Did you know, Mom? Dad?
August 18, 2016 11:52 AM Subscribe
New Merck ad for Gardasil is sparking controversy - do they tell the hard truths, or are they guilt-tripping parents? Earlier this summer, Merck began airing new commercials for Gardasil. These commercials (which show an adult man and an adult woman talking about how they had cancers caused by HPV, and then show video clips in a "rewind" to a child actor who asks if their parents knew that their cancer could have been prevented), have upset some who say that the ad bullies parents. Proponents of the ads say the ads give parents the facts necessary to hold them accountable.
Nearly 12,000 women are diagnosed with cervical cancer in the US annually, with over 4,000 yearly deaths. Rates of cervical cancer are highest in black and Hispanic populations. There are significant disparities in in vaccination rates and HPV awareness in these populations.
Gardasil – or recombinant human papilloma virus vaccine (types 6, 11, 16, 18) – is a series of vaccinations that was first approved by the US FDA in 2006, with an initial indication for prevention of genital warts and cervical cancer in females ages 9 to 26 years old. Later indications were added for prevention of anal and penile cancer in males ages 9 to 26 years old, and extension to females age 27 to 45 years of age. The CDC recommends routine vaccination at age 11 or 12, through age 26. A new 9-valent vaccine manufactured by Merck protects against five additional HPV types which are high-risk of progression to cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers. The addition of these subtypes covers the implicated strains in up to 81% of cervical cancers.
The vaccine has faced previous challenges. Efforts to make Gardasil vaccination mandatory have faced significant opposition from religious and parents’ groups, and there have been multiple challenges at the state level. The most famous example: now-former Texas governor Rick Perry mandated vaccination for girls, then reversed his mandate. In spite of aggressive advertising in the past, vaccination has not gained the anticipated traction, with only 60% of adolescent girls and only 40% of adolescent boys vaccinated before the age of 18.
Nearly 12,000 women are diagnosed with cervical cancer in the US annually, with over 4,000 yearly deaths. Rates of cervical cancer are highest in black and Hispanic populations. There are significant disparities in in vaccination rates and HPV awareness in these populations.
Gardasil – or recombinant human papilloma virus vaccine (types 6, 11, 16, 18) – is a series of vaccinations that was first approved by the US FDA in 2006, with an initial indication for prevention of genital warts and cervical cancer in females ages 9 to 26 years old. Later indications were added for prevention of anal and penile cancer in males ages 9 to 26 years old, and extension to females age 27 to 45 years of age. The CDC recommends routine vaccination at age 11 or 12, through age 26. A new 9-valent vaccine manufactured by Merck protects against five additional HPV types which are high-risk of progression to cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers. The addition of these subtypes covers the implicated strains in up to 81% of cervical cancers.
The vaccine has faced previous challenges. Efforts to make Gardasil vaccination mandatory have faced significant opposition from religious and parents’ groups, and there have been multiple challenges at the state level. The most famous example: now-former Texas governor Rick Perry mandated vaccination for girls, then reversed his mandate. In spite of aggressive advertising in the past, vaccination has not gained the anticipated traction, with only 60% of adolescent girls and only 40% of adolescent boys vaccinated before the age of 18.
It is a good vaccine. It needs wider adoption.
The scare tactics of special interests and the (sometimes scary) marketing efforts of manufacturers are how we decide these matters in the US.
posted by Glomar response at 11:59 AM on August 18, 2016 [5 favorites]
The scare tactics of special interests and the (sometimes scary) marketing efforts of manufacturers are how we decide these matters in the US.
posted by Glomar response at 11:59 AM on August 18, 2016 [5 favorites]
the ad bullies parents.
Get a grip. Vaccinate or don't vaccinate, but getting the vaccine-preventable disease if you aren't vaccinated is the expected consequence.
posted by jeather at 11:59 AM on August 18, 2016 [32 favorites]
Get a grip. Vaccinate or don't vaccinate, but getting the vaccine-preventable disease if you aren't vaccinated is the expected consequence.
posted by jeather at 11:59 AM on August 18, 2016 [32 favorites]
I think these ads are very good.
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices (November 17, 2015)
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices (November 17, 2015)
Responding to the billions of advertising dollars being spent to promote prescription products, physicians at the Interim Meeting of the American Medical Association (AMA) today adopted new policy aimed at driving solutions to make prescription drugs more affordable.posted by filthy light thief at 11:59 AM on August 18, 2016 [27 favorites]
Physicians cited concerns that a growing proliferation of ads is driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives.
I'm mostly annoyed by the ad with the guy, guilt tripping his parents about a vaccine that didn't exist at the time he was a kid.
posted by Bulgaroktonos at 11:59 AM on August 18, 2016 [8 favorites]
posted by Bulgaroktonos at 11:59 AM on August 18, 2016 [8 favorites]
Whether or not DTC advertising should exist at all is a separate issue, I think.
posted by praemunire at 12:01 PM on August 18, 2016 [9 favorites]
posted by praemunire at 12:01 PM on August 18, 2016 [9 favorites]
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
I'm far less annoyed by advertising a thing that everyone should get than "Do you sometimes have slightly dry eyes? There's a pill for that! Side effects include dry eyes and death."
posted by Etrigan at 12:03 PM on August 18, 2016 [64 favorites]
I'm far less annoyed by advertising a thing that everyone should get than "Do you sometimes have slightly dry eyes? There's a pill for that! Side effects include dry eyes and death."
posted by Etrigan at 12:03 PM on August 18, 2016 [64 favorites]
From my perspective as a non-parent: my spouse was watching a show on Hulu or Netflix or one of those, and these ads were almost the only ones they ever played. I heard "Right Mom? Dad?" dozens of times, and was pretty sick of the whole thing.
Is advertising that annoys the hell out of people still considered effective?
posted by Foosnark at 12:03 PM on August 18, 2016 [1 favorite]
Is advertising that annoys the hell out of people still considered effective?
posted by Foosnark at 12:03 PM on August 18, 2016 [1 favorite]
New Merck ad for Gardasil is sparking controversy - do they tell the hard truths, or are they guilt-tripping parents?
Could the ads do both? A lot of advertising works on emotional manipulation, drugs particularly, even if the product being sold is obviously a good thing. Merck has shareholders to account to, after all, so if you're a responsible parent, pull out your checkbook, roll up your kid's sleeve, and let's spend some money.
posted by a lungful of dragon at 12:03 PM on August 18, 2016 [2 favorites]
Could the ads do both? A lot of advertising works on emotional manipulation, drugs particularly, even if the product being sold is obviously a good thing. Merck has shareholders to account to, after all, so if you're a responsible parent, pull out your checkbook, roll up your kid's sleeve, and let's spend some money.
posted by a lungful of dragon at 12:03 PM on August 18, 2016 [2 favorites]
On the one hand, direct-to-consumer pharmaceutical marketing is an atrocity that needs to go away. On the other hand, important public health issue.
Maybe Ad Council can start running these things. Maybe once the patent runs out.
posted by uncleozzy at 12:03 PM on August 18, 2016 [10 favorites]
Maybe Ad Council can start running these things. Maybe once the patent runs out.
posted by uncleozzy at 12:03 PM on August 18, 2016 [10 favorites]
Efforts to make Gardasil vaccination mandatory have faced significant opposition from religious and parents’ groups.
No surprise there. This graph (hat tip to Metafilter's Own cstross for the retweet) https://twitter.com/adam_tooze/status/765866165604417536 shows that 30% of Americans think that premarital sex is morally unacceptable. I remember getting my hep B vaccine in high school, and not really knowing anything about heb B, and asking my doctor and getting the wishywashiest medical answer EVER. Still, I got the gist, and both myself and my parents supported me getting the vaccine.
posted by Phredward at 12:05 PM on August 18, 2016 [3 favorites]
No surprise there. This graph (hat tip to Metafilter's Own cstross for the retweet) https://twitter.com/adam_tooze/status/765866165604417536 shows that 30% of Americans think that premarital sex is morally unacceptable. I remember getting my hep B vaccine in high school, and not really knowing anything about heb B, and asking my doctor and getting the wishywashiest medical answer EVER. Still, I got the gist, and both myself and my parents supported me getting the vaccine.
posted by Phredward at 12:05 PM on August 18, 2016 [3 favorites]
Etrigan: I'm far less annoyed by advertising a thing that everyone should get than "Do you sometimes have slightly dry eyes?
Annoyance is only one aspect here - the other is that ad buys drive up the cost of medication, and increase the amount of medication used by patients.
Maybe Ad Council can start running these things. Maybe once the patent runs out.
Exactly (on the first part) On the second part, it's tricky - is this a viable form of cancer prevention? If so, the government could make bulk purchases to drive the price down (somewhat) and add it to the vaccine schedule. If not, leave it up to your doctor (again, assuming you have one, and she or he is aware of your family medical history and current medical best practices or whatever the terminology is in medicine).
posted by filthy light thief at 12:07 PM on August 18, 2016
Annoyance is only one aspect here - the other is that ad buys drive up the cost of medication, and increase the amount of medication used by patients.
Maybe Ad Council can start running these things. Maybe once the patent runs out.
Exactly (on the first part) On the second part, it's tricky - is this a viable form of cancer prevention? If so, the government could make bulk purchases to drive the price down (somewhat) and add it to the vaccine schedule. If not, leave it up to your doctor (again, assuming you have one, and she or he is aware of your family medical history and current medical best practices or whatever the terminology is in medicine).
posted by filthy light thief at 12:07 PM on August 18, 2016
In America, parents are ultimately the ones making health decisions for their children- not doctors. It is absolutely a nightmare from a public health standpoint.
I think these get the message across - HPV causes cancer. You can stop that. And manages to do so without getting into sexual activities of adolescents.
posted by AlexiaSky at 12:07 PM on August 18, 2016 [14 favorites]
I think these get the message across - HPV causes cancer. You can stop that. And manages to do so without getting into sexual activities of adolescents.
posted by AlexiaSky at 12:07 PM on August 18, 2016 [14 favorites]
Is advertising that annoys the hell out of people still considered effective?
This Ad Will Give You a Headache, but It Sells
posted by tonycpsu at 12:07 PM on August 18, 2016
This Ad Will Give You a Headache, but It Sells
posted by tonycpsu at 12:07 PM on August 18, 2016
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
This is the US so TV and magazine ads are roughly equivalent to licensed doctors.
posted by GuyZero at 12:08 PM on August 18, 2016 [6 favorites]
This is the US so TV and magazine ads are roughly equivalent to licensed doctors.
posted by GuyZero at 12:08 PM on August 18, 2016 [6 favorites]
If "choosy moms choose jif" can stand without being wah wah guilt tripped off the TV, then I'm cool guilt tripping parents over a thing that could literally prevent cancer.
posted by phunniemee at 12:10 PM on August 18, 2016 [42 favorites]
posted by phunniemee at 12:10 PM on August 18, 2016 [42 favorites]
In Doctor-patient counseling, guilt is extremely ineffective. Trying this line of persuasion in person will probably result in the parent shutting down or getting defensive. I don't know if guilt's effective in advertising, but having seen loads of parents go from "vaccine against cancer? Awesome!" to "wait, HPV is sexually transmitted? Never mind, my 17 year old is never having sex ever" in a blink of an eye, seeing these ads at least helps sublimate my own personal frustration and rage.
posted by midmarch snowman at 12:12 PM on August 18, 2016 [11 favorites]
posted by midmarch snowman at 12:12 PM on August 18, 2016 [11 favorites]
The Rick Perry thing is what has always made Gardasil an interesting case for me.
On the one hand, it will literally save lives. The only reason (besides medical exclusions discussed with your child's doctor) not to vaccinate is some prudish head-in-sandery about teenagers having sex.
On the other hand, Rick Perry's mandate was like textbook crony capitalism.
This ad campaign? Gross and manipulative. But, maybe it will guilt some parents into saving their children's lives.
Part of me hopes that Merck is also running campaigns in high schools and colleges to remind kids who weren't vaccinated that you can still get Gardasil until you are 26 years old.
posted by sparklemotion at 12:13 PM on August 18, 2016 [5 favorites]
On the one hand, it will literally save lives. The only reason (besides medical exclusions discussed with your child's doctor) not to vaccinate is some prudish head-in-sandery about teenagers having sex.
On the other hand, Rick Perry's mandate was like textbook crony capitalism.
This ad campaign? Gross and manipulative. But, maybe it will guilt some parents into saving their children's lives.
Part of me hopes that Merck is also running campaigns in high schools and colleges to remind kids who weren't vaccinated that you can still get Gardasil until you are 26 years old.
posted by sparklemotion at 12:13 PM on August 18, 2016 [5 favorites]
"Something that makes me feel bad" is not necessarily "bullying". The more you know!
posted by ThePinkSuperhero at 12:14 PM on August 18, 2016 [53 favorites]
posted by ThePinkSuperhero at 12:14 PM on August 18, 2016 [53 favorites]
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
The problem there is that so many Americans don't have doctors, or don't see them on any kind of reasonable schedule. Parents are probably a little better if they can afford it, but that's a huge if.
posted by Mitrovarr at 12:15 PM on August 18, 2016 [3 favorites]
The problem there is that so many Americans don't have doctors, or don't see them on any kind of reasonable schedule. Parents are probably a little better if they can afford it, but that's a huge if.
posted by Mitrovarr at 12:15 PM on August 18, 2016 [3 favorites]
Part of an actual conversation I had this weekend:
Colleague: "...I mean, don't get me wrong, I'm not anti-vaccine. Measles, mumps? Sure! But Hep C? Look, I told my sons 'listen, the only way you'll get Hep C is if you use needles and have unsafe sex. So, don't use needles or have unsafe sex!' Easy as that, no need for a vaccine."
Me: ...
So, yea, I think guilt tripping parents into vaccinating their kids is a really good idea.
posted by hopeless romantique at 12:17 PM on August 18, 2016 [43 favorites]
Colleague: "...I mean, don't get me wrong, I'm not anti-vaccine. Measles, mumps? Sure! But Hep C? Look, I told my sons 'listen, the only way you'll get Hep C is if you use needles and have unsafe sex. So, don't use needles or have unsafe sex!' Easy as that, no need for a vaccine."
Me: ...
So, yea, I think guilt tripping parents into vaccinating their kids is a really good idea.
posted by hopeless romantique at 12:17 PM on August 18, 2016 [43 favorites]
I know for myself, I haven't gotten this vaccine for my daughter because it's a series of shots, which means a series of expensive dr visits (co-pays if I'm lucky, out-of-pocket more likely, even WITH insurance), and time off work and school. I will probably have her get it eventually but if it were just one shot, it would be a lot easier, and maybe more people would get it for their kids.
posted by cass at 12:19 PM on August 18, 2016 [2 favorites]
posted by cass at 12:19 PM on August 18, 2016 [2 favorites]
this is something that should come from your doctor, not your television
Came to say exactly this. This is a great example of why permitting drug companies to advertise directly to consumers is a bad idea: it is impossible to disentangle the profit motive from the public health messaging, and our natural (justified) skepticism towards the profit motive undermines the important public health message. Advertising the importance of the HPV vaccine is a great idea, but it should come from public health officials who have assessed the evidence and identified it as a public health priority, not a company that stands to make millions of dollars regardless of whether the message is true (it is, but the investors don't necessarily care).
Even then things would not be perfect (drug companies would certainly lobby the FDA/CDC/etc to create ad campaigns for their drugs), but there is at least an added check on the process.
posted by biogeo at 12:20 PM on August 18, 2016 [10 favorites]
Came to say exactly this. This is a great example of why permitting drug companies to advertise directly to consumers is a bad idea: it is impossible to disentangle the profit motive from the public health messaging, and our natural (justified) skepticism towards the profit motive undermines the important public health message. Advertising the importance of the HPV vaccine is a great idea, but it should come from public health officials who have assessed the evidence and identified it as a public health priority, not a company that stands to make millions of dollars regardless of whether the message is true (it is, but the investors don't necessarily care).
Even then things would not be perfect (drug companies would certainly lobby the FDA/CDC/etc to create ad campaigns for their drugs), but there is at least an added check on the process.
posted by biogeo at 12:20 PM on August 18, 2016 [10 favorites]
Goddammit. Can we just have single-fucking-payer healthcare already? Add this to the damn vaccine schedule, get all the damn kids vaccinated. How will we pay for it? How about with the extra fucking hours worked by parents who don't have to take days off from work taking care of kids suffering from easily preventable diseases!
Calling this bullying is ridiculous. Parents should be confronted with pictures of kids ravaged by fucking polio so that they're reminded of what a goddamn miracle vaccines are. We're living in the future, folks! We really gotta act like it, okay?
posted by explosion at 12:20 PM on August 18, 2016 [51 favorites]
Calling this bullying is ridiculous. Parents should be confronted with pictures of kids ravaged by fucking polio so that they're reminded of what a goddamn miracle vaccines are. We're living in the future, folks! We really gotta act like it, okay?
posted by explosion at 12:20 PM on August 18, 2016 [51 favorites]
If "choosy moms choose jif"
It's Gif, dammit!
What about squeezing the Charmin? or a whispered direction to come closer for Pepto-Bismol? You're soaking in it? Ring around the collar...
posted by lazycomputerkids at 12:21 PM on August 18, 2016 [2 favorites]
It's Gif, dammit!
What about squeezing the Charmin? or a whispered direction to come closer for Pepto-Bismol? You're soaking in it? Ring around the collar...
posted by lazycomputerkids at 12:21 PM on August 18, 2016 [2 favorites]
On the second part, it's tricky - is this a viable form of cancer prevention?
No offense, but you're neatly demonstrated why consumer education is necessary (even though I'd agree that it would be better not coming from the drug manufacturers). Yes, it is a very viable form of cancer prevention and it's been pretty thoroughly covered in the media. They've reached a plateau of what doctor/parent communication has gotten them to and are trying to reach the people that still don't know or have chosen not to listen to the doctors thus far.
It's an especially good form of cancer prevention because HPV is so commonly spread that herd immunity really kicks in very well.
If so, the government could make bulk purchases to drive the price down (somewhat) and add it to the vaccine schedule.
It does. Most low income kids get it for free or very inexpensively. But the problems with the US health insurance system are well discussed here.
The Canadian and UK governments have made it standard and free or cheap.
But we literally have parents that would rather their children suffer horrible cancer than deal with the idea of them having sex outside of marriage, so the US government hasn't gone there.
posted by Candleman at 12:23 PM on August 18, 2016 [28 favorites]
No offense, but you're neatly demonstrated why consumer education is necessary (even though I'd agree that it would be better not coming from the drug manufacturers). Yes, it is a very viable form of cancer prevention and it's been pretty thoroughly covered in the media. They've reached a plateau of what doctor/parent communication has gotten them to and are trying to reach the people that still don't know or have chosen not to listen to the doctors thus far.
It's an especially good form of cancer prevention because HPV is so commonly spread that herd immunity really kicks in very well.
If so, the government could make bulk purchases to drive the price down (somewhat) and add it to the vaccine schedule.
It does. Most low income kids get it for free or very inexpensively. But the problems with the US health insurance system are well discussed here.
The Canadian and UK governments have made it standard and free or cheap.
But we literally have parents that would rather their children suffer horrible cancer than deal with the idea of them having sex outside of marriage, so the US government hasn't gone there.
posted by Candleman at 12:23 PM on August 18, 2016 [28 favorites]
Part of an actual conversation I had this weekend:
Colleague: "...I mean, don't get me wrong, I'm not anti-vaccine. Measles, mumps? Sure! But Hep C? Look, I told my sons 'listen, the only way you'll get Hep C is if you use needles and have unsafe sex. So, don't use needles or have unsafe sex!' Easy as that, no need for a vaccine."
Me: ...
ahahah ohhhhh boy my roommate who just left her position at a hep c clinic in our west oakland neighborhood to go to med school will laugh and laugh and laugh at this story
posted by burgerrr at 12:24 PM on August 18, 2016 [5 favorites]
Colleague: "...I mean, don't get me wrong, I'm not anti-vaccine. Measles, mumps? Sure! But Hep C? Look, I told my sons 'listen, the only way you'll get Hep C is if you use needles and have unsafe sex. So, don't use needles or have unsafe sex!' Easy as that, no need for a vaccine."
Me: ...
ahahah ohhhhh boy my roommate who just left her position at a hep c clinic in our west oakland neighborhood to go to med school will laugh and laugh and laugh at this story
posted by burgerrr at 12:24 PM on August 18, 2016 [5 favorites]
My mom wouldn't sign the permission slip for me to get my FREE Hep B shots in middle school because "you're a good kid, I know you'll never have sex before marriage or do drugs, so you'll never need to worry about hep B. So I'm not letting them put those evil vaccine toxins in you". If Gardasil had been out back then, it would have gotten the same response.
I honestly kinda doubt ads like this would have changed that kind of mindset, but who knows - it's worth a shot.
posted by randomnity at 12:27 PM on August 18, 2016 [2 favorites]
I honestly kinda doubt ads like this would have changed that kind of mindset, but who knows - it's worth a shot.
posted by randomnity at 12:27 PM on August 18, 2016 [2 favorites]
A friend of mine lost her infant to a disease that he was too young to be vaccinated for. I'm pretty sure she would be happy to talk to any parents about this.
posted by roomthreeseventeen at 12:29 PM on August 18, 2016 [15 favorites]
posted by roomthreeseventeen at 12:29 PM on August 18, 2016 [15 favorites]
Ever since the vaccine for boys became available, I've had it on my Giant To Do List to get my kiddo this vaccination when he's old enough. Which is now next year. Because I would like to lower his chances of getting or passing on something that might cause cancer. Because I want to protect my child, which is the lowest bar you should have to clear, as a parent.
I get so so angry at the idea that someone is more concerned about their kid being perceived as "slutty" than their kid dying from actual cancer that I tend to sputter a bit. Your child. Whom you claim to love. Dying. From cancer. BECAUSE OF YOU.
I know it's a thing, I know the reasons we Can't Deal With Sex in this country, I know it's about God being angry and people just refusing to deal with reality, but Jesus. It's keeping cancer away from your kid.
posted by emjaybee at 12:30 PM on August 18, 2016 [36 favorites]
I get so so angry at the idea that someone is more concerned about their kid being perceived as "slutty" than their kid dying from actual cancer that I tend to sputter a bit. Your child. Whom you claim to love. Dying. From cancer. BECAUSE OF YOU.
I know it's a thing, I know the reasons we Can't Deal With Sex in this country, I know it's about God being angry and people just refusing to deal with reality, but Jesus. It's keeping cancer away from your kid.
posted by emjaybee at 12:30 PM on August 18, 2016 [36 favorites]
Needed to add: that there are parents out there who want this vaccine for their kids but can't obtain or afford it is a different matter, and my rage is not directed at them.
posted by emjaybee at 12:32 PM on August 18, 2016 [3 favorites]
posted by emjaybee at 12:32 PM on August 18, 2016 [3 favorites]
Ever since the vaccine for boys became available, I've had it on my Giant To Do List to get my kiddo this vaccination when he's old enough.
My wife and I are both Excited about the possibility of vaccinating our daughter whose first round of shots is coming up soon. At our last doctor's appointment, we talked for a while with the pediatrician about how great it was to be able to protect her from something.
posted by Bulgaroktonos at 12:36 PM on August 18, 2016 [3 favorites]
My wife and I are both Excited about the possibility of vaccinating our daughter whose first round of shots is coming up soon. At our last doctor's appointment, we talked for a while with the pediatrician about how great it was to be able to protect her from something.
posted by Bulgaroktonos at 12:36 PM on August 18, 2016 [3 favorites]
this is something that should come from your doctor, not your television
Counterpoint: 33 Million Americans Still Don’t Have Health Insurance
That being said, pharmaceutical companies aren't exactly jumping onto the side of single-payer healthcare in the US.
posted by zombieflanders at 12:37 PM on August 18, 2016 [2 favorites]
Counterpoint: 33 Million Americans Still Don’t Have Health Insurance
That being said, pharmaceutical companies aren't exactly jumping onto the side of single-payer healthcare in the US.
posted by zombieflanders at 12:37 PM on August 18, 2016 [2 favorites]
but if it were just one shot, it would be a lot easier, and maybe more people would get it for their kids.
There is benefit in just one shot and you can pick up with #2 whenever you get around it, it is not like you have to start over. I have patients who got 1 in the series every year at their annual sports physical, spread out over 3 years.
The most common reason I hear for parents denying their kids the vaccine is that they're kids won't have sex until they are adults and then they can decide for themselves. My response is that your kids are going to have sex before you are ready for it, regardless of their age, and that's why I'm doing it for my boys as soon as they are eligible, age 9, long before I have to confront the reality of them being sexually active.
posted by Slarty Bartfast at 12:38 PM on August 18, 2016 [19 favorites]
There is benefit in just one shot and you can pick up with #2 whenever you get around it, it is not like you have to start over. I have patients who got 1 in the series every year at their annual sports physical, spread out over 3 years.
The most common reason I hear for parents denying their kids the vaccine is that they're kids won't have sex until they are adults and then they can decide for themselves. My response is that your kids are going to have sex before you are ready for it, regardless of their age, and that's why I'm doing it for my boys as soon as they are eligible, age 9, long before I have to confront the reality of them being sexually active.
posted by Slarty Bartfast at 12:38 PM on August 18, 2016 [19 favorites]
Physicians cited concerns that a growing proliferation of ads is driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives.
I don't watch much live tv but when I do turn on CNN or MSNBC or any other news channel during prime-time I'm bombarded with nothing but commercials for Insurance companies or pharmaceutical advertisements. Very relentless. And it also shows how much money they have at their disposal.
posted by Fizz at 12:44 PM on August 18, 2016 [2 favorites]
I don't watch much live tv but when I do turn on CNN or MSNBC or any other news channel during prime-time I'm bombarded with nothing but commercials for Insurance companies or pharmaceutical advertisements. Very relentless. And it also shows how much money they have at their disposal.
posted by Fizz at 12:44 PM on August 18, 2016 [2 favorites]
On the 'no doctor' note above, I would say that fewer than 1/3rd of the people I've talked about it with see a general practitioner. Most of that 1/3rd have a chronic health concern that forces the issue. And insurance isn't the problem.
I think the big issues are: too few doctors (so it's hard to schedule), overtesting and overtreatment, insurance companies are unpredictable and flakey for paying for things even when it's covered, and everyone spends a good 10-15 years too broke to see a doctor around 20-35 years of age so they get out of the habit.
posted by Mitrovarr at 12:49 PM on August 18, 2016 [5 favorites]
I think the big issues are: too few doctors (so it's hard to schedule), overtesting and overtreatment, insurance companies are unpredictable and flakey for paying for things even when it's covered, and everyone spends a good 10-15 years too broke to see a doctor around 20-35 years of age so they get out of the habit.
posted by Mitrovarr at 12:49 PM on August 18, 2016 [5 favorites]
“It’s kind of like Catholic and Jewish guilt combined..."
I've had to deal with Catholic Guilt my whole life, and will have to deal with it for my whole life, and, frankly, this level of guilt doesn't even register. On the Guilt Geiger Counter, this is just background static. Maybe I was inoculated by too many interim report card days at Thanksgiving...
posted by Capt. Renault at 12:50 PM on August 18, 2016 [1 favorite]
I've had to deal with Catholic Guilt my whole life, and will have to deal with it for my whole life, and, frankly, this level of guilt doesn't even register. On the Guilt Geiger Counter, this is just background static. Maybe I was inoculated by too many interim report card days at Thanksgiving...
posted by Capt. Renault at 12:50 PM on August 18, 2016 [1 favorite]
We need to stop treating vaccines for sexually transmittable diseases differently than other vaccines. It doesn't matter if your kid is a "good kid," they could do everything perfectly by that metric and still marry somebody who wasn't/isn't "good" and catch the disease.
I just. Argh.
posted by joannemerriam at 1:02 PM on August 18, 2016 [16 favorites]
I just. Argh.
posted by joannemerriam at 1:02 PM on August 18, 2016 [16 favorites]
My stepmom had this kind of cancer, and it rendered her infertile. When this vaccine became available, she kept pushing me to take it, and I resisted, until I had a grown-up job, and the insurance that came with it.
Then I happily paid my co-pays and got my three shots ASAP, since by then I was on the cusp of not having it covered by insurance anymore.
My co-workers, through, were taking about "how their kids didn't really need this vaccine" and "eleven is too young!" despite how "they gave them every other vaccine. They weren't crazy parents, after all."
That was perhaps, the closest I'd even gotten to having a full-blown emotional rant at the office. There were feelings, and I said some things, and then seethed in the sheer ignorance of it all for a while.
posted by PearlRose at 1:08 PM on August 18, 2016 [11 favorites]
Then I happily paid my co-pays and got my three shots ASAP, since by then I was on the cusp of not having it covered by insurance anymore.
My co-workers, through, were taking about "how their kids didn't really need this vaccine" and "eleven is too young!" despite how "they gave them every other vaccine. They weren't crazy parents, after all."
That was perhaps, the closest I'd even gotten to having a full-blown emotional rant at the office. There were feelings, and I said some things, and then seethed in the sheer ignorance of it all for a while.
posted by PearlRose at 1:08 PM on August 18, 2016 [11 favorites]
It doesn't matter if your kid is a "good kid," they could do everything perfectly by that metric and still marry somebody who wasn't/isn't "good" and catch the disease.
Or get raped.
posted by Etrigan at 1:09 PM on August 18, 2016 [27 favorites]
Or get raped.
posted by Etrigan at 1:09 PM on August 18, 2016 [27 favorites]
My parents wouldn't let my sister get the shots because they were skeeved out by the idea of teenagers having sex. Then she got HPV. She's still angry about it. They never stopped us getting any of our other necessary vaccinations, because it was totally normalized and expected. I think ads like this help to normalize the shot, and this is vital-- we're talking fucking preventable cancer, people.
posted by thetortoise at 1:10 PM on August 18, 2016 [22 favorites]
posted by thetortoise at 1:10 PM on August 18, 2016 [22 favorites]
pretty sure the kind of people who shame children for preventing disease will also gleefully shame and blame them for getting sexually assaulted
posted by poffin boffin at 1:10 PM on August 18, 2016 [13 favorites]
posted by poffin boffin at 1:10 PM on August 18, 2016 [13 favorites]
My response is that your kids are going to have sex before you are ready for it,
Not to mention the sad fact that they might have sex before they're ready for it, without having decided to have it.
On preview I see Etrigan and I are sharing the brain today.
But seriously, I just do not understand the mindset that ignores this. I see it on facebook all the time about what they expect their kids to do. You don't apply this logic to them wearing their seat belts, do you?
posted by phearlez at 1:12 PM on August 18, 2016 [1 favorite]
Not to mention the sad fact that they might have sex before they're ready for it, without having decided to have it.
On preview I see Etrigan and I are sharing the brain today.
But seriously, I just do not understand the mindset that ignores this. I see it on facebook all the time about what they expect their kids to do. You don't apply this logic to them wearing their seat belts, do you?
posted by phearlez at 1:12 PM on August 18, 2016 [1 favorite]
I think it is tied up in parents' ingrained thinking that they own their children and their bodies. And this vaccine seems like some kind of marker of adulthood, a line in the sand between when your child is pure and when they are forever tainted by sexual activity. So Merck might need to do a campaign about that. The vaccine isn't about sex, it's about cancer. It isn't for sluts, it's for all humans. And it is sooooooo very much for boys as well as girls.
Merck, please guilt parents into getting over their sexual hangups and help their kids avoid potential cancers.
posted by amanda at 1:13 PM on August 18, 2016 [2 favorites]
Merck, please guilt parents into getting over their sexual hangups and help their kids avoid potential cancers.
posted by amanda at 1:13 PM on August 18, 2016 [2 favorites]
I will also point out that the UK, where DTC pharma advertising is illegal, has had government-sponsored adverts for the HPV vaccine: English, Scottish - so this isn't just about DTC adverts. It may also be of issue that in a free healthcare system which accepts that a competent twelve year old can consent to immunisation (and even request that their parents are not informed), this can be aimed at teenagers themselves as well as parents. (Though we're still not vaccinating boys yet, which is bloody annoying)
posted by Vortisaur at 1:21 PM on August 18, 2016 [5 favorites]
posted by Vortisaur at 1:21 PM on August 18, 2016 [5 favorites]
I know that part of the story is what makes the joke funny, but since there's so much god damn misinformation in the world, I have to say this even though everybody probably knows this and I'm overreacting:
There's currently no such thing as a Hep C vaccine.
posted by MCMikeNamara at 1:21 PM on August 18, 2016 [6 favorites]
There's currently no such thing as a Hep C vaccine.
posted by MCMikeNamara at 1:21 PM on August 18, 2016 [6 favorites]
Maybe if, instead of those pesky, obviously-teen-age-sex-inducing vaccinations or potentially mildly-uncomfortable-to-some commercials, if we all just shouted "Calgon, take me away!"
also, a bit of a side track, but this helps a tiny bit
posted by BigHeartedGuy at 1:55 PM on August 18, 2016 [1 favorite]
also, a bit of a side track, but this helps a tiny bit
posted by BigHeartedGuy at 1:55 PM on August 18, 2016 [1 favorite]
As someone who's actually been bullied, it bugs me that so many people consider simply being confronted with true, verifiable facts they don't like bullying. If something makes you feel guilty, that's *your* guilt unless it really is untrue or unfair. Your sympathetic nervous system's healthy function is not something to be scared of. It's like it's a bigger crime these days to trigger someone's feelings of guilt over a thing they actually did do wrong than it is to do the wrong thing.
posted by saulgoodman at 2:33 PM on August 18, 2016 [7 favorites]
posted by saulgoodman at 2:33 PM on August 18, 2016 [7 favorites]
...asking my doctor and getting the wishywashiest medical answer EVER.
My doula said this too.
Relying on the medical profession is a great idea until you run into the wishy washy, the religious wing-nuts, or the just plain ignorant shitheads.
Target the kids for education as well as parents with these commercials emphasizing they aren't sluts if the get these shots, they are being responsible and proactive in their own health
Hey, you're an adult!
posted by BlueHorse at 2:36 PM on August 18, 2016
My doula said this too.
Relying on the medical profession is a great idea until you run into the wishy washy, the religious wing-nuts, or the just plain ignorant shitheads.
Target the kids for education as well as parents with these commercials emphasizing they aren't sluts if the get these shots, they are being responsible and proactive in their own health
Hey, you're an adult!
posted by BlueHorse at 2:36 PM on August 18, 2016
As much as I dislike marketing prescription drugs direct to consumers, this seems like it might do some good. And while leaving this conversation up to physicians seems like a good idea, there are plenty of physicians out there with screwed up ideas who would agree wholeheartedly with parents who think their kids are pure as the driven snow and therefore don't need a vaccine intended for women of loose morals. Think of how backwards thinking some Republican politicians who are also physicians are; Paul Broun for example.
My daughter is 11 and just got her first dose; her mother and I were in complete agreement on that point.
posted by TedW at 2:43 PM on August 18, 2016 [1 favorite]
My daughter is 11 and just got her first dose; her mother and I were in complete agreement on that point.
posted by TedW at 2:43 PM on August 18, 2016 [1 favorite]
I don't understand why parents are allowed to make this kind of health care decision for their children at all. Getting the standard vaccinations should be considered part of the minimum standard of health care--religious and moral objections be damned. Children aren't fucking property; they're people who deserve basic healthcare. It is unjust that some children will have a higher risk of cancer because of their parents' sexual hangups.
(Obvs, some parents can't do this because of the cost but in that case it's the system that's failing, not them.)
posted by Kutsuwamushi at 2:45 PM on August 18, 2016 [5 favorites]
(Obvs, some parents can't do this because of the cost but in that case it's the system that's failing, not them.)
posted by Kutsuwamushi at 2:45 PM on August 18, 2016 [5 favorites]
There's currently no such thing as a Hep C vaccine.
Haha, I think this was one of those times where I got so overwhelmed by what the woman said that I couldn't think through the details. I'm sure she was talking about Hep B. Whether that's what she *meant* to say is up for debate. She very likely doesn't know the difference.
Anyway, thanks for the clarification.
posted by hopeless romantique at 3:26 PM on August 18, 2016 [3 favorites]
Haha, I think this was one of those times where I got so overwhelmed by what the woman said that I couldn't think through the details. I'm sure she was talking about Hep B. Whether that's what she *meant* to say is up for debate. She very likely doesn't know the difference.
Anyway, thanks for the clarification.
posted by hopeless romantique at 3:26 PM on August 18, 2016 [3 favorites]
“It’s kind of like Catholic and Jewish guilt combined,” said Susie Cambria, a public policy analyst and community activist who lives in Washington, D.C. “I don’t have any kids, but I can only imagine how badly it makes parents feel.”
Uh, that sounds like a pretty fucked up way to communicate a great thing (vaccines), and what's worse is these white-privileged doctors in the WaPo article repeatedly saying it's a terrific ad. It teaches people that science is about fear, and stirring up strong feelings of shame, which is as anti-science as it gets. Am I supposed to assume that all the other constructive avenues, like community and interpersonal outreach/advocacy, have been exhausted and that's why pharma companies are resorting to this level of social control?
posted by polymodus at 4:00 PM on August 18, 2016
Uh, that sounds like a pretty fucked up way to communicate a great thing (vaccines), and what's worse is these white-privileged doctors in the WaPo article repeatedly saying it's a terrific ad. It teaches people that science is about fear, and stirring up strong feelings of shame, which is as anti-science as it gets. Am I supposed to assume that all the other constructive avenues, like community and interpersonal outreach/advocacy, have been exhausted and that's why pharma companies are resorting to this level of social control?
posted by polymodus at 4:00 PM on August 18, 2016
TIL that I'm now within the recommended extended age group! Going to talk to my doc about it next week!
posted by merriment at 4:27 PM on August 18, 2016
posted by merriment at 4:27 PM on August 18, 2016
Here in Canada it's given in schools, just like Hep B is. Line up the kids, get some public health nurses in the cafetorium, let's get some screaming tweens.
When I worked in a clinic we had Gardasil pamphlets - they come from the sample form you get from the Sample people that you then fax in and a bunch of tiny packets of Advil turn up in the mail later, like when you think you'll have a headache in two weeks. It's the same place Formedic continuation sheets come from.
The Merck school of medical pamphlet theory is very much the 'you will learn about your body DAMNIT' health class as taught by a well meaning PE teacher. Nice looking, concerned white teenage boy on the front and you open it up and it's THIS IS YOUR DICK IF YOU GET HPV *imagine a disease-riddled penis pic here*
It was not uncommon to have dads accompany their son (who might have been too old for Gardasil in school depending on when they started the program) for a routine thing, and in the interminable period of waiting in the exam room, pick up the pamphlet and go straight to "well no son of mine is getting the zombie dick" for the rest of the visit.
They're so much better than the Zostavax pamphlets which are far more "YOU WILL GET SHINGLES AND DIE"
posted by the uncomplicated soups of my childhood at 4:27 PM on August 18, 2016 [4 favorites]
When I worked in a clinic we had Gardasil pamphlets - they come from the sample form you get from the Sample people that you then fax in and a bunch of tiny packets of Advil turn up in the mail later, like when you think you'll have a headache in two weeks. It's the same place Formedic continuation sheets come from.
The Merck school of medical pamphlet theory is very much the 'you will learn about your body DAMNIT' health class as taught by a well meaning PE teacher. Nice looking, concerned white teenage boy on the front and you open it up and it's THIS IS YOUR DICK IF YOU GET HPV *imagine a disease-riddled penis pic here*
It was not uncommon to have dads accompany their son (who might have been too old for Gardasil in school depending on when they started the program) for a routine thing, and in the interminable period of waiting in the exam room, pick up the pamphlet and go straight to "well no son of mine is getting the zombie dick" for the rest of the visit.
They're so much better than the Zostavax pamphlets which are far more "YOU WILL GET SHINGLES AND DIE"
posted by the uncomplicated soups of my childhood at 4:27 PM on August 18, 2016 [4 favorites]
Just to clarify for those discussing vaccination for hepatitis C -- there is no such vaccine yet. (Most unfortunately.) Perhaps you are thinking of hepatitis B? Some of the same parental objections to HPV vaccines have been made to the HBV vaccine.
posted by reren at 4:29 PM on August 18, 2016 [4 favorites]
posted by reren at 4:29 PM on August 18, 2016 [4 favorites]
It teaches people that science is about fear, and stirring up strong feelings of shame
But you know what? If you've weighed "I don't want my daughter to get cancer and die" versus "I want to pretend my daughter will never have sex" and went with the pretending, then shame is appropriate.
posted by ROU_Xenophobe at 4:35 PM on August 18, 2016 [17 favorites]
But you know what? If you've weighed "I don't want my daughter to get cancer and die" versus "I want to pretend my daughter will never have sex" and went with the pretending, then shame is appropriate.
posted by ROU_Xenophobe at 4:35 PM on August 18, 2016 [17 favorites]
Whoever feels ashamed after watching an ad - any ad - deserves what they feel.
posted by jpe at 5:13 PM on August 18, 2016
posted by jpe at 5:13 PM on August 18, 2016
Whoever feels ashamed after watching an ad - any ad - deserves what they feel.I dunno, dude. Even a Carl's Jr. ad?
posted by Davenhill at 5:19 PM on August 18, 2016 [3 favorites]
I wanted to thank just about everyone in this thread. It's always a nice treat to wander into a positive, decent, and rational corner of the internet every now and again. :)
Also, because I could only favorite it once, I'm re-sharing this:
Also, because I could only favorite it once, I'm re-sharing this:
explosion: Goddammit. Can we just have single-fucking-payer healthcare already? Add this to the damn vaccine schedule, get all the damn kids vaccinated. How will we pay for it? How about with the extra fucking hours worked by parents who don't have to take days off from work taking care of kids suffering from easily preventable diseases!posted by Davenhill at 5:25 PM on August 18, 2016 [3 favorites]
Calling this bullying is ridiculous. Parents should be confronted with pictures of kids ravaged by fucking polio so that they're reminded of what a goddamn miracle vaccines are. We're living in the future, folks! We really gotta act like it, okay?
My mother would absolutely have refused to get me the vaccine; she would have said that cancer would be my punishment for having sinned.
Do I deserve cancer because my mother is a backward troglodyte? Does anyone?
posted by winna at 5:28 PM on August 18, 2016 [11 favorites]
Do I deserve cancer because my mother is a backward troglodyte? Does anyone?
posted by winna at 5:28 PM on August 18, 2016 [11 favorites]
I know about a dozen people my age (early 30s) who have had an HPV+ pap, the vast majority of these going on to a colposcopy, and a large proportion of those have had a follow-up procedure from there for abnormal tissue (eg, anything from CIN-II pre-cancer to stage 1 cancer). Most of my cervix-having friends are well-educated cis-women from suburban backgrounds. We were too old for the vaccines, and that sucks.
Because it turns out that even pre-cancer is pretty scary! Even the less-invasive interventions are pretty invasive when they occur in a vagina. And instead of a pap smear every three years, they're every year.
The addition of these subtypes covers the implicated strains in up to 81% of cervical cancers.
81%! And think of all the people who catch it before it becomes cancer - that's a lot of people not having to get pieces of their cervix surgically removed because of a vaccine.
On the second part, it's tricky - is this a viable form of cancer prevention?
Most sexually active people get infected with HPV at some point - it's super contagious, condoms are only so effective (mode of transmission being skin to skin, so fluid containment only does so much). Many infections clear within 1-2 years, but a lot don't. HPV infection is considered a near-necessary causal factor for cervical cancer - you see wording like HPV is detected in 'virtually all' and '>99%' of cervical cancers. A highly-transmissible virus with discrete high-risk strains that induces an otherwise symptom-free infection associated with a relatively common, potentially fatal cancer - a vaccine is pretty much the best public health intervention imaginable!
The effectiveness of the vaccines in preventing infection seems pretty good so far. In 2013, The Journal of Infectious Diseases published this finding (html, full text):
It has been about 10 years since HPV vaccines were first introduced in the US. The people who received those vaccines would have been 11, 12 years old then. Because of the fairly long time to develop cervical cancer from time of infection, we wouldn't expect a lot of cervical cancer cases in the 22-25 year old crowd, even in a condition of no vaccine uptake. It will be a few more years before results on cancer prevention become clear, as the cohort of people who were 11 or younger in 2006 reach an age where cancer risk becomes more common. Due to the rarity of the other cancers preventable by HPV vaccines, it may be even longer to determine the long-term cancer prevention efficacy of the vaccines.
But a hugely important factor is clearly being removed from the causal pie. Unless our epidemiology on the link between HPV and cervical cancer was way off, we should expect a significant reduction in cancers as vaccination rates increase and the vaccinated population ages. People born after, say, 1995 who get HPV then develop pre-cancerous cells or cancer? There are a lot of real people, who will really be suffering from decisions made by their parents. If anything, I hope those ads encourage pediatricians to continue their hard, thankless, essential work convincing intransigent parents - because it really matters!
caveat: I am an infectious disease epidemiologist, not a cancer epidemiologist. This is not my sub-specialty (tropical disease), but I sure did a lot of reading before my colposcopy. My daughter will be vaccinated against HPV. My pediatrician loves me.
posted by palindromic at 5:40 PM on August 18, 2016 [33 favorites]
Because it turns out that even pre-cancer is pretty scary! Even the less-invasive interventions are pretty invasive when they occur in a vagina. And instead of a pap smear every three years, they're every year.
The addition of these subtypes covers the implicated strains in up to 81% of cervical cancers.
81%! And think of all the people who catch it before it becomes cancer - that's a lot of people not having to get pieces of their cervix surgically removed because of a vaccine.
On the second part, it's tricky - is this a viable form of cancer prevention?
Most sexually active people get infected with HPV at some point - it's super contagious, condoms are only so effective (mode of transmission being skin to skin, so fluid containment only does so much). Many infections clear within 1-2 years, but a lot don't. HPV infection is considered a near-necessary causal factor for cervical cancer - you see wording like HPV is detected in 'virtually all' and '>99%' of cervical cancers. A highly-transmissible virus with discrete high-risk strains that induces an otherwise symptom-free infection associated with a relatively common, potentially fatal cancer - a vaccine is pretty much the best public health intervention imaginable!
The effectiveness of the vaccines in preventing infection seems pretty good so far. In 2013, The Journal of Infectious Diseases published this finding (html, full text):
We found a decrease in vaccine type HPV prevalence among a nationally representative sample of females 14–19 years old in the vaccine era (2007–2010) compared with the prevaccine era (2003–2006). No decreases were observed in other age groups. Our point estimate of a 56% decrease in prevalence is greater than expected, considering vaccination history in our data and vaccine coverage estimates from national immunization surveys. In NHANES 2007–2010, only 34% of females in this age group reported receipt of at least 1 HPV vaccine dose. National immunization surveys found that coverage by at least 1 dose among females aged 13–17 years increased from 25% in 2007 to 49% in 2010.In a comment on that study, the CDC released a statement including this comment from CDC Director Tom Frieden:
"Our low vaccination rates represent 50,000 preventable tragedies – 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates. For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes.”A 2015 study published in New England Journal of Medicine (html, full text):
In the per-protocol efficacy population, the incidence rate of high-grade disease related to HPV-31, 33, 45, 52, and 58 was 0.1 per 1000 person-years in the 9vHPV group and 1.6 per 1000 person-years in the qHPV group (1 case vs. 30 cases) [...] The single participant with HPV-58–positive grade 2 cervical epithelial neoplasia in the 9vHPV vaccine group had positive results for HPV-56 at baseline and in all specimens obtained between day 1 and the time of diagnosis, with HPV-58 detected only at the time of diagnosis. In contrast, the incidences of high-grade cervical, vulvar, and vaginal disease in the qHPV group continued to increase over time.At the time this study was conducted, it was no longer considered ethical to compare the vaccine to placebo, the vaccine having been proven to be effective already, so that's why the comparison was made between vaccines that protect against 4 or 9 strains of HPV.
It has been about 10 years since HPV vaccines were first introduced in the US. The people who received those vaccines would have been 11, 12 years old then. Because of the fairly long time to develop cervical cancer from time of infection, we wouldn't expect a lot of cervical cancer cases in the 22-25 year old crowd, even in a condition of no vaccine uptake. It will be a few more years before results on cancer prevention become clear, as the cohort of people who were 11 or younger in 2006 reach an age where cancer risk becomes more common. Due to the rarity of the other cancers preventable by HPV vaccines, it may be even longer to determine the long-term cancer prevention efficacy of the vaccines.
But a hugely important factor is clearly being removed from the causal pie. Unless our epidemiology on the link between HPV and cervical cancer was way off, we should expect a significant reduction in cancers as vaccination rates increase and the vaccinated population ages. People born after, say, 1995 who get HPV then develop pre-cancerous cells or cancer? There are a lot of real people, who will really be suffering from decisions made by their parents. If anything, I hope those ads encourage pediatricians to continue their hard, thankless, essential work convincing intransigent parents - because it really matters!
caveat: I am an infectious disease epidemiologist, not a cancer epidemiologist. This is not my sub-specialty (tropical disease), but I sure did a lot of reading before my colposcopy. My daughter will be vaccinated against HPV. My pediatrician loves me.
posted by palindromic at 5:40 PM on August 18, 2016 [33 favorites]
Counter: this is something that should come from your doctor, not your television (assuming you have a doctor).
I'm an epidemiologist. My background is in vaccine development and toxicology. The AMA's statement only obliquely refers to vaccines and preventive health measures (i.e. there's not a banging black market for the flu vaccine). The AMA's statement directly refers to literally everything else.
No physician has ever been bummed out by a patient asking, "hey, I saw this ad for a vaccine... can I get it?" Many physicians (I wish more physicians) are bummed out by patients asking, "hey, I saw this ad for a miraculous sounding drug that will resolve my pain / heart disease / diabetes / high blood pressure / etc. and I want it no matter what."
posted by late afternoon dreaming hotel at 5:42 PM on August 18, 2016 [16 favorites]
I'm an epidemiologist. My background is in vaccine development and toxicology. The AMA's statement only obliquely refers to vaccines and preventive health measures (i.e. there's not a banging black market for the flu vaccine). The AMA's statement directly refers to literally everything else.
No physician has ever been bummed out by a patient asking, "hey, I saw this ad for a vaccine... can I get it?" Many physicians (I wish more physicians) are bummed out by patients asking, "hey, I saw this ad for a miraculous sounding drug that will resolve my pain / heart disease / diabetes / high blood pressure / etc. and I want it no matter what."
posted by late afternoon dreaming hotel at 5:42 PM on August 18, 2016 [16 favorites]
I got the Gardasil vaccine eight years ago in my mid-twenties. I had to wait (very impatiently) a little longer because it was not yet approved in my country of residence. Fast forward to when I turned 30 and got a HPV test. I cannot tell you how relieved and surprised I was when the results were negative. No doubt, this was due in large part to having gotten the Gardasil vaccination.
I'm careful when it comes to safer sex but I also like to have fun and live life fully. Back in her early twenties and right before Gardasil was available, friend of mine dealt with hell after an abnormal Pap, a positive HPV test, and the resulting medical treatments and stress. Fortunately, she's been able to have children and is currently in good health but she wouldn't want anyone to go through what she did -- and she considers herself one of the lucky ones. There shouldn't be stigma around having HPV but let's avoid it when possible. Fortunately, the vaccine makes it much easier to do.
I am incredibly and unapologetically pro-vaccine, and I believe Gardasil should be free and mandatory. Some people are against vaccines but they generally haven't had to deal with polio and other diseases that could have been eradicated but now are regaining traction. Would people react so negatively if the ad were for a different vaccine such as polio?
I'm not a parent but I teach at a public school that is low-income. Many families don't have health insurance and/or regular access to a pediatrician or a GP. However, the parents obviously love their children and want what's best for them. If parents see a convincing ad on TV, they can contact the local health department and see if the vaccine is covered and their child eligible. Therefore, I full support those ads being shown due to the increased buy-in and improved personal and public health.
posted by smorgasbord at 5:56 PM on August 18, 2016 [5 favorites]
I'm careful when it comes to safer sex but I also like to have fun and live life fully. Back in her early twenties and right before Gardasil was available, friend of mine dealt with hell after an abnormal Pap, a positive HPV test, and the resulting medical treatments and stress. Fortunately, she's been able to have children and is currently in good health but she wouldn't want anyone to go through what she did -- and she considers herself one of the lucky ones. There shouldn't be stigma around having HPV but let's avoid it when possible. Fortunately, the vaccine makes it much easier to do.
I am incredibly and unapologetically pro-vaccine, and I believe Gardasil should be free and mandatory. Some people are against vaccines but they generally haven't had to deal with polio and other diseases that could have been eradicated but now are regaining traction. Would people react so negatively if the ad were for a different vaccine such as polio?
I'm not a parent but I teach at a public school that is low-income. Many families don't have health insurance and/or regular access to a pediatrician or a GP. However, the parents obviously love their children and want what's best for them. If parents see a convincing ad on TV, they can contact the local health department and see if the vaccine is covered and their child eligible. Therefore, I full support those ads being shown due to the increased buy-in and improved personal and public health.
posted by smorgasbord at 5:56 PM on August 18, 2016 [5 favorites]
"The ads bully parents"; "The ads give information to hold parents accountable."
More importantly, they are ads.
They are viral elements hauling their commercial payload into the delicate balance of discourse.
posted by adoarns at 6:23 PM on August 18, 2016
More importantly, they are ads.
They are viral elements hauling their commercial payload into the delicate balance of discourse.
posted by adoarns at 6:23 PM on August 18, 2016
There are ads that encourage patients to demand drugs that might not be the best or most cost-effective treatment option for them. This isn't one of them.
If you think you've got a better solution for preventing infection with cancer-causing strains of HPV, let's hear it. "Telling people not to have sex" has been tried and found not to be very effective, so don't suggest that.
posted by Anne Neville at 6:38 PM on August 18, 2016 [7 favorites]
If you think you've got a better solution for preventing infection with cancer-causing strains of HPV, let's hear it. "Telling people not to have sex" has been tried and found not to be very effective, so don't suggest that.
posted by Anne Neville at 6:38 PM on August 18, 2016 [7 favorites]
I think it wouldn't be a bad idea to require any parents who want a religious or philosophical exemption to school vaccination requirements to read some literature or watch some videos about the effects of communicable diseases. They should know what risks they are imposing on their children.
posted by Anne Neville at 6:49 PM on August 18, 2016 [1 favorite]
posted by Anne Neville at 6:49 PM on August 18, 2016 [1 favorite]
Just saw a 32 year old in clinic today so I post. Too old for the vaccine. The cervical cancer is everywhere. She's burnt through cutting edge clinical trials and the regular chemo. She would like perhaps try surfing before she dies. Let's raise awareness about this thing please. The side effects are minimal. Her death at this young age was really preventable. At least she's allowed to smoke some medical pot before she goes out.
posted by skepticallypleased at 6:51 PM on August 18, 2016 [35 favorites]
posted by skepticallypleased at 6:51 PM on August 18, 2016 [35 favorites]
There are knowledgeable people here, I wonder if anyone can share some insight. This virus (or set of strains) can be fatal, evidently. Yet, most people you sleep with will carry it, and show no signs. (Some are nervous and disclose; many don't give it a second thought, or know they have it.) It might appear, disappear, reappear, and disappear again from one test to another. (Not really, I know; it's whether your immune system permits it to show itself or not. Or does it go away?) And, should a cancer emerge, it's slow-growing, and can apparently can be removed in a simple in-office procedure, if Ask, for example, is to be believed.
Is it both as easy as all that - fine, manageable, as long as there's regular monitoring - and as scary as it probably needs to be for these ads? (Or are adults being told a different story, one that lets them sleep?)
(The vaccine should totally just be mandatory, imo)
posted by cotton dress sock at 8:15 PM on August 18, 2016 [1 favorite]
Is it both as easy as all that - fine, manageable, as long as there's regular monitoring - and as scary as it probably needs to be for these ads? (Or are adults being told a different story, one that lets them sleep?)
(The vaccine should totally just be mandatory, imo)
posted by cotton dress sock at 8:15 PM on August 18, 2016 [1 favorite]
This isn't worthy of an article; there's no actual debate. The only folks they could find who oppose the ads are some people on twitter and an anti-vaccination activist group.
posted by sid at 10:05 PM on August 18, 2016 [1 favorite]
posted by sid at 10:05 PM on August 18, 2016 [1 favorite]
Cotton dress sock, there are a lot of strains of HPV. Most of them do not cause cancer. In most cases, the body's own immune system clears the infection away. In a relatively small percentage of people, the infection persists over years, and causes the cellular changes that can develop into cancer. Why some infections persist when most are cleared away is not known. Just like when most people get the flu, they spend a few days in bed drinking soup and wishing they were dead, but a small percentage end up in the ICU on a ventilator.
For people with persistent HPV and precancerous changes, regular surveillance can indeed prevent cancer or catch it at its earliest stages. But even those people need frequent checkups and the procedures that remove precancerous tissue are not exactly fun. (Plus then there are the folks with genital warts).
And then there are the people who are unlucky, either because they've skipped paps (not uncommon, especially in healthy young women without a lot of money) or because they have very aggressive cancer. I've only had one patient with metastatic cervical cancer. She was also in her early 30s, she had small children and she was very, very angry that she was going to leave them soon.
So the answer to your question is yes. For most people, it's NBD. For some people, it results in their lives being periodically inconvenient, uncomfortable or embarrassing. But for about 12,000 women in the US every year, it results in a diagnosis of invasive cancer, and for about 4000 women a year, it results in death. Multiply those percentages by a lot for countries that don't have good screening systems in place.
posted by The Elusive Architeuthis at 10:13 PM on August 18, 2016 [15 favorites]
For people with persistent HPV and precancerous changes, regular surveillance can indeed prevent cancer or catch it at its earliest stages. But even those people need frequent checkups and the procedures that remove precancerous tissue are not exactly fun. (Plus then there are the folks with genital warts).
And then there are the people who are unlucky, either because they've skipped paps (not uncommon, especially in healthy young women without a lot of money) or because they have very aggressive cancer. I've only had one patient with metastatic cervical cancer. She was also in her early 30s, she had small children and she was very, very angry that she was going to leave them soon.
So the answer to your question is yes. For most people, it's NBD. For some people, it results in their lives being periodically inconvenient, uncomfortable or embarrassing. But for about 12,000 women in the US every year, it results in a diagnosis of invasive cancer, and for about 4000 women a year, it results in death. Multiply those percentages by a lot for countries that don't have good screening systems in place.
posted by The Elusive Architeuthis at 10:13 PM on August 18, 2016 [15 favorites]
Is it both as easy as all that - fine, manageable, as long as there's regular monitoring
In the US, the 5 year survival rate for cervical cancer is 68% and if it's not caught early, the treatment can involve pretty nasty side effects including bowel and bladder problems and may require hysterectomies (or more extensive removal of the reproductive organs) and all that they entail. Younger women may have to chose between trying to maintain their fertility and the most effective treatments. It's not as minor as skin cancers that are caught early.
Roughly 1 out of 10,000 adult women in the US will be diagnosed with it each year - not as bad as some cancers, but certainly not nothing.
There's also less quantified cases of anal, penile, and oral cancers caused by some of the same strains of HPV. The CDC estimates 8,000 cases of cancer are caused in men each year by HPV and there is no recommended test for men nor are women routinely checked for non-cervical HPV caused cancers prior to them becoming symptomatic.
I will note that the long term efficacy of the vaccines is not yet known (because they've not been around long enough), though IIRC there is at least some drop off with time. For the time being, we know it's helping - a 2013 study showed a 56% reduction in the vaccine targeted strains of HPV in teen girls since it was introduced in 2006. Perhaps not coincidentally, the vaccination rate at the time was approximately 50% at the time.
posted by Candleman at 11:18 PM on August 18, 2016 [3 favorites]
In the US, the 5 year survival rate for cervical cancer is 68% and if it's not caught early, the treatment can involve pretty nasty side effects including bowel and bladder problems and may require hysterectomies (or more extensive removal of the reproductive organs) and all that they entail. Younger women may have to chose between trying to maintain their fertility and the most effective treatments. It's not as minor as skin cancers that are caught early.
Roughly 1 out of 10,000 adult women in the US will be diagnosed with it each year - not as bad as some cancers, but certainly not nothing.
There's also less quantified cases of anal, penile, and oral cancers caused by some of the same strains of HPV. The CDC estimates 8,000 cases of cancer are caused in men each year by HPV and there is no recommended test for men nor are women routinely checked for non-cervical HPV caused cancers prior to them becoming symptomatic.
I will note that the long term efficacy of the vaccines is not yet known (because they've not been around long enough), though IIRC there is at least some drop off with time. For the time being, we know it's helping - a 2013 study showed a 56% reduction in the vaccine targeted strains of HPV in teen girls since it was introduced in 2006. Perhaps not coincidentally, the vaccination rate at the time was approximately 50% at the time.
posted by Candleman at 11:18 PM on August 18, 2016 [3 favorites]
When I [male] wanted to get a gardasil vaccination, it wasn't even a thing they gave men, at least in the US. But I found a doctor that specialized in gay men that would do it, because I guess they were more at risk (I'm straight). It was weird that it was so hard to find.
But three shots to prevent penis cancer? What a deal! That's one of the cancers I most want to avoid!
posted by ryanrs at 12:01 AM on August 19, 2016 [1 favorite]
But three shots to prevent penis cancer? What a deal! That's one of the cancers I most want to avoid!
posted by ryanrs at 12:01 AM on August 19, 2016 [1 favorite]
P.S. It is less painful than even a flu shot. Didn't even make my arm sore. You do need 3 shots though, several weeks apart. I think it cost me about $200 with no insurance coverage.
posted by ryanrs at 12:07 AM on August 19, 2016 [1 favorite]
posted by ryanrs at 12:07 AM on August 19, 2016 [1 favorite]
But Hep C? Look, I told my sons 'listen, the only way you'll get Hep C is if you use needles and have unsafe sex. So, don't use needles or have unsafe sex!' Easy as that, no need for a vaccine."
Anytime you wonder how, in this day and age, people have horrific and/or deadly workplace safety accidents that were easily preventable by basic safety procedures, look no further than this mentality. "I don't need to set up that safety equipment, only an idiot would ...".
posted by tocts at 6:49 AM on August 19, 2016 [2 favorites]
Anytime you wonder how, in this day and age, people have horrific and/or deadly workplace safety accidents that were easily preventable by basic safety procedures, look no further than this mentality. "I don't need to set up that safety equipment, only an idiot would ...".
posted by tocts at 6:49 AM on August 19, 2016 [2 favorites]
I think the discussion here has covered the topic very well, but one more thing to add: cervical cancer is a disease that still has very large outcome disparities based on ethnicity, socioeconomic status, and sexual orientation. We have so many structural problems with the delivery of effective care to all -- giving the Gardasil vaccine is one of the easier (gosh, relatively) ways of pulling that lever and reducing rates of cervical cancer in the future, even if we haven't solved the problem of providing high quality care with dignity and respect to all.
posted by telegraph at 7:05 AM on August 19, 2016 [5 favorites]
posted by telegraph at 7:05 AM on August 19, 2016 [5 favorites]
I got the vaccine in my early twenties because our college campus offered it, thankfully. My children, a girl and a boy, will be vaccinated as soon as they are old enough. I can help prevent my kids from getting cancer and THAT IS AMAZING.
I remember having these conversations in 2006-ish, when people objecting to the vaccine would trot out the "but it only covers some strains that cause cancer" routine and it would just blow my mind. Wow, so you have a chance of reducing your risk of cervical cancer by oh, 80 or 90% and that's your problem with it? That it's not 100%? What kind of risk assessment is that?
Of course, their argument was actually "sluts," which is why this ad is necessary.
posted by lydhre at 7:35 AM on August 19, 2016 [9 favorites]
I remember having these conversations in 2006-ish, when people objecting to the vaccine would trot out the "but it only covers some strains that cause cancer" routine and it would just blow my mind. Wow, so you have a chance of reducing your risk of cervical cancer by oh, 80 or 90% and that's your problem with it? That it's not 100%? What kind of risk assessment is that?
Of course, their argument was actually "sluts," which is why this ad is necessary.
posted by lydhre at 7:35 AM on August 19, 2016 [9 favorites]
I try not to argue about vaccines with people because they don't need to hear it from a healthy, middle-class dude. They need to hear it from someone who got their life ruined by not getting a vaccine.
But the few times I have gotten into a discussion/argument about it, I simply ask:
"Do you wear your seatbelt"?
"Yeah, of course. Why?"
"Do you plan on crashing?"
"No..."
"Then why do you wear it?"
It's not like it's triggered an epiphany, and some folks are always stubborn, but it does get the message across sometimes.
posted by -1 at 7:58 AM on August 19, 2016 [4 favorites]
But the few times I have gotten into a discussion/argument about it, I simply ask:
"Do you wear your seatbelt"?
"Yeah, of course. Why?"
"Do you plan on crashing?"
"No..."
"Then why do you wear it?"
It's not like it's triggered an epiphany, and some folks are always stubborn, but it does get the message across sometimes.
posted by -1 at 7:58 AM on August 19, 2016 [4 favorites]
But three shots to prevent penis cancer? What a deal! That's one of the cancers I most want to avoid!
posted by ryanrs at 3:01 AM on August 19 [+] [!]
I thought it manifested as either cervical or throat cancer? But not penis cancer.
I literally cannot wait to for my son to get this shot (just like I was counting down the days till his MMR). 10 years to go!
posted by St. Peepsburg at 8:32 AM on August 19, 2016
posted by ryanrs at 3:01 AM on August 19 [+] [!]
I thought it manifested as either cervical or throat cancer? But not penis cancer.
I literally cannot wait to for my son to get this shot (just like I was counting down the days till his MMR). 10 years to go!
posted by St. Peepsburg at 8:32 AM on August 19, 2016
Just an FYI to everyone:
Your county or state Health Department might offer Gardisil at a very reduced rate, even if you have insurance and do not qualify as low-income. We couldn't really afford to have our kids get the vaccine at our doctor's office (it's not on the CDC site so insurance won't necessarily cover some or any of it, plus the office co-pay; it would have been $300 for each shot, each kid...$1800 in the end) so I checked out our county Health Department: $15 per shot (vs. $5 for other vaccines), no co-pay. The only downside was that the HD was only open certain days and times, but I was going to have to take off work and take them out of school anyway, so it wasn't that big of a deal.
Also, we donated $50 to the Health Department (you can do that!) each time we went in. $300 was doable; $1800 not so much.
posted by cooker girl at 8:40 AM on August 19, 2016 [2 favorites]
Your county or state Health Department might offer Gardisil at a very reduced rate, even if you have insurance and do not qualify as low-income. We couldn't really afford to have our kids get the vaccine at our doctor's office (it's not on the CDC site so insurance won't necessarily cover some or any of it, plus the office co-pay; it would have been $300 for each shot, each kid...$1800 in the end) so I checked out our county Health Department: $15 per shot (vs. $5 for other vaccines), no co-pay. The only downside was that the HD was only open certain days and times, but I was going to have to take off work and take them out of school anyway, so it wasn't that big of a deal.
Also, we donated $50 to the Health Department (you can do that!) each time we went in. $300 was doable; $1800 not so much.
posted by cooker girl at 8:40 AM on August 19, 2016 [2 favorites]
I thought it manifested as either cervical or throat cancer? But not penis cancer.
Certain strains of HPV are definitely linked to penile cancer (as well as various parts of the vulva).
posted by Candleman at 9:23 AM on August 19, 2016 [1 favorite]
Certain strains of HPV are definitely linked to penile cancer (as well as various parts of the vulva).
posted by Candleman at 9:23 AM on August 19, 2016 [1 favorite]
I'm trying to understand whether the vaccine is considered deductible-proof preventative care: this HHS link seems to suggest it is covered for all women and this healthcare.gov link seems to suggest it is for everyone - can anyone help clarify? I'm surprised and disappointed if it isn't, because it does seem like pretty textbook preventative medicine.
posted by R a c h e l at 9:28 AM on August 19, 2016
posted by R a c h e l at 9:28 AM on August 19, 2016
Thank you for answering my question so comprehensively, The Elusive Architeuthis. And Candleman, and telegraph - it does seem that an equitable and accessible health care system plays a critical role in outcomes.
One thing I'm still a little confused about is what "cleared" means - it seems that there's a question as to whether after treatment of cervical cancer (i.e. the removal of cells that have been triggered to replicate in the wrong ways), the virus remains in the body in a latent state, and is suppressed by an immune system that's been told what's what and is now on the ball since the assault has been contained, and just doesn't show up on tests in detectable quantities, or whether the virus is "cleared" (presumably leaves the body?).
posted by cotton dress sock at 9:54 AM on August 19, 2016
One thing I'm still a little confused about is what "cleared" means - it seems that there's a question as to whether after treatment of cervical cancer (i.e. the removal of cells that have been triggered to replicate in the wrong ways), the virus remains in the body in a latent state, and is suppressed by an immune system that's been told what's what and is now on the ball since the assault has been contained, and just doesn't show up on tests in detectable quantities, or whether the virus is "cleared" (presumably leaves the body?).
posted by cotton dress sock at 9:54 AM on August 19, 2016
Rachel, the healthcare.gov information only pertains to Marketplace (aka Obamacare) plans and "many other plans." It may not necessarily be deductible-proof under all insurance plans. And as I look at the HHS site, I'm seeing the same thing.
posted by cooker girl at 11:52 AM on August 19, 2016
posted by cooker girl at 11:52 AM on August 19, 2016
I see that it's on healthcare.gov, but I think those rules are specifically talking about the preventative care which is legally required of most plans. In this case, I believe the "many other plans" that provide the preventative care listed under those links refers to all private plans that aren't grandfathered in. Here's how the Kaiser Family Foundation explains that:
That page also explains the vaccine-related guidelines more clearly:
Not to discount the other important subsidized/free HPV vaccine programs that exist - I know I got at least one round for free from the health center at my high school, which is pretty awesome - but most insured people in the target group should not have to pay out-of-pocket for the vaccine (unfortunately the office visit is still fair game) under current rules. I didn't realize that, and it sure wasn't clear from my first round of searching, so hopefully it's helpful information to someone else!
posted by R a c h e l at 12:33 PM on August 19, 2016
These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status. In order to have been classified as “grandfathered,” plans must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions). In 2014, 26% of workers covered in employer sponsored plans were still in grandfathered plans, and it is expected that over time almost all plans will lose their grandfathered status.So ~75% of people in employer sponsored plans and all people in marketplace plans should be covered by the rules on free preventative care regardless of deductible.
That page also explains the vaccine-related guidelines more clearly:
Health plans must also provide coverage without cost-sharing for immunizations that are recommended and determined to be for routine use by the Advisory Committee on Immunization Practices (ACIP), a federal committee comprised of immunization experts that is convened by the Centers for Disease Control and Prevention. These guidelines require coverage for adults and children and include immunizations such as influenza, meningitis, tetanus, HPV, hepatitis A and B, measles, mumps, rubella, and varicella. An ACIP recommendation is considered to be issued on the date that it is adopted by the Director of the CDC.Lower still, you'll see more explicit HPV-related guidelines for preventative care from private plans that aren't grandfathered in (PDF links for adults and children). That specifically explains that women between 11-26 and men between 11-21 as well as "at risk" men who are 21-26 should be eligible for "free" HPV vaccines no matter their deductible.
Not to discount the other important subsidized/free HPV vaccine programs that exist - I know I got at least one round for free from the health center at my high school, which is pretty awesome - but most insured people in the target group should not have to pay out-of-pocket for the vaccine (unfortunately the office visit is still fair game) under current rules. I didn't realize that, and it sure wasn't clear from my first round of searching, so hopefully it's helpful information to someone else!
posted by R a c h e l at 12:33 PM on August 19, 2016
Is it both as easy as all that - fine, manageable, as long as there's regular monitoring - and as scary as it probably needs to be for these ads? (Or are adults being told a different story, one that lets them sleep?)
I see these questions have been mostly answered quite well, but I wanted to speak a little more generally about how public health interventions are chosen.
Public health, at its core, is about improving the health of populations. Even the best health interventions carry some risk. In an ideal world, public health decision-makers would balance factors such as disease prevalence, disease severity, efficacy of interventions, and harms related to interventions. In practice, each of those factors also runs into the issue of resource availability. The question, then, is how can we most effectively improve the health of the most people without running up costs or causing additional harms via our interventions?
Take, for example, the yellow fever vaccine. It is one of the most effective vaccines humanity has ever produced - >99% of recipients develop a lifelong immunity to the virus within a month of a single dose. That is good. And it's pretty safe too. Yet this masterpiece of a vaccine is not routinely administered in the US - why? Because there's no yellow fever in the US. Even the extremely low risk of harm from the vaccine is outweighed by the total lack of risk for yellow fever in this context.
That was sort of a canned example, but we've seen examples of this play out in the real world. There are two kinds of polio vaccine, for example - the oral vaccine contains 'live' attenuated virus matter, while the injection contains inactivated viral particles. The oral vaccine produces a longer lasting immunity and requires less infrastructure to administer than the injected version, but it carries a very rare risk (on the order of 1 in 1,000,000) of causing polio disease in recipients. In areas where polio is still endemic, the oral vaccine tends to be preferred because it travels well and is easy to administer. In countries where polio has been eliminated, we use the inactivated vaccine almost exclusively - because the risk of polio from the oral vaccine is orders of magnitude greater than the risk of contracting polio in some other way.
To get back to the HPV vaccine: this is a relatively new public health intervention with its own associated risk and costs. Like yellow fever and polio, it works against a serious, potentially life-threatening disease. Unlike yellow fever and polio, it can take years from time of exposure to become a life-threatening disease. In the lead up to becoming a life-threatening disease, there are procedures that can be done to mitigate against potentially fatal disease, but each of those procedures carries its own risks and costs. The follow-up for infected people may last for many years and require multiple procedures to prevent mortality.
In an ideal world, where there were no disparities in access to health care and all people potentially exposed to HPV received timely, appropriate diagnosis and treatment, it is still possible to make an argument in favor of vaccination. If the risks and costs of long-term monitoring and treatment of potentially exposed people are greater than the risks and costs of mass vaccination, then mass vaccination would be a good public health intervention. How one calculates the costs and benefits of a given intervention versus a different intervention or none at all is complicated, political, and the stuff of much rowdy debate among public health decision-makers.
In our less than ideal world, the treatments can be as easy as all that, if you catch it soon enough, if you have good health insurance, if you're already in pretty good health. Even in that relatively easy scenario, there are a variety of risks for each intervention, with increasing risk as more invasive procedures are needed. By the time outpatient procedures are being done, there is increased risk of miscarriage for subsequent pregnancies, risk of infection, costs to manage post-treatment bleeding, loss of time for work/school/childcare/etc, the monetary costs of treatment itself (either to the patient or insurer).
How many of those procedures, those extra paps, those lost hours, days, and dollars could have been avoided with mass vaccination? How many vaccinated people would it take to prevent 1 colposcopy, 1 LEEP procedure, 1 conic biopsy, 1 hysterectomy, 1 round of chemotherapy? How much risk and cost is averted by having a larger proportion of the population receiving a pap smear every three years instead of every year? Is there a better, more cost-effective approach to prevent those adverse health outcomes? These are the kinds of wonky questions that are central to public health decision-making.
In my opinion, the vaccine is a good deal, even at its currently inflated price. Its value will only improve as costs per vaccinated person decline.
And in my dream world: enough people get vaccinated over a long enough time that we reach a point where most strains of HPV are eliminated from the population, and the number of HPV+ paps and cervical cancer cases approach 0. At that point it would be a valid public health question to ask whether the vaccine now confers more risk than the risk of becoming infected. Thus the circle of wonky public health policy decision-making is unbroken!
posted by palindromic at 1:33 PM on August 19, 2016 [9 favorites]
I see these questions have been mostly answered quite well, but I wanted to speak a little more generally about how public health interventions are chosen.
Public health, at its core, is about improving the health of populations. Even the best health interventions carry some risk. In an ideal world, public health decision-makers would balance factors such as disease prevalence, disease severity, efficacy of interventions, and harms related to interventions. In practice, each of those factors also runs into the issue of resource availability. The question, then, is how can we most effectively improve the health of the most people without running up costs or causing additional harms via our interventions?
Take, for example, the yellow fever vaccine. It is one of the most effective vaccines humanity has ever produced - >99% of recipients develop a lifelong immunity to the virus within a month of a single dose. That is good. And it's pretty safe too. Yet this masterpiece of a vaccine is not routinely administered in the US - why? Because there's no yellow fever in the US. Even the extremely low risk of harm from the vaccine is outweighed by the total lack of risk for yellow fever in this context.
That was sort of a canned example, but we've seen examples of this play out in the real world. There are two kinds of polio vaccine, for example - the oral vaccine contains 'live' attenuated virus matter, while the injection contains inactivated viral particles. The oral vaccine produces a longer lasting immunity and requires less infrastructure to administer than the injected version, but it carries a very rare risk (on the order of 1 in 1,000,000) of causing polio disease in recipients. In areas where polio is still endemic, the oral vaccine tends to be preferred because it travels well and is easy to administer. In countries where polio has been eliminated, we use the inactivated vaccine almost exclusively - because the risk of polio from the oral vaccine is orders of magnitude greater than the risk of contracting polio in some other way.
To get back to the HPV vaccine: this is a relatively new public health intervention with its own associated risk and costs. Like yellow fever and polio, it works against a serious, potentially life-threatening disease. Unlike yellow fever and polio, it can take years from time of exposure to become a life-threatening disease. In the lead up to becoming a life-threatening disease, there are procedures that can be done to mitigate against potentially fatal disease, but each of those procedures carries its own risks and costs. The follow-up for infected people may last for many years and require multiple procedures to prevent mortality.
In an ideal world, where there were no disparities in access to health care and all people potentially exposed to HPV received timely, appropriate diagnosis and treatment, it is still possible to make an argument in favor of vaccination. If the risks and costs of long-term monitoring and treatment of potentially exposed people are greater than the risks and costs of mass vaccination, then mass vaccination would be a good public health intervention. How one calculates the costs and benefits of a given intervention versus a different intervention or none at all is complicated, political, and the stuff of much rowdy debate among public health decision-makers.
In our less than ideal world, the treatments can be as easy as all that, if you catch it soon enough, if you have good health insurance, if you're already in pretty good health. Even in that relatively easy scenario, there are a variety of risks for each intervention, with increasing risk as more invasive procedures are needed. By the time outpatient procedures are being done, there is increased risk of miscarriage for subsequent pregnancies, risk of infection, costs to manage post-treatment bleeding, loss of time for work/school/childcare/etc, the monetary costs of treatment itself (either to the patient or insurer).
How many of those procedures, those extra paps, those lost hours, days, and dollars could have been avoided with mass vaccination? How many vaccinated people would it take to prevent 1 colposcopy, 1 LEEP procedure, 1 conic biopsy, 1 hysterectomy, 1 round of chemotherapy? How much risk and cost is averted by having a larger proportion of the population receiving a pap smear every three years instead of every year? Is there a better, more cost-effective approach to prevent those adverse health outcomes? These are the kinds of wonky questions that are central to public health decision-making.
In my opinion, the vaccine is a good deal, even at its currently inflated price. Its value will only improve as costs per vaccinated person decline.
And in my dream world: enough people get vaccinated over a long enough time that we reach a point where most strains of HPV are eliminated from the population, and the number of HPV+ paps and cervical cancer cases approach 0. At that point it would be a valid public health question to ask whether the vaccine now confers more risk than the risk of becoming infected. Thus the circle of wonky public health policy decision-making is unbroken!
posted by palindromic at 1:33 PM on August 19, 2016 [9 favorites]
Just a note in the United States, your State Department of Public Health runs vaccine programs for FREE for children. So if money is the issue, your DPH will have some method of obtaining it. I sure didn't know all the things they did.
posted by AlexiaSky at 6:46 PM on August 19, 2016 [1 favorite]
posted by AlexiaSky at 6:46 PM on August 19, 2016 [1 favorite]
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posted by praemunire at 11:57 AM on August 18, 2016 [116 favorites]