Here we go again: The pharmaceutical maker Merck is seeking approval from the FDA for boys as young as 9 to get the Gardasil vaccine, which prevents some strains of the Human Papilloma Virus (or HPV), a virus spread during sex which, in turn, can cause cervical cancer in women.
This is not a case against giving kids of either sex the vaccine for reasons of principle, though such reasons might suffice. The vaccine, targeted to children and very young teens, is new. (We don't even know if it will be effective beyond five years or so.) So, giving it to my child? No.
And doesn't giving kids the vaccine -- hard to do that "secretly," since it takes three separate doses during a time kids are not being routinely vaccinated -- communicate that we expect our kids to behave sexually? Could a child easily think, despite a parent's best efforts to communicate otherwise, that he's protected in ways he is not after having "the vaccine"?
Of course. These are kids.
But what really outrages me is that encouraging the routine vaccination of children and very young teens with Gardasil, a push happening now, makes no sense from a public health standpoint.
There are about 40 different strains of sexually transmitted HPV, and while the Gardasil vaccine protects against some of the most problematic ones, it does not guard against all of them.
Anyway, most sexually active people will get HPV at some point, according to a number of reliable medical Web sites. And the body typically clears the virus on its own. In maybe 10 to 20 percent of cases, that won't happen. And some of those cases in women will go on to become cervical cancer.
BTW, while HPV can, rarely, lead to certain genital cancers in men, circumcision greatly reduces such risks, but that's another column. (Actually "circumcision" goes on the list of "topics I will never write about," which in itself may be a column.)
Cervical cancer is almost always curable when caught early, and an extremely effective, easy, and relatively inexpensive test to detect it, the pap smear, is routine. (BTW, the vaccine protects against less than 80 percent of cervical cancer cases, which is why the pap smear is still a must, even after the vaccine. Do most women know this?)
Still, cervical cancer last year afflicted more than 11,000 American women and almost 4,000 died of it, because the cancer wasn't detected early. Truly a tragedy.
But now let's circle back. For starters, the series of vaccines, which may not give protection over the long term, costs, on average, $360. Very expensive compared to other vaccines. No wonder Merck loves it, and would like insurance companies to pay for it. Last year alone, in targeting only half of a very young population, it generated more than $1.5 billion dollars for Merck.
So, there are billions -- yes, billions -- of dollars to be sucked out of our health care system to pay to help prevent a disease that is relatively rare, easily detected, and almost always curable if found early. And consider that almost certainly the same people "responsible" enough to get the vaccine for themselves or their kids will be the same ones having the annual pap tests to begin with.
Yes, any particular individual may be helped by Gardasil. Yes, young adult women and men might want to consider the vaccine, particularly before becoming sexually active.
But from a public health standpoint, to encourage expensive, widespread vaccination of children with Gardasil, as is currently the case? It makes no sense. Or cents.
How about doing something really helpful, and instead spend a fraction of those billions to get women at greatest risk, who aren't likely to be the ones getting Gardasil anyway -- the poor -- a pap test on a regular basis? Why not spend the balance to perhaps fight childhood and adult obesity, now the second leading cause of preventable death in the United States, claiming some 300,000 lives a year?
In other words, can we please do a public health cost/benefit analysis here?
Apparently not. Too often in recent decades when it comes to public health issues in the United States, and very often when it comes to public health and sex, we simply lose our senses -- and our cents.
Bonnie - I couldn't have said it better myself.