaccinations, but if it doesn't, the worst that will happen is that it will not fund the vaccine (leaving us exactly where we are now), not that it will start encouraging people to catch HPV in order to kill us all off earlier.