Monday, August 27, 2007

The HPV Vaccine: Coming to a school near you

Merck has joined forces with the CDC (Center for Disease Control) and our Department of Public Health to launch a humanitarian effort aimed at ridding the world of cervical cancer by preventing strains of the HPV (human papillomavirus) that has been found in 100% of CV. They have aggressively enlisted the Public School System to help corral high school girls for the three stage vaccination.

The CNMI's rate of cervical cancer is astonishing, almost four times that of the U.S.. The HPV vaccine has the potential to eradicate cervical cancer by preventing the strain of HPV that causes it. HPV is one of the most common sexually transmitted diseases found gender-wide. In boys, it is like the stealth virus, asymptomatic and not nearly as deadly as it is for girls. Sexual activity increases the risk of HPV, and thus for girls, cervical cancer. Gardasil, the FDA approved vaccine made and marketed by Merck, has not yet been approved for boys. The vaccine is not cheap, but argumentatively, neither is cervical cancer.

At the risk of sounding unappreciative for this generous gift, I want to explain myself. My friends think this is unnecessary, but I am moved by many recent happenings. My comments on Jeff's blog have taken a detour from my maternal gut instincts to whether or not I am grateful for this federal endowment. It's been suggested that I do my research before "killing Frankenstein", and so I have.

As Jeff puts it, "pharmaceuticals are big business". I agree, and this is one of the reasons that Merck has been under scrutiny for it's overly aggressive campaign to make Gardasil mandatory in public schools. The question the nation seems to be asking is, "have we lost focus from the prevention of cervical cancer to fattening the pockets of drug makers?" The vaccine is not mandatory in the CNMI, so my question is, "why are we going to vaccinate hundreds of girls at school, during instructional time, when it is a voluntary shot?" Wouldn't it be better to invite parents to the clinic or a public forum so that they can ask their questions freely? Or are we just trying to get as much of this free stuff used as fast as possible? Maybe free is the wrong word since the CDC, A.K.A. the feds, are buying it in bulk from Merck, on our behalf. I'm not sure how many federal dollars are going into the media campaign for this vaccine, but wouldn't a public meeting be more appropriate in our culture? Many man-amko will not be able to understand the catchy commercials, and given the power of TV persuasion, few people will feel compelled to question them. I think this is too important an issue, given our statistics, not to reach out to the community.

I am not questioning the integrity of the DPH. There are many people who work there that I admire for their determination to bring quality health care to the CNMI. I am not even questioning the intentions of the CDC. I am certain that the Cancer Society supports this, and so they should. I am a little bit uncomfortable knowing that the feds and Merck are in bed with this one. $50 million bucks is a lot of money for one year and it makes me wonder about the aggressiveness of the drive. This is my right, no? Nobody's perfect, but no one, including Merck, has a spotless record when it comes to the medications they promote. Many states are tinkering with the idea of mandating this vaccine in schools for girls as young as 9 years old. I'll let you chew on that one.

All of our public schools have Wellness Policies that are directly aligned with National Wellness standards and they do address preventative measures in health. In fact, we welcome the participation and partnership of Public Health. However, is it really the school's responsibility at this time, to aide in mass vaccinations? What about possible mandatory vaccinations? (Because, that's what will be coming down the line if we are not vigilant)

All my children have been immunized, and I do not wish to expose any of them to the horrors of cancer, especially if I can help prevent it. If I felt 100% certain that this was safe, I'm sure we'd be the first family in line. However, it is my maternal prerogative to shelter my girls no matter how hyper-sensitive it looks to others. I know it's "Saipanese" to ask for studies, but I demand them for my children. Show me that it is safe and I will put my daughters in your trusted hands.

To be fair, most of the reported side effects are non life threatening and in comparison to cervical cancer, they are almost harmless. Even girls who have no sexual history are susceptible to HPV, because as Jane puts it, they can be victims of sexual crimes. The benefits today, seem to outweigh the risks. If you are willing to do the research, not rely on my seemingly biased opinions, and you become convinced, then please, get your daughter(s) inoculated. It's a golden opportunity to avail of preventative medicine that would otherwise cost the average person an arm and a leg (and a cervix).

I will continue to exert my right as an American and a mother, to reserve judgment/a decision. Here are a list of objections and some benefits that I've found useful. Though my tone seems otherwise, I am neither campaigning for or against the vaccine. I am asserting my right and yours, to make informed decisions. Go to the DPH with your daughter before signing the consent form, ask lots of questions, even the ones you feel silly asking, and don't leave until you are satisfied. Call your doctor and get his/her opinion. The DPH has made it clear that they are eager to hear the public's concerns. Read about it everywhere, even on the government sites. No one should die of cervical cancer if they don't have to, especially not our daughters. But, please, don't pull my toenails out with your tweezers just because I'm skeptical. Not until you have spent years listening to my Sommer's laugh, seen Peyton's crayon-drawn family portraits and heard Hope talk about the dreams she has for her life. Not until you've agonized over every decision you've ever made when it came to their futures.


Saipan Writer said...

It's too late for you to be first in line. :-)

I think you touch on an important issue that has nothing to do with the merits of the vaccine--whose decision is it? I hadn't heard that there was talk of making it mandatory. I hadn't heard that there was talk of mandating that it be administered through the schools.

I like education campaigns. And I think we do need to be educated about this vaccine. I had heard about it a couple of years ago, before it was available here, and every time I went with my daughter to the doctor's office, I asked --is it available, what do I have to do to get it. I'd already done research about it, talked to a nurse (who shares some of your concerns, Boni, and has others, and also has a daughter in the target range), and had made up my mind.

But it was my mind, as a parent, for my daughter.

I'm pretty sure that any campaign through the schools would have to include an opt-out provision--parents have to be able to withhold consent. So it couldn't truly be "mandatory." As devastating as cervical cancer is, and as huge a concern as it is here, it's not like those other contagious diseases that caused wide-spread epidemics and require mandatory vaccination as part of a public health policy. Is it? (I'm willing to hear more on this.)

I think we should cooperate with public health in their public education campaign. A wide variety of strategies, from meetings to pamphlets to television PSAs, can help in such an education campaign.

And I think parents should be educated, and even encouraged, to get their girls vaccinated. I'm not sure about "mandated."

And Boni, I think it's good that you questioned this. Your willingness to sincerely look at the issue from your perspective, with your hopes and dreams, fears and anxieties, questions and analysis, helped bring out aspects of the situation that might otherwise have gone unnoticed.

BoReGo said...

Thank you Jane. All I ever wanted was healthy dialogue on this issue. I'm looking forward to watching my girls grow up to be great women. I want to see our daughters live healthy lives long after they are in our schools. I was brought up to speak my mind, and I am glad I had a father who encouraged that in us.

The vaccine seems safe, but like everything in this world, politics and money get their grubby hands on a good thing.

Jeff said...

Couple thoughts. First, I don't think a few minutes of instruction time matters at all. We have a dance assembly every few weeks, so this is hardly a poor use of time by comparison.

Government has long been in bed with Big Business. The prescription drug act was a giant giveaway to the pharmaceutical industry. Look at Enron's stock chart since Cheney assumed hte presidency as well. Corporate welfare is a much bigger expensive than welfare for the poor, just not as reviled unfortunately. Merck has the federal tit providing money, and probably a great team of lobbyists, so they'll do everything they can to get people taking it. It is at least more productive than the 12 billion per month in Iraq.

There are no medications that are 100 percent safe. The FDA runs pretty rigorous tests, and the damages that result to a company who mess up are pretty severe, so it isn't exactly in their interest to put some poison on the market.

Overall, a healthy dose of skepticism is a great idea, not just with this, but with all things. This vaccine helps for life, not just for teens, so the whole teen sex thing is a nonsense moralist distraction that some people will use.

Overall fair statement.

Bruce A. Bateman said...

The most important thing that came out of this issue is the discourse. As several have pointed out already, interaction and discussion between different viewpoints is healthy. Better than that it is mind expanding, at least for some.

Both your blog and Jeffs got a lot of responces because the topic is an important one and the conflicting viewpoints make the issue more interesting.

Congrats to you both. Keep it up!

Anonymous said...

^^^^ when you say "discourse," is that the opposite of inter...? nevermind.....

Anonymous said...

^^^^ when you say "discourse," is that the opposite of inter...? nevermind.....

BoReGo said...

How do you delete the opposite of smart comments?

Angie said...

Like you, I am questioning this drug and it's administration at any school. I do not have a daughter, but have had family members die from female related cancers. I know that drugs are rigerously tested, but I also know how easily it is to manipulate the data to say what never you want it to say. Also, how long were any of these tests. One year, two years, five years? What about the reprocussions ten, twenty, even thirty years down the road? I do not think they can answer THOSE questions. Those are the questions that I feel any parent needs to consider before giving any medicine to their child or themselves.