Tuesday, January 30, 2007

I need someone to check my pulse ...

I think there may be something wrong with me.

I can't believe I'm standing with uber-conservative fundamentalist Christians on the topic of Merck's new wonder drug, even if our reasons may differ.

Since June when a federal advisory panel voted unanimously to recommend all girls and women ages 11 to 26 receive Merck's new vaccine for genital warts, Gardasil, which in clinical studies proved to prevent cervical cancers by preventing infection from four strains of the human papilloma virus, I have been waiting for government entities to mandate its use.

Now it seems Merck is pouring its money into pushing its revolutionary new drug -- which, for the record, costs $360 for the three-shot regimen needed for effectiveness -- on state legislatures across the country, hoping they will mandate the costly prevention for all girls beginning at age 11.

Merck isn't saying how much it's spending on this endeavor, but one might imagine such non-disclosure could mean the grand total is a boatload. Why just image, if even a small percentage of states pass measures to require parents vaccinate their girl children against HPV, the company stands to have a lucrative payday ... at least until its patent runs out or until the drug is approved for our boy children and the process starts all over again.

Let me just get a few things off my chest:

I know that HPV is the most common sexually transmitted disease in the world, and particularly devastating to underdeveloped and impoverished nations.

I believe Merck's vaccine is safe and effective.

I fully expect Ittybit to get this vaccine when she turns 11, even if I have to pay out of pocket for it (currently most insurance WILL* cover this preventive measure).

I think the idea that HPV can be completely prevented by morally responsible living is akin to sticking your head in the sand.

I think that discovering that cancer can be caused by a virus is INCREDIBLY exciting for the future of medical research.

BUT ...

Do I want government telling me how to raise my child?

What if I were afraid of the repercussions of vaccines on cognitive development?

What if I was convinced of anecdotal accounts of parents who believed their kids were adversly affected by innoculations instead of peer-reviewed research showing no link between childhood vaccinations and autism?

What if *shudder* I believed in my heart of hearts that giving her the shot would be akin to giving her the keys to a lifetime of debauchery and moral decay?

In short, what if I were someone else?

I suppose there are still choices I could make. I could pull my kid from school and take her education on at home.

Sure, I could fight the good fight and buck the laws of man. But should I have to, especially where medical decisions are concerned?

Mind you, I have no trouble with the use of the term "herding" as it relates to mass innocuations being the most effective way to irradicate dieases.

Yes! I think it's wonderful that this discovery has been made. I think it's a valuable health care tool that all people -- even boys when the drug is approved for use in the other 49 percent of our population -- should seriously consider. Like many have said, I feel there really ARE more pros than cons.

However I wonder if Gardasil, in it's current $360 form, will be made available to the developing world and those marginalized by inadequate medical coverage, where the need is arguably the greatest?

I know this issue may one day go the way of seat belts, the infant car seat and, most recently, the ban of trans fats in NYC restaurants, but I can't help but want government to make its recommendations, decide such discoveries are worth funding for those least likely to afford it, and then step off and let folks make their own decisions.

The last time I checked, the government has a lot on its plate. It has to figure out how the millions of uninsured in this country can get adequate health care; it has to deal with this mess it created in Iraq; the future of education; and what to do about global warming. I really wish it would make some headway on these issues before it goes and tells US how to raise our kids.

And to tell you the truth, I'd just feel a lot better if a single drug company didn't stand to reap the benefit.

*** UPDATE ***

This just in ... it would appear, according to Associated Press reports, that pediatricians and gynecologists from Arizona to New York are refusing to stock Gardasil because of its $360 price tag and what the doctors say is inadequate reimbursement from most insurers.

Surprise, surprise. ...

*** UPDATE II ***

Merck is completing testing of Gardasil on women ages 26 to 45 and will apply for approval for those groups by year’s end; it is testing it in young males and could seek approval in 2008.

*** UPDATE III ***

Rival drugmaker GlaxoSmithKline is developing its own vaccine, Cervarix, and could seek approval this year.


Andrea said...

Heck yeah! Toyfoto for President!

There's a line that is continually being tested and sometimes crossed between responsible law making and over-governing. It's happening more often, and not just in your example (which is an excellent one). If we as an informed public don't stand up and say, "We're not stupid, so while we appreciate your effort, and will take a little help if you offer it, we can make our own decisions, thank you very much."

I cannot stand it when people tell me, in the name of the greater good, how I should be raising my child or thinking. Great post.

BlogWhore said...

A big strong ditto from me.

This is an issue very close to my heart. I contracted HPV, then diagnosed with cervical cancer. A bad doctor over-treated my cancer so poorly that I was lucky to have Maizie.

Before HPV (and husband), I was a slut. Let's not mince words here, a big slut. I slept with a lot of different people - mostly protected sex. And I was all about sexual female power - ya know - the whole," y am i called a slut, but the man is a stud?" I also thought, if the sex is safe, have a ton of it.

I quickly change my platform when 1) I discovered that HPV causes cancer and 2) I had a daughter.

Now, I truly hope she will not explore her sexuality to length I did. I hope she waits sometime to experiments... and then experiments with a lot fewer men than I.

How will I help her to avoid my pitfalls? I don't know. I'm not a religious person... so that removes the fear of hell.

But this shot is definately not the answer... in my book.

Sorry so long winded.

toyfoto said...

Don't be sorry for length, you bring up a really interesting point about something this won't address, and also something that a drug will never address.

I am glad to know that you survived your ordeal and were able to have a daughter. The fact of the matter
is though, you don't need to be a 'slut' to contract HPV. The statistics indicate something between 75 and 80 percent of all sexually active women will become
infected during in their lifetime. That means 3 out of 4 women will
contract the virus that can lead to this type of cancer.

Because genital warts can be present in places a condom doesn't cover, safer sex isn't necessarily the best way to avoid infection. But similarly we should also know that abstinance is not going to protect us either.

Eventually we will partner off and even with all the best intensions
there are no guarantees we'll be safe.

For this reason, I think the shot is a wonderful thing that can have far reaching affects for women's health, and that for health reasons alone it probably should be widely accepted by parents. But I see no reason to rush into mandating its use for everyone.

Sexual diseases aside - which still is a big consideration - I'm with
you in wanting my daughter to make these potentially life-changing
decisions based on a love for herself instead of self loathing.

Now I don't think the shot will take common decency away or incourage promiscuous behavior -- that happens as a result of surging hormones and unfinished brainmatter anyway -- but I know it also has no chance of administering self worth.

Now if Merck could manufacture that in a shot ... I might have to change my tune about mandated vaccines. Of course at that point the government would probably have NO use for a drug that frees women from feelings of inferiority.

kimmyk said...

Having worked in women's health for over 10 years-I think this is a good thing. A step in the right direction.

I see parents bring their children in everyday-children who don't get vaccinated when they should, if at all. I imagine there will be those that don't get their daughters vaccinated for the HPV virus just as they don't for the MMR. And I feel sorry for those children...they weren't given a choice because their parent took that choice away. And for those people-it should be mandated.

SeaBird said...

Hello! I came to your site from Two Okapis. I had heard of this vaccine, but was unaware of some of the other issues you brought up... a good read.


gingajoy said...

this is a really well crafted post on the topic. I've also been thinking "hmmm. does not seem quite right, but can't put my finger on why..." I think there is something that makes me automatically squeamish when it's related to girls and sexual health/reproduction, as if there is a line there that, once crossed....

your point about the fact that one drug company also reaps the benefit is also very well taken.

kimmyk said...

I guess I should be thankful, here in Ohio it paid 100% of my daughters vaccine. That's sad news that they're refusing to offer the shot.

toyfoto said...

KimmyK, the insurance coverage would likely be imperceptable to patients. You wouldn't be billed because most insurance, according to what I read, pays about $12-15 OVER the cost of the $120 per-dose shot.

Doctors say, however, that the reimbursement is not enough to pay for maintenance of its inventory, refrigeration and reporting, etc.