Everything Not Forbidden Is Compulsory

When we last checked in on Gardasil, a vaccine against viruses that cause cervical cancer, the issue was whether the treatment would be allowed at all. HPV viruses are transmitted sexually, and the shot is most effective when given to girls aged 10 to 14; opponents argued that it might encourage preteen promiscuity.

Now the issue is whether the vaccination should be required. Since Gardasil was approved, several states have been mulling mandates for middle-school girls to get the shots. In Maryland, the legislator who sponsored such a bill has just withdrawn it from consideration.

So far, the loudest opposition to these bills has come from religious-right groups like Focus on the Family, which "supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school" because "the decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parent or guardian." The drive to require the shots has largely come from the pharmaceutical company Merck, which -- surprise! -- manufactures the vaccine. The larger medical community has been cooler to the idea, as the Baltimore Sun reported Monday:

The American Academy of Pediatrics, for instance, is urging a go-slow approach, with an initial focus on raising public awareness of HPV and more monitoring of the safety of the vaccine, which had minimal side effects in clinical trials but hasn't been observed in larger-scale rollouts.

"A lot of us are worried it's a little early to be pushing a mandated HPV vaccine," said Dr. Martin Myers, director of the National Network for Immunization Information. "It's not that I'm not wildly enthusiastic about this vaccine. I am. But many of us are concerned a mandate may be premature, and it's important for people to realize that this isn't as clear-cut as with some previous vaccines."

He added, "It's not the vaccine community pushing for this."

The stakes here weren't quite as high as the rhetoric on either side might suggest. Without the Maryland bill, the vaccine will still be available on a voluntary basis. With the bill, parents could receive a religious exemption from its requirements; and if you aren't religious, you could still probably get the exemption if you want it, since the only thing you need to do is sign a form. So the vaccinations would have been more a default setting than an absolute mandate.

But the stench of corporate welfare is still in the air, and so is the smell of social engineering. The terms of the debate have shifted; the issue now is not whether the government should deny us a vaccine that could save lives, but whether it should push it on people who don't want it. You can count me with the fundies on that one.

Comments

R C Dean | January 31, 2007, 11:47am | #

the decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parent or guardian

Sounds about right to me, with the caveat that in many states, a minor over, say, age 14 may have (and should have) the right to get the vaccine without parental approval or knowledge.

Sam Franklin | January 31, 2007, 11:47am | #

I was wondering if you would be allowed to blog this story. Good on ya, Jesse!

Sam Franklin | January 31, 2007, 11:48am | #

Sounds about right to me, with the caveat that in many states, a minor over, say, age 14 may have (and should have) the right to get the vaccine without parental approval or knowledge.

should she be informed of the existence of the vaccine at public schools (assuming public schools continue to exist)?

highnumber | January 31, 2007, 11:49am | #

I am, of course, totally against the vaccine being required, but I admire Merck's chutzpah.

Jesse Walker | January 31, 2007, 11:50am | #

R.C.: I would go along with that.

Sam: Who would stop me?

David | January 31, 2007, 11:51am | #

By my count, vaccinations are already required for Hepatitis B, Pneumococcal conjugate vaccine (PCV), DTaP (diphtheria, tetanus, acellular pertussis), Hib (meningitis), IPV (polio), MMR (measles, mumps, rubella), Varicella (chickenpox), MCV4 (bacterial meningitis), and Hepatitis A.

Should we not require those vaccines?

If you're going to argue against a corporate handout to Merck, then fine -- that's simply an argument to wait for the patent to expire before requiring it. But for the first time in history, we have a CANCER vaccine. That's a pretty big deal. If we're going to mandate a dozen other vaccines, why not tack on a vaccine that will actually eradicate the vast majority of cervical cancer?

Mad Max | January 31, 2007, 11:56am | #

Good on you for taking a sound public-policy position *even though* the "fundies" support it.

I will definitely give a favorable report on this to the Central Conspiracy Headquarters, so that when we fundies take over, you will be given a special exemption from the penalties we would otherwise impose on secularists who oppose our conspiracy.

lunchstealer | January 31, 2007, 11:59am | #

Did anyone ever think of trying this vaccine on males, to prevent their becoming a disease vector?

joe | January 31, 2007, 12:01pm | #

David,

Each of the other diseases you mention (as far as I know) can be spread through the types of person-to-person contact that normally occurs between students in a school setting.

HPV isn't. That's a significant difference.

thoreau | January 31, 2007, 12:01pm | #

David-

I see your point about how a cancer vaccine is at least as big a deal as a vaccine against any other disease. However, there is a difference between the disease in question and some of the diseases you list:

I don't have as much problem mandating (or having policies that strongly encourage) vaccines against serious airborne diseases, or serious diseases that can be spread inadvertently by touching doorknobs, desks, etc. (We'll leave aside for now which diseases are "serious", and whether chickenpox belongs on the same list as some of the others.) We're talking about things that can be easily spread without knowledge or consent.

With a sexually transmitted disease, OTOH, the spread of the disease is most likely to occur via a very deliberate (and usually consensual) act. In that case, it seems more appropriate to make it elective.

No, I'm not about to suggest that a vaccine will encourage promiscuity or anything like that, just that I'm only interested in mandating a vaccine if the disease in question can be spread by routine activities that neither person gave any thought to. Sex is, well, not exactly routine. Yeah, insert your favorite joke here, but it's a very deliberate thing and almost always consensual.

c-cipher | January 31, 2007, 12:02pm | #

Wow, this has to be the least objectionable form of corporate welfare evar.

Vaccinations prevent externalities. A pure libertarian wouldn't mandate vaccines for polio, either. Would polio still have been eradicated? Seems doubtful.

If the prevalence of HPV--which often turns cancerous--is stunted by changing the default vaccination rules, then it seems to be a good policy.

Provided that there is an ability to opt out, this is a lot more like "libertarian paternalism" than classic corporate welfare.

Changing the default rules so that people are less likely to get diseases....goddamn, Jesse Walker, that comes perilously close to just plain good policy.

jb | January 31, 2007, 12:04pm | #

I'm with David. Why is this vaccine different from the already-required ones? HPV is pretty communicable and pretty deadly. If we're requiring any vaccine, this seems like a good one.

Also, when you consider the cost of cancer treatment, this "handout" will take quite a lot of money out of the pocket of the manufacturers and providers of current cancer treatements. We might even save money. It's more of a tech-induced transfer than a handout.

TomHynes | January 31, 2007, 12:13pm | #

Any mention of how much it costs? I think the current price is about $600 for the set of three shots. Not that price matters, it is for the children.

tros | January 31, 2007, 12:15pm | #

Of course I am against any form of coercive chemical conditioning (wow, that's pretty catchy) but although I agree in principle with the fundies I must take issue with their motivations. These people should be less concerned about pre-teen promiscuity and more concerned about Republican politicians fucking their children, literally and figuratively.

Seriously, people, can we think of the children? Cause you know I'm doing it for the children.

grumpy realist | January 31, 2007, 12:17pm | #

*sigh*. Please read up on transmission of HPV strains before commenting any more about it being a "sexually transmitted disease." It can be contacted much more easily than that--public toilet seats being one possible vector. Women will end up contracting HPV even if they practice "safe sex" activities that will avoid other, more typical STDs such as syphilis.

Vaccinations and immunizations are a case where libertarian philosophy breaks down. The idea behind vaccinations/immunizations is that enough of the group members are immune so that it is difficult for a non-immune person to come in contact with an infected person. The higher the percentage of the group protected, the lower the chances of transmission (and it's probably a power law.) This means that your choice to not get vaccinated/immunized doesn't happen in a vacuum--it has definite effects on the people you come in contact with every day.

We tolerate a certain number of non-vaccinated people because there is a bit of a slop factor--as long as they are a very small percentage of the population the increase in transmission risk is negligible. In the case of an epidemic, I doubt that this would be tolerated. You either vaccinate or quarantine EVERYBODY.

Sam Franklin | January 31, 2007, 12:20pm | #

Sam: Who would stop me?

I don't know different periodicals enforce editorial policies in different ways. I can imagine a newspaper, say, where they reported a reporter being put on some kind of probation for diagreeing with the management too often on matters of policy. You know, the article might say what writings got the reporter (or op-ed columnist or cartoonist or whomever) in trouble and how long the probation would be for and what the probationary terms were.

Then the readership could watch as the publically chastised reporter tried to toe the line , while still maintaining personal integrity, by writing in a way that maintained her intellectual integrity while still being sufficiently in tune with editorial policy. I would buy more newspapers than I do now if that ever happened.

But that ain't how this world works. When there are disputes between a reporter and the management of the periodical, those disputes are not reported upon as matters of public interest. This lack of transparency is traditional and goes back a long, long way. It is a tradition that is not going away. The upshot is that I have little idea how any policy disputes between editors and reporters play out.* Maybe it is like Studio 60. Maybe it is more like Waiting for Godot.

If you ever do end up at LAT, I may resubscribe. I don't like what happened with LAT when they failed to cancel my subscription last time around and I found the error by reading my credit reports a year later (its still there!), but for you I would be willing to let bygones be that.

FOOTNOTE

* During my career as a "journalist" I did a monthly column. Things went well for a year, but then one day the newspaper wanted me to sign a new contract that said that the newpaper would not defend me against charges of libel and/or copyright infringement. The contract required me to indemnify the newspaper if there was any problem on these heads. I would not agree to that, and that was the end of my monthly column. If anyone had been following my column, then they would have had no idea why. I think all the other columnists signed on.

thoreau | January 31, 2007, 12:21pm | #

grumpy realist-

I was not aware of the ease of transmission. That may change things.

Overall, I think pushing for mandatory vaccination is probably a bad idea here. Given a little time to get used to the idea, and some time for costs to come down a bit, I think most people will come around on their own.

David | January 31, 2007, 12:22pm | #

For the record, Human Papilloma Virus (HPV) afflicts at least 50 percent of sexually active men and women at some point in their lives. Most studies have found that HPV infection is responsible for more than 90% of the cases of cervical cancer.

joe | January 31, 2007, 12:25pm | #

If grumpy realist is correct, that changes things considerably.

Seamus | January 31, 2007, 12:28pm | #

Should we not require those vaccines?

In the case of chicken pox, absolutely not. In most cases, children contract chicken pox without any adverse effect other than discomfort and missing a few days of school. (Actually, that last one is probably a benefit, not an adverse effect.) The real adverse impact is the loss of work time by the parents who stay home to care for their sick children, and is probably the real reason for the big push for universal vaccination. Given that contracting chicken pox before the onset of puberty usually gives you a lifelong immunity, while the vaccine requires boosters throughout life in order to guard against the (potentially devastating) impacts of getting chicken pox after puberty, I don't see any question.

(Unfortunately, the drive for universal chicken pox vaccination has been so successful that I haven't been able to find anyone in to infect my daughter in her entire 11 years. Given her age, I guess I'll have to get her vaccinated now, unless someone can find me someone with active chicken pox right away. (Or shingles. When I had shingles, my first daughter contracted chicken pox from me, so she's innoculated now.))

tros | January 31, 2007, 12:28pm | #

I think that this vaccine is going to do a lot less than we all think, at least until we know more about which forms of HPV cause cancer. This is something that 70% of women have in one form or another, but it very rarely causes cancer. I'm no expert, but I highly doubt that this vaccine is going to prevent ALL forms of HPV.

John | January 31, 2007, 12:28pm | #

The fundies are just insane on this. Getting the vacination doesn't encourage sex. Is it that hard to tell your daughter, "I know you won't have sex and I trust you, but God forbid something bad happen to you and get this disease or you contract through other means. Also, eventually you will have sex and we might as well get it out of the way now." Is that so hard?

I understand the principle that freedom means the right to be stupid. This is one minor exception to that generally good rule. Force them to get the shots. Their parents will scream and whine but if in a few years this horrible disease is reduced by say half or better, it will have been worth it.

Ammonium | January 31, 2007, 12:32pm | #

HPV from a toilet seat is a load of bullshit. They're just trying to scare you so you'll relinquish your freedoms and your money.

There is no reason for this vaccine to required for school since there isn't anything happening in school that would transmit the disease.

The cost of this thing is $400-600. That's a pretty good incentive to spread this bullshit, plus it filters down to the politicians and gives them a good incentive to make the vaccine compulsory.

Sam Franklin | January 31, 2007, 12:33pm | #

If grumpy realist is correct, that changes things considerably.

Yeah, it would mean we should vaccinate when they get out of diapers and not wait til 12.

Unless the toilet seats are more a theoreticist's possibility than a realist's concern.

I. Self. Divine. | January 31, 2007, 12:37pm | #

I have the same question as lunchstealer.

Did anyone ever think of trying this vaccine on males, to prevent their becoming a disease vector?

Anyone heard anything about whether or not there are any intentions to provide this vaccine to the male population?

Number 6 | January 31, 2007, 12:37pm | #

Vaccinations and immunizations are a case where libertarian philosophy breaks down.

Not really, since most thinking libertarians' philosophies account for externalities. While libertarians might disagree about what consitutes an externality or what should be done about it, to suggest that libertarianism "breaks down" when faced with an issue like vaccination is simply wrong.
Libertarianism that doesn't account for externalities is not pure libertarianism-it's incoherent libertarianism.

Chris S. | January 31, 2007, 12:42pm | #

On a related topic, let me express my frustration at the notion of government granted religious exemptions. Apparently, the less evidence you have to justify a given position, the more the government respects your opinions. Don’t bother with facts or a rational argument – you’ll never get an exemption this way. Instead, you should cite arbitrary rules allegedly imposed upon humanity by an angry sky fairy. Talk about crazy incentives…

Jennifer | January 31, 2007, 12:43pm | #

Sounds about right to me, with the caveat that in many states, a minor over, say, age 14 may have (and should have) the right to get the vaccine without parental approval or knowledge.

Exceot that, if the reports are true, by the time the girl reaches age 14 the vaccine loses a lot of its effectiveness. I'm not at all convinced that parents have the "right" to prevent their daughers' receiving an immunity to a form of cancer.

Sam Franklin | January 31, 2007, 12:46pm | #

Exceot that, if the reports are true, by the time the girl reaches age 14 the vaccine loses a lot of its effectiveness.

The question is why. is it:

a. because changes take place as the body ages from 10 to 14;

or

b. because too many 14 year olds already have the virus in them (somehow) before the vaccine is introduced?

pigwiggle | January 31, 2007, 1:00pm | #

The cutaneous HPV strains, those that are transferable in the ways grumpy is talking about, are not associated with an increased risk for the development of cancer. Or so says JAMA. There are something like 30 HPV strains that are not associated with cancer, and a dozen that are. I would like to see a credible source claiming a toilet seat (or any non-sexual contact) vector for the transmission of any one of the high-risk HPV strains.

greg | January 31, 2007, 1:01pm | #

Seamus made me think of the time my Mom made me go play with the neighbor kids when they got chicken pox. I didn't understand it at the time, but it's a whole lot better than having boosters the rest of my life.

A friend of mine got them when she was 27 and spent a good amount of time in the hospital over it.

But to the point, I still think everyone is glossing over the method of transmission a little too quickly.

grumpy realist | January 31, 2007, 1:02pm | #

OK, it looks like the HPVs that are linked with cervical cancer ARE pretty well spread through "sexual contact" although simple skin-to-skin contact is quite enough, i.e., very contagious. There are about 100 strains of HPVs around, 30 of which are considered STDs.

http://www.cancer.gov/cancertopics/factsheet/Risk/HPV

It isn't made any easier because a lot of these are relatively asymptomatic and can reside in the body for years before making their presence known (during which time the carrier is contagious but has no idea of being so.)

Considering how contagious this stuff seems to be, I'd still want a daughter of mine to be protected--haven't the fundies heard about sexual assault? Or do they think that that's not ever going to happen to their little darlings?

Jennifer | January 31, 2007, 1:03pm | #

Based upon my own memories of female puberty, Sam, I'd say it's because there are some serious changes that take place in the body between the ages of ten and fourteen.

Schutz | January 31, 2007, 1:04pm | #

There is a reason that the medical community is not rushing forward on this one. Vaccines are generally tolerated because they have very low risk and high preventative benefit. While HPV has been shown to be a great risk factor for cervical cancer, the vaccine is simply too new to start requiring it for everyone without disastrous results. Quite simply- until there has been a little more time and use with the vaccine, that preferable risk/benefit ratio cannot be guaranteed and so to do so could be considered quite criminal.

As to the requirement for entering schools. The issue here is that we have public schools and that they set requirements as though they were a private institution. Quibbling about what they require is not the issue.

Jesse Walker | January 31, 2007, 1:11pm | #

haven't the fundies heard about sexual assault? Or do they think that that's not ever going to happen to their little darlings?

From the Focus on the Family page that I linked to:

• The use of these vaccines should involve informed consent for parents as well as education for both parents and youth regarding the potential benefits and risks of the vaccine. In making this decision, parents should consider the following:...

The possibility of HPV infection resulting from sexual assault, including date rape...

Dave B. | January 31, 2007, 1:46pm | #

As to the requirement for entering schools. The issue here is that we have public schools and that they set requirements as though they were a private institution. Quibbling about what they require is not the issue.

What's worse, forcing kids to get vaccinated to enter public schools, or forcing kids to be confined in close quarters with unvaccinated children? Public schools shouldn't exist, but since they do, children at least shouldn't get easily preventable diseases from attending them.

Art | January 31, 2007, 2:02pm | #

I can't believe I am going to agree with joe and not with john on this but here goes.

The wait and see attitude is very justifiable. Although the initial test results look incredible (almost too incredible to believe) so have other medical "miracles" that proved a disaster.

As a parent I would be homicidal if in 5 years this proves to be detrimental to my daughter and it was given to her without my knowledge or permission. I am always amazed that school nurses and public health clinics that will not take the responsibility for giving a child an aspirin with permission are always in a hurry to stick something into the children without parental permission.

The promiscuity issue is not even relevant, as there has been a huge increase in all sexually transmitted diseases among teenagers in the last two decades. Singling out one is a pretty weak argument.

The other issue is information. How many people were even aware that a virus can cause cancer a year ago? Education of people should precede any new medical program.
This concept of "it's good for you so let me stick three needles in you whether you want it or not” is bull.

By the way many of my public health peers are working very hard on circumventing parental authority on this. Their attitude is that they know better so we have to take the authority away from the parents to make the decision. If you don't believe that this is wrong, then it might help you to realize that those working the hardest to get around parents are the biggest socialists in the group.

If this is a good thing it will rise to the occasion. But please don’t let the State make this decision for us.

TJIT | January 31, 2007, 2:08pm | #

The fact that the maker of this vaccine is pushing to make it mandatory is a bad thing and I flatly oppose the efforts by merck to make it mandatory.

This will open the way for other drugs or vaccines to be made mandatory just because the maker has political clout, not because of any actual need or effectiveness.

Art | January 31, 2007, 2:09pm | #

Self-divine:
Yes there is considerable talk about vaccinating boys as well.

No, the reason the number being quoted is 10-14 is exactly because they feel the girls will already have had sex and contracted the virus after that age.

Jennifer:
It is precisely because there are so many changes going on in the female body from 10-14 that has many in the medical community questioning whether it is a good idea to inject a three dose vaccine, with no long term proven track record, into them.

Jennifer | January 31, 2007, 2:55pm | #

It is precisely because there are so many changes going on in the female body from 10-14 that has many in the medical community questioning whether it is a good idea to inject a three dose vaccine, with no long term proven track record, into them.

I agree. And I have no problem with the "I don't want my daughter vaccinated because we don't know if this stuff is safe" attitude. What sticks in my craw is "I don't want my daughter vaccinated because making her immune to a form of cancer offends my religious sensibilities."

Sam Franklin | January 31, 2007, 2:59pm | #

What sticks in my craw is when people say "the vaccine loses effectiveness" when what they mean is that "the vaccine doesn't work on boys and girls who already got the virus."

I think that is a misleading use of the phrase "loses effectiveness." It is tough not to see that kind of misleading, but technically accurate, speech as objective.

Sam Franklin | January 31, 2007, 3:00pm | #

"objective" should be --politically motivated--

Jennifer | January 31, 2007, 3:04pm | #

Just imagine the brouhaha when somebody develops a safe and effective vaccine for AIDS. "This vaccine will encourage needle-drug use and anonymous sodomy!"

Bagger | January 31, 2007, 3:09pm | #

"This vaccine will encourage needle-drug use and anonymous sodomy!"

God I hope so.

Seamus | January 31, 2007, 4:10pm | #

What sticks in my craw is "I don't want my daughter vaccinated because making her immune to a form of cancer offends my religious sensibilities."

Nice straw man, Jennifer.

Thomas Paine's Goiter | January 31, 2007, 4:59pm | #

God I hope so.

Bagger wins the thread.

Jennifer | January 31, 2007, 5:54pm | #

Nice straw man, Jennifer.

How so, Seamus?

MattXIV | January 31, 2007, 6:04pm | #

Grumpy,

"HPV is primarily a sexually transmitted disease. It is actually the most common sexually transmitted disease, both in the US and worldwide. There are a variety of mechanisms by which HPV can be transmitted. Sexual penetrative intercourse is not required, because this is a virus that likes to live on the skin, so skin-to-skin contact is the mechanism by which the virus is transmitted from one person to another as opposed to transmission by blood or body fluids, which is more characteristic of other sexually transmitted infections. Because of this, HPV can be transmitted through sexual intercourse or through other types of nonpenetrative sexual contact such as genital-to-genital contact, oral-to-genital contact, or digital-to-genital contact. Condoms are probably helpful in preventing HPV transmission but are not completely protective, because condoms don't cover the entire area where HPV may live.

There are also well-established nonsexual modes of transmission, the primary one of which is mother-to-newborn transmission, thought to occur during the birth process. This transmission is very rare but is one of the ways that it is believed that genital warts can occur in very young children and also probably the mode of transmission for respiratory papillomatosis.

There are a couple of studies that suggest the theoretical possibility of transmission of HPV via fomites. There is one that talks about finding HPV in shared bathing suits or in poorly sterilized surgical equipment, but the clinical relevance of these studies is really not well established, and this is a theoretic concern at best; also, HPV can be seen in virginal women, although this is quite rare."

http://www.medscape.com/viewarticle/548960_3

newgrl | January 31, 2007, 6:18pm | #

The promiscuity issue is not relevant at all. This doesn't have to do with your 10 year old having sex. This has to do with getting the vaccine when it will do the most good, and then having sex... later... anytime later. That could be when your daughter is 16, or 25, or 19 and fully married in the eyes of the lord (or whomever). 99.999999% (this number is completely made up... and probably higher) of all women have sex at some point... really. If this thing really does all it's hyped up to do, it should absolutely be a requirement. No question.

crimethink | January 31, 2007, 6:25pm | #

Jennifer,

I don't think the problem "fundie" parents have with this vaccine is that it would immunize their daughters from cancer (which of course is NOT what this vaccine does anyway).

Jennifer | January 31, 2007, 6:50pm | #

No, Crimethink, they merely think that shielding their daughters from a potentially fatal consequence of S-E-X is bad. (Hence the complaints that this vaccine would "send the wrong message.")

Eric | January 31, 2007, 6:54pm | #

I'm all for waiting and seeing what happens. It's hard to believe that something this good doesn't have *anything* wrong with it (call me cynical).

And who's going to pay for the vaccine if it's made mandatory? It's three shots at $125 a pop, as I understand it. That's a significant chunk of change, especially for families with more than one girl.

Jesse Walker | January 31, 2007, 7:22pm | #

And who's going to pay for the vaccine if it's made mandatory? It's three shots at $125 a pop, as I understand it.

That's something I probably should have mentioned int he post: Merck is also pushing for laws requiring insurance companies to pay for the shots.

Eric | January 31, 2007, 7:59pm | #

"No, Crimethink, they merely think that shielding their daughters from a potentially fatal consequence of S-E-X is bad. (Hence the complaints that this vaccine would "send the wrong message.")"

Jennifer, this argument only works if "fundies" (to use your unfortunate term) are pushing to ban the vaccine. If their religious inclinations lead them to believe that this vaccine will harm thier children, either through the increased risk of promiscuity, or simple bodily pollution (in the case of Mormons or Jehovah's), then they have every right to fight tooth and claw to keep it from being mandated.

BTW Jesse, very nice literary allusion for the header.

Jennifer | January 31, 2007, 8:05pm | #

this argument only works if "fundies" (to use your unfortunate term). . .

I didn't use that term here, Eric.

. . . are pushing to ban the vaccine.

No, it also works if they talk about how the vaccine "sends the wrong message" when they discuss why they don't want to vaccinate their daughters. You yourself talked about the "increased risk of promiscuity," which exactly proves my point: we must let the girls run the risk of death if they have sex, lest they hump like little bunnies.

Eric | January 31, 2007, 8:23pm | #

My appologies Jennifer, the derogatory term was someone elses.

However, my point still stands. People who publicly disapprove of other people's behavior aren't violating anyone's rights. They are engaging in public discourse. Even if they say something stupid like the HPV vaccine causes promiscuity or video games cause violence.

The violation of rights comes when you make other people behave in ways contrary to their will, like mandating vaccinations.

Just because I endorse someone'e right to be stupid doesn't mean I agree with stupid behavior or beliefs.

Jennifer | January 31, 2007, 8:45pm | #

Eric, I would also say that refusing your daughter this vaccine because you WANT her to face the risk of death if she has sex violates her rights. "I won't vaccinate her because that will encourage promiscuity." How else should such a comment be interpreted?

Eric | January 31, 2007, 9:07pm | #

Jennifer,

What about her risk of death from climbing trees or crossing the street or drinking bleach? We let parents recklessly make decisions that will increase the chances of death of thier kids all the time.

The only way to really reduce the risk of kids dying is to ban their creation in the first place.

Otherwise you just have to parent based on your limited understanding.

Jennifer | January 31, 2007, 9:52pm | #

What about her risk of death from climbing trees or crossing the street or drinking bleach?

For that analogy to work, you must assume the existence of a readily available vaccine that would make these activities much less risky, only you refuse to give your child that vaccine for fear of "sending the wrong message."

jb | January 31, 2007, 10:50pm | #

Who's going to pay for this? The insurance companies, with the money they'll save from, you know, not paying for cancer treatment for these people.

Seamus | February 1, 2007, 10:15am | #

Nice straw man, Jennifer.

How so, Seamus?

Well, for one, because opponents of mandatory vaccination don't oppose it "because making [their daughters] immune to a form of cancer offends my religious sensibilities," as crimethink pointed out at 6:25 pm and you conceded at 6:50 pm. People oppose mandatory vaccination because all vaccines have costs, both monetary and in the form of side effects, because the benefit of the vaccine may not outweigh the costs for all people, and because the opponents believe that parents are in a better position to make that individualized assessment for their minor daughters than the government is.

I think this fact would be more obvious if there were a vaccine that would substantially reduce the risk that people who smoke would get lung cancer, lip, mouth, or throat cancer, and it was proposed to give to everyone at the age of 13, on the grounds that x% of all people smoke cigarettes, cigars, or pipes some time in their lives.

Seamus | February 1, 2007, 10:17am | #

The don't have sex outside of marriage vaccine is pretty effective so it should absolutely be made a requirement. No question./sarc

Yeah, but it's not 100% effective unless *everyone* takes it. Oh, wait; that's another reason it needs to be mandatory.

Seamus | February 1, 2007, 10:49am | #

Merck is also pushing for laws requiring insurance companies to pay for the shots.

This makes no sense. The purpose of insurance is to spread risks that are highly predictable over a population but not so predictable when it comes to individuals within the population. But if everyone has to get the vaccine, then that cost becomes highly predictable for each individual as well as in the aggregate. "Spreading the cost" around in that case just means adding a layer of administrative costs that wouldn't be incurred if everyone just paid for the vaccine directly. It would be as if your comprehensive auto insurance policy covered periodic oil changes.

(Of course, it might be argued that the premium increase is spread over the number of years that the insured is paying in premiums. Thus, if the cost of the vaccine is $300, and the average insured is expected to pay premiums between ages 20 and 80, the yearly premium that goes for the vaccine is $5, plus administrative costs. But since some insureds will die before age 80, the premium has to be raised above $5 go cover those who get the vaccine at age 14 but die (in auto accidents or from dread diseases for which there is no vaccine) before they've had a chance to pay in premiums covering the cost of their vaccine. In that case, having health insurance cover the vaccine turns out not to be health insurance at all, but a form of life insurance.)

(Also, it could be argued that having the vaccine covered by insurance is a way of spreading the cost over men as well as women. If that's the case, then what we're talking about undercuts another basic principle of insurance, which is classifying insureds into different risk classes. Not that there's anything wrong with that)

Sam Franklin | February 1, 2007, 11:52am | #

Yeah, but it's not 100% effective unless *everyone* takes it. Oh, wait; that's another reason it needs to be mandatory.

I suppose we could get into the issue of how the side effects of the drug (when administered universally) compare to the number of sex attacks (sex attacks sufficient to spread the germ, that is). Don't have the numbers.

But to me, this is a personal responsibility thing. If you take the vaccine, or have your child take the vaccine, then it is effective for you/her.

This isn't the kind of thing you get from airplane air.

If someone wants to have unprotected sex, then they should be willing to bear the consequences. that little rule can get dicey if a baby is involved, but if it is merely a tumor we are talking about, then the person that consented to the risk should bear the cost.

If rape is the problem, this vaccine is a bad fix because the vaccine protects against only one of the deadly STDs.

Pirate Jo | February 1, 2007, 12:15pm | #

In another 50 years, the only women with cervical cancer will be the fundies. Darwin at work.

Sam Franklin | February 1, 2007, 12:24pm | #

In another 50 years, the only women with cervical cancer will be the fundies. Darwin at work.

In another 50 years, the only women without deadly STDs (other than cervical cancer, that is) will also be the fundies (and maybe some Catholics and Muslims). Darwin at work, again.

Captain Holly | February 1, 2007, 1:24pm | #

I'm not usually one to see corporate conspiracies in every corner, but the HPV vaccine is probably the most over-hyped and expensive medical treatment to come down the pike recently. I can't help but wonder how many of the vaccine proponents own Merck stock.

To review, there are about 100 strains of HPV, about 30 of which can be sexually transmitted. But only 6 of those strains are associated with genital warts and cervical cancer. The rest result in mild, self-limiting infections that are quite often unnoticed by the infected person.

The hysterical statistic that most women have been infected with HPV by age 50 has two big caveats: It is describing sexually-active, non-monogamous women, and it takes into account infections by all types of HPV, not just the cancer-causing ones.

But hey, it prevents cancer, so why not use it? Well, not quite: The vaccine only protects against 4 of the 6 cancer-associated strains, those that cause roughly 70% of cervical cancer. So even though you may get vaccinated, it doesn't eliminate your chances of getting cervical cancer.

Which is why even women who have been vaccinated are still advised to have yearly Pap smears once they become sexually active.

But hey, reducing cancer risk by some 70% is a big thing because cervical cancer is so widespread. Well, no. Cervical cancer isn't even in the Top 10 of either most common or most fatal cancers. And both the death rates and incidence rates of cervical cancer have been steadily dropping for the past 30 years, largely due to...Pap smears.

Then there's a very un-PC secret about cervical cancer: It occurs much more frequently in lower-income and minority women. The average white middle-class teenage girl whose parents would be able to afford the vaccine is statistically the least likely person to get HPV.

And finally, it doesn't protect against any other type of STD, meaning that women who get the vaccine will still have to protect take steps to protect themselves, steps that will also prevent HPV infection in the first place.

So in summary, you have a very expensive vaccine that protects against a disease that isn't very easily transmitted, that doesn't even protect against all forms of the disease, that still requires the recipient to behave as if they hadn't been vaccinated, and that protects against a cancer that is already both relatively uncommon and easily preventable. To me, that's a relatively small benefit at a relatively large cost.

Oh, and all the above facts were taken from those hotbeds of Right-Wing Christer Activism: the Centers for Disease Control and the National Cancer Institute. See http://www.cdc.gov/nip/vaccine/hpv/hpv-faqs.htm#5 and http://www.cancer.gov/cancertopics/types/cervical/.

Art | February 1, 2007, 5:05pm | #

Captain Holly
You win the thread.
To bad you didn't have those numbers when it started.
Art

Captain Holly | February 1, 2007, 6:45pm | #

To bad you didn't have those numbers when it started.

Thanks. I had all that information to begin with (a bruising debate with Jennifer in a previous related thread prompted me to do some in-depth research) but since I was out-of-town I didn't read H&R yesterday.

stickdog | February 4, 2007, 5:44pm | #

The Facts About GARDASIL

1) GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.

2) HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four “bad ones” protected for in GARDASIL) results in no known health complications of any kind.

3) Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don’t get pap smears until after the cancer has existed for many years.

4) Merck’s clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the “placebo”) and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.

5) Both the “placebo” groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications — as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.

6) Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM — MUCH LESS DIED OF IT. Instead, this vaccine’s supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and “precancerous lesions” (dysplasias) than the alum injected “control” subjects.

7) Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.

8) GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck’s biggest cash cow of this and the next decade.

These are simply the facts of the situation as presented by Merck and the FDA.

Cain | February 5, 2007, 6:46pm | #

Seamus, chicken pox still has a relatively small chance of fucking up a child pretty well (retardation, death, infection of the scars themselves). I don't understand why you would take this risk when there is a vaccine readily available. I also don't understand why you willingly want your child to experience a disease they don't have to get in the first place.