smells like teen spirit

as an ob/gyn, i know i'm supposed to be thrilled and wildly enthusiastic about the new HPV vaccine. HPV is a virus of many strains, some of which cause genital warts, and some of which are known to cause cervical cancer. most sexually active people are infected with at least one strain of HPV, even though most of them have neither genital warts nor cervical cancer--HPV is entirely asymptomatic in the vast majority of people.

the HPV vaccine, newly released by the FDA and widely advertised to the general public, can prevent infection when given to individuals not yet exposed to the virus. we think that this will prevent many cases of cervical cancer.

yay, right? nobody wants cancer, and most of us would be happy if told we could do something to prevent it.

still, i have a MAJOR problem with the new push to make the HPV vaccine mandatory to girls ages 9-13 years of age. people pushing for mandatory vaccination (namely a group of female lawmakers in Michigan, and of course, Merck, the drug company that makes it) are proposing that all females entering sixth grade should be required to be vaccinated against HPV. of course, the opposing group of conservatives are arguing that it infringes on parental rights and will encourage young people to have sex.

that's a load of crap, in my opinion. the fear of pregnancy is barely a deterrent for most kids who will start having sex, let alone a virtually symptom-less and usually consequence-less STD. i don't even think there are 3 teenagers in the entire united states who will say, "phew, now that i don't have to worry about HPV, i can start having sex."

as for parental rights, well, there are plenty of other mandatory vaccines, so i don't think the argument carries any more weight than for the others.

no, my problem is that making a vaccination MANDATORY should be reserved for diseases that are communicable with casual contact. after all, with those diseases it is as much a matter of protecting ME as it is YOU. epidemiologists refer to "herd immunity" when a certain percentage of the population is vaccinated against a communicable disease. if the critical threshold is reached, then even unvaccinated individuals are protected against infection because there is no source of communication. and when individuals decide not to vaccinate in greater numbers, then the entire population is at risk for outbreak. therefore, it is as much a matter of public as it is personal interest to require vaccinations for diseases such as smallpox and polio as EVERYBODY is at risk. but HPV is a different story--it requires intimate contact to spread. there are some people who will never ever ever be at risk for HPV no matter how many other people have it. people who are celibate or who are monogamous over a lifetime with a monogamous partner have ZERO percent change of catching it. granted, that group of people might be shrinking, but they still exist.

the first rule of medicine is "do no harm." it is non-hippocratic to force a group of people who are at zero risk of acquiring a disease to be given medication to prevent the disease. vaccines are very very safe--but they are not without risk.

the problem is, it is pretty difficult to tell who, at nine years old, will be at risk for the disease. and by the time risky sexual behavior (or let's face it, even "normal" sexual behavior) emerges, it is often too late for the vaccine. i don't have a good answer for this. but i don't think mandatory vaccination is the answer.

my second problem is with the push to vaccinate FEMALES. yes, women have cervixes and therefore get cervical cancer. but males can get genital warts, and, more importantly, males can spread HPV. actually, if all males were mandatorily vaccinated, then no female would ever have to be--the transmission of the virus would cease. (okay, i suppose there would be a certain amount of female-female spread, but i bet it would be pretty low).

and finally, i'm just sick of the government butting its head into my life at every turn. i am all for laws that protect the public from individuals. sure, drunk driving is illegal, not because we care so much if the drunk kills him/herself, but more because we know drunk drivers kill innocent people. we are protecting society from the drunk driver. but what's up with mandatory seat belt laws? if i, an adult, choose to drive without the protection of a belt, who will it hurt besides me?

and why should the government protect me against myself?

for that matter, why in some aspects but not others? 16-year-olds can go to tanning booths. 47,700 new cases of melanoma are diagnosed each year. 7,700 people will die of melanoma each year. compare that with cervical cancer: 9,700 new cases per year with 3,700 deaths. so while all of our young women are protected against cervical cancer with our snazzy new vaccine, we continue to let them grow melanomas one tan at a time (can you hear me, little sister?). where does it stop? smoking in public is illegal in many areas. good: protect MY lungs. but can we outlaw smoking at home? sure, but those donuts and fast food are next. soon exercise will be mandatory. so will multivitamins.

someone make it stop.

i will continue to encourage my patients to vaccinate their children against HPV. i spent quite a bit of time discussing it with parents during my adolescent gynecology clinic yesterday. luckily, most parents are quite open, realistic, and reasonable when discussing their child's current and future sexuality.

let's keep these decisions to be made between parents, children, and physicians.
government: butt out.


At 1:56 PM, Blogger Bardiac said...

It seems to me that making the vaccine mandatory means that insurance is more likely to cover it, and that medicare/medicade will have to cover it. That means poor girls are way more likely to be vaccinated than if their families have to pony up $300+, no?

I guess that's my assumption. Are there optional vaccines that are covered for medicare/medicaid and such generally (without some special qualification)? Are they $300+?

I'd like to see it required for males, too, but I'm willing to go with girls as a start.

At 4:12 PM, Anonymous Anonymous said...

I completely agree. Our state has manditory seatbelt laws, but does not have a manditory helmet law for motorcycles. Does that make sense? I hope the legislation in Michigan doesn't pass.

At 9:13 PM, Blogger dr. whoo? said...

Freaking A-men! Great post.

At 7:26 AM, Anonymous Anonymous said...

Because the vaccine is recommended by the American Academy of Pediatrics and other specialty groups, insurance companies and Medicaid do cover it. It does not have to be mandatory for coverage to apply.

I totally agree that vaccines that have to do with lifestyle issues should not be mandatory, but HepB has already gone that route and it probably is only a matter of time before the industry convinces the public that HPV should be too.


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