Thursday, March 29, 2007

HPV Vaccine Boondoggle


Copyright © 2007 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved

There’s a growing controversy about the newest crusade from the medical establishment and the giant Merck pharmaceutical company: the demand that U.S. state governments pass laws requiring that all sixth-grade girls get a three-shot vaccination against human papillomavirus (HPV) on the ground that this will reduce their risk of later getting cervical cancer, The establishment media have framed this issue the usual way they do new-drug stories, claiming flatly that HPV “causes” cervical cancer even though only 70 percent of women with cervical cancer have the virus and no virus has ever been definitively linked to any sort of cancer. They proclaim the vaccine to be “life-saving” and demand that it be forced on pre-teen girls, and claim that the opponents are idiots living in the past and unwilling to embrace this new wonder of pharmaceutical technology.

And the opponents — at least the ones that get the publicity — are playing their assigned roles in this sick script. The HPV vaccine is being debated in the same way as stem-cell research: the stupid arguments against it are crowding out the sensible ones. The stupid arguments are coming largely from the Christian Right and center around the idea that, since HPV is sexually transmitted, vaccinating against it would essentially be encouraging young girls to have sex. They claim that people can avoid contracting HPV simply by not having sex until marriage to an uninfected partner, and monogamy thereafter, and argue that since HPV isn’t casually transmissible it’s not a disease that should be attacked by mandatory vaccination the way smallpox and polio were.

The sensible arguments against mandatory HPV vaccination are, first, that it’s using a cannon to shoot a flea. According to American Cancer Society estimates, just 3,670 American women with HPV die from cervical cancer each year. The only link between HPV and cervical cancer is a simple 70 percent correlation between the virus and the disease — not the 100 percent correlation that Koch’s postulates, the classic rules for identifying a microorganism as the cause of a disease, require. Since 50 percent of all sexually active Americans, of either gender, contract HPV at some point in their lives, that’s a lot of people who will never get the disease getting an expensive, risky vaccine for a virus that most people who encounter it won’t suffer from in any way — especially if the vaccine requirement is extended to boys as well, as some advocates have called for, though HPV has never even been claimed to cause a disease in men.

The vaccine is both expensive and potentially toxic. It won approval from the U.S. Food and Drug Administration (FDA) on the basis of a clinical trial in 20,000 women — a larger sample size than most of the anti-HIV medications but still a small fraction of the up to 100 million women for whom the vaccine is being promoted. It must be taken in three doses, each of which costs $120 — which has led some to suspect that Merck is promoting the mandatory vaccine requirement as a form of corporate welfare in which the profits from Gardasil, as they call the HPV vaccine, will bail them out of the potential billions of dollars in legal liability from the over 28,000 people who died or became seriously ill from Merck’s last (now withdrawn) blockbuster drug, Vioxx.

Those suspicions grew when Texas, of all states, became the first U.S. state to mandate HPV vaccination for young girls. Instead of coming from the Texas legislature, the mandate was imposed by an executive order by governor Rick Perry, who was George W. Bush’s hand-picked successor and has usually faithfully done the bidding of the radical Right. Not this time. Defending the mandate against criticism from the Christian Right, Perry said, “While I understand the concerns expressed by some, I stand firmly on the side of protecting life. The HPV vaccine does not promote sex, it promotes women’s health.”

Then information came out that showed Perry might have had a less high-minded and more mercenary motive for imposing the vaccine requirement. Perry’s former chief of staff had been hired by Merck as a lobbyist, and Merck’s political action committee had given $6,000 to Perry’s campaign. What’s more, the supposedly “independent” lobbying group Women in Government, composed of female state legislators banding together to push for HPV vaccine mandates in their respective states, also turned out to have received major donations from Merck. The controversy over that hurt the company’s image enough that Merck spokespeople announced that they would stop funding future campaigns for HPV vaccine mandates — but the suspicion remains that Merck not only wants to see the mandates imposed, but wants to see them imposed quickly while they still have a monopoly on the product, before GlaxoSmithKline and other big drug companies have their own HPV vaccines on the market.

There are also civil-liberties arguments against vaccine mandates. Though the mandate proposals include an “opt-out” clause that any parent objecting to having their child vaccinated can pull out of the program, Barbara Loe Fisher, spokesperson for the National Vaccine Information Center — a group which provides information on the health risks of vaccines and urges parents to consider the option of not having their children vaccinated — argues that the medical establishment systematically harasses parents who choose the no-vaccine option for their kids.

“Your name goes on a state list,” Fisher told The Nation (in an article whose author was clearly biased in favor of mandatory HPV vaccination). “You get harassing phone calls from the CDC [the U.S. Centers for Disease Control] for your views on vaccines. Some families get thrown off health insurance plans, thrown out of their pediatricians’ offices, thrown out of public schools — or parents are put in a room and grilled by officials about the depth of their religious convictions on this.”

Much of this pressure is justified on the ground that in order to work the way they’re supposed to, vaccine programs must reach a critical mass of their target population; if they don’t, the theory goes, the disease being vaccinated against will have a large enough population in which to incubate and grow into a major health threat. Some health professionals derisively refer to kids whose parents haven’t had them vaccinated as “free riders,” meaning that they’re getting the benefit of vaccination without having to run the health risks involved. But these arguments don’t make sense for a vaccine against a virus like HPV which isn’t casually transmitted and causes a disease, if at all, only far later in life than childhood.

Over and over again, we’ve seen the pharmaceutical industry use the same marketing strategy for disease after disease. First, you either take a real disease and magnify its significance or, as in the case of so-called “attention deficit hyperactive disorder,” you simply invent one by redefining normal human behavior as “sick.” Then you fund massive “awareness” campaigns to persuade people to test for your disease, following which you sell them the drugs you just happen to have available to “treat” it. In the case of HPV vaccination, Merck has taken a rare but still terrifying disease — cervical cancer — identified it as viral on the basis of shaky scientific evidence and is now marketing a vaccine to make a quick buck out of perfectly healthy children, scared parents and intimidated or bought politicians.