An amazing medical breakthrough has occurred in the treatment of cervical cancer. Merck has developed a vaccine that is 100% effective in preventing Human Papilloma Virus, or HPV. HPV has been identified as the primary risk factor for getting cervical cancer. While the Pap test has reduced the number of deaths from cervical cancer by 74%, nearly 4,000 women a year still die from the disease. (Source)
Cervical cancer is an insidious cancer; the symptoms are ambiguous and easily mistaken for other causes, and a vaccine to prevent its occurrence is an amazing development. Merck is hoping to market the drug in 2006.

So, a vaccine to prevent HPV, the leading cause of cervical cancer is a good thing, right? I think that’s a no-brainer.

But, I would be wrong, because not everyone thinks a vaccine that is 100% effective in eradicating the leading cause of cervical cancer is a good thing.



Like the writer said, getting a tetanus vaccination doesn’t send kids running after rusty nails.

Issues dealing with sex and young people have historically been anathema to our conservative government, and fundamentalists have ever-increasing influence on that government. I fear that this vaccine may be prevented from reaching its “target” population (young people who are not yet sexually active) for political and/or religious reasons.

So, a couple of questions for debate:

Will we see Gardasil available in 2006, or will government and fundamentalist intervention prevent its approval?

Is there any validity to the notion that the approval of a drug to treat HPV sends a “message” that having sex is OK?

Again, the moons are in alignment in that I believe that we might be on the same side of this subject.

1. I believe that the Government is least likely to prevent the release of this drug, of course unless there are overwhelming side effects. If they can sell Viagra on Prime Time TV 6 times/night, this should be a no-brainer. I also would hope that with an understanding that this will prevent deaths, this will be a postive addition to medicine and be widely prescribed. As some fundamentalist groups dip to the deep dark crevices of absurdity, I'm sure it will be spun as a negative by some groups, but would venture to guess that position would only be publicly addressed by abstinence-related organizations.

2. HPV is so widespread that it's existence is common knowledge for many Americans. By age 50, nearly 80% of women will have acquired this disease. http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common
I would imagine that this drug will become widely available, and frankly, can be construed only as a positive. Consider the statistic listed above. Obviously the disease hasn't deterred unprotected sex as of late, and if it can save lives then great. Cancer in any form is an awful thing....

Will we see Gardasil available in 2006, or will government and fundamentalist intervention prevent its approval?

Has the government prevented the Hepatitis B vaccine from being approved? Why didn't fundamentalist intervention prevent it? For that matter, why are you providing a link to a site entitled 'Why Does the Extreme Right Love Cancer?' and expecting a serious discussion on this issue? I might offer a counter-point. Why in the world aren't I aware that unprotected sexual promiscuity is responsible for 80 percent of cervical cancer? Did you hear about this in your sex ed class? Did anyone? I'd think this information would be more helpful than the vaccine.

Unless there are some side effects I am unaware of, the vaccine will likely be approved. According to what I've read this vaccine must be prescribed at a rather young age and I am cautious about vaccines in general.

Is there any validity to the notion that the approval of a drug to treat HPV sends a “message” that having sex is OK?

No. But it is a bit weird to vaccinate your 9 year old to prevent him/her from obtaining genital warts. Just my opinion.

Because it was the only source providing quotes from the aforementioned extremist groups. Regardless of the rhetoric in the article, there are some important facts noted...if you are able to look past the other stuff to read it. Regardless of the source and its views, its facts and references are valid. And besides, it was only one source of many I cited. And the subject is most worthy of discussion; I don't understand how anyone could think otherwise.

As for inoculating "a nine-year old" against genital warts being weird, isn't vaccinating your kid against diphtheria, polio, tetanus or pertussis strange too? Do you explain to the kid the horrific details of each disease (and how long it has been since any of those diseases have been prevalent) while they're being stuck with a needle? I didn't think so.

Which would indicate to me that those extremist groups have very little clout in government. Your first question to be debated is, "will government and fundamentalist intervention prevent" the vaccine from being approved. What government intervention? You have provided us with quotes from extremist group figureheads I have never heard of. Do these groups and individuals have more power than the rest of us? Furthermore, I didn't read that they are necessarily all against the vaccines. I actually agree with these quotes myself:

Scott Phelps, "Sexually transmitted diseases in the United States will not be contained by injecting vaccines into pre-adolescents in anticipation of promiscuous behavior".

True.

"If you tell a 13-year-old, You are protected against this STD, will she suddenly start thinking she is protected against all STDs, and therefore does not worry about having premarital sex and becomes sexually active?"

Well, she might. I know I was (and AM, for that matter) more sexually active with birth control, for example, than I would have been without birth control. If a girl is told she is immunized against STDs, she might assume she is immunized against all of them. There is no underestimating human stupidity. I knew a girl who thought she only had to take one birth control pill after sex to be safe, so there you go...At any rate, I don't see any reason why those opinions would influence approval of a vaccine.



I certainly agree it is worthy of discussion. For many reasons. First and foremost, why isn't it common public knowledge that 80 percent cervical cancer is caused by an STD? I had my first pap smear before I'd even kissed a boy. That is ridiculous. Every year, women are expected to have their annual exams and pap smear for this reason. If 80 percent of cervical cancer is caused by HPV, there should be a test to find if a woman has been exposed to HPV, rather than obligating every woman to go to an annual exam for her birth control or lose the privilege because she might be one of the exposed.

And before penicillin, men contracted syphilis, gave it to their wives, who gave birth to children with the disease. And of course, those who did have the disease got to look forward to going insane before finally dying. If there had been a vaccine for the disease, would you also be against that, because it’s an STD?

Something we can both agree on.

From WebMd:
(emphasis mine)
Not just for this reason, but I disagree with your premise that women shouldn’t have to have a yearly pap test, unless that woman really doesn’t care much about her health. Sure, it’s a rotten, uncomfortable, annoying test, but such is the price of being female.

And how many drugs have been developed that actually PREVENT cancer?! I still maintain that a vaccine to prevent cervical cancer is a terrific thing, and should be given to all girls who are old enough to menstruate…except for those girls whose parents' fear of sexual activity makes them think that protecting their daughter from cancer isn't important enough.

I'm not sure of your point. Neither I, nor the person we are quoting have suggested that the vaccine should not be available. I agree with him that STDs "won't be contained by vaccines in anticipation of promiscuous behavior". You believe that they will be? According to what you have said on this thread, you believe that cervical cancer will be erradicated, but even so we should still be inspected for it every single year because "that is the price of womanhood". And even though 80 percent of cervical cancer is related to sexual history, that is irrevelant information. Okay.

Apparently there is a HPV test which was approved in 2003. Here is the link for anyone interested. I have little more to add.

I never said that. Of course, the potential is there, but human nature being what it is, the chances are that it will never happen, hence my agreement with you (e.g. stupid people).

I never said cervical cancer WILL be eradicated, only that the LEADING CAUSE of it COULD be eradicated. And the “yearly inspection” includes millions of women who were not able to take advantage of the vaccine (after all, it IS a vaccine, not a cure. Once ya got it, the vaccine won’t do diddly for you). Who knows, maybe 30 years down the road, there will be no use for pap smears, but until then, we're stuck with 'em...so to speak.

1.) I do not see why the government would interfere. Some people argue that the Morning After pill, for example, kills the baby. But this drug would keep a woman alive to have a baby; I think that that will slate the drug for approval.

1.) Wrong. Sex still has hazards, regardless of this one STI having a cure, which does not prevent a person from contracting one of the other dozens of STIs currently running rampant around the world. People will not jump into bed just because of one cured STI and expect to live the rest of their lives happy and STI-free.

I could blame Doc for posting but... /sigh

The HPV vaccine presents a problem for abstinence-only education advocates. HPV is the only STD that condoms can’t prevent from transmitting 100% of the time with correct use. Without HPV abstinence-only advocates lose some of the clout they’ve enjoyed up to now.

Will we see Gardasil available in 2006, or will government and fundamentalist intervention prevent its approval?

They will undoubtedly try. This CNSNews.com article (or one similar) appeared on Concerned Women for America. The article was pulled and still isn’t up as far as I know. (Our web filter blocks “Advocacy Groups.”) Months ago I emailed CWfA asking why the article was pulled. I didn’t receive a response.

Hopefully conservative groups will back off. They have a decent track record where sexuality is concerned with this administration and the FDA, the agency responsible for keeping Plan B off the shelf because it may "lead to increased promiscuity" among teens according to CWfA. Still, since we’re talking about a vaccine it will be a harder sell for CWfA and like-minded PACs unless they can generate stronger public support in keeping with their archaic, sexually related ideas at the heart of their objections. Apparently, not only is it wrong to trust the government to teach sex ed, but you, the parent footing the bill in part or whole, can’t be trusted to disclose sexual information to your child at the time s/he receives the vaccination or later when s/he approaches young adulthood. Perhaps, to balm their conscience, social conservatives can make your strapping 10 year-old sign an abstinence disclosure form before s/he can receive their shot.

Is there any validity to the notion that the approval of a drug to treat HPV sends a “message” that having sex is OK?

That depends on who you ask. Beholding policy to the lowest common denominator sends the wrong message about responsibility. Policy decisions taking the need for frank dialogue between parents and children for granted don’t preempt the hormones at work and their consequences. Contraceptive education is synonymous with a sexual green light as long as parents pretend they don’t need to instill values to avoid an awkward discussion.* Putting off the vaccine as a parental thumb’s up to marital sex is irresponsible.



HPV is a virus. There are several dozen versions of HPV. Some versions end up being annoying contagious warts, others turn cancerous. Planned Parenthood tests for HPV during yearly exams, the only cheap, quick way to get a biopsy—perhaps the only way. I don’t know the testing percentage among general practitioners. I wouldn’t mind avoiding a sizeable percentage of the medical cost and discomfort associated with pap smears.

* I’ve never understood the sex ed paranoia or the supposed good it generates according to abstinence-only advocates. When shown studies that suggest teenage unintended pregnancies are declining I countered that teens are taking the hint by engaging in non-reproductive sexual acts. It looks like I’m on to something. In regards to Saletan’s statistical analysis that “The spin that activists, scholars, and journalists have put on the survey—that abstinence-only sex education is driving teenagers to an epidemic of oral sex—doesn't hold up,” heterosexual anal sex may’ve always been in the 20% – 30% range, but since anal sex has largely been regarded as a matter of sin by social conservatives they focus more on the homosexual “problem”—or perhaps hetero anal sex cuts too close to home.

I don't think it's just paranoia on the part of those of us on the Secular Left to be a little concerned with the objections of the Religious Right to this medication (and to the very similar medication Cervarix.) Let's look at the opinion of the investment advisors known as the Motley Fool, who are much more concerned with money than politics:

Link



(Bold added for emphasis)

Keep in mind that the Motley Fool is just giving reasons why you might want to invest money in one drug company or the other. If financial experts think that religious conservatives may have an important impact on the acceptance of these drugs, I have to take them seriously.

Religious conservatives seem to have had some influence on the decision of the FDA to refuse to make the "morning-after" contraceptive Plan B over-the-counter. Here's an editorial about this decision from a Libertarian source:

Link



With all that in mind, I think that Gardasil and Cervarix will be approved. If not, unless there is a very clear medical reason why these drugs should not be approved, I will have to conclude that the Religious Right is in control of the FDA.

Obviously, it's important to combine effective methods of contraception and prevention of sexually transmitted diseases with accurate information about why responsible sexual behavior is very important. Without good knowledge about the risks of being sexually active, some young women may be foolish enough to think that these drugs will magically protect them from the consequences.

CERVICAL CANCER MISPERCEPTIONS


I just spent much of the last month researching cervical cancer for a friend of mine who had many concerns about her daughters condition. It is only because of this that I have become a temporary expert on the matter.

The medical community has done a horrible job in explaining clearly the underlying causes of cervical cancer. This has resulted in widespread misperceptions, misunderstandings, and inaccuracies. Sadly, I have seen many of these inaccuracies repeated here on this thread. It is important to correct these and to clarify the misperceptions and misunderstandings.



This statement is very misleading. First, there are currently at least 13 HPV types that are known to cause cervical cancer.
Source: High-Risk HPV DNA Test, Large pdf file

Both the Merck and the Glaxo vaccines apply to only 2 strains: HPV 16 and HPV 18!

"Two cervical cancer vaccines are currently being developed: GlaxoSmithKline's Cervarix, which targets only HPV 16 and 18, and Merck's Gardasil, which prevents HPV 16, 18, 6 and 11; the latter two viruses cause genital warts. Cervarix could be released on the market as early as spring 2007, months after Gardasil's expected debut in fall 2006, Harper said." (UPI, April 6, 2006) These strains--HPV 16 and HPV 18--are the most common in the U.S. and account for about 70% of all cervical cancers. (USA Today, May 17, 2006)

All other strains currently known to cause cervical cancer--HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68--are not affected at all by the current vaccines! Thus, one could take either vaccine, be 100% innoculated from HPV 16 and HPV 18, and still be completely exposed to 11 different types of HPV strains known to cause cervical cancer!

This is not a vaccine for cervical cancer. Not yet, anyway. It is only a vaccine against two common types of the virus that causes cervical cancer.



HPV is more than just a risk factor. Smoking is a risk factor--probably because it weakens the immune system and allows the HPV to grow into invasive cancer faster. HPV is the CAUSE of cervical cancer. Let me say that again. Carcinogenic strains of HPV have been found to be the exclusive cause of ALL cervical cancers.

“It is now agreed that 100 percent of cervical cancer is caused by HPV,” says Saslow. “The actual number is about 99.7 percent, but it is thought that the 0.3 percent is due to failure of testing rather than the absence of HPV.”
Source: Association of Reproductive Health Professionals

"The human papillomavirus (HPV) has been detected in virtually all invasive cervical cancers and has been confirmed as the major cause of this cancer."
Source: University of Maryland Medical Center


"...it (cervical cancer) can almost always be traced back to one of those types. In other words, infection with high-risk types appears to be "necessary" for the development of cervical cancer..."
Source: National Family Planning & Reproductive Health Association


So, if you have not been infected with a carcinogenic strain of HPV, you have absolutely no chance whatsoever of contracting cervical cancer. None!







HPV is not the cause of only 80% of cervical cancers. HPV is the cause of 100% of cervical cancers! Yes, HPV--a sexually transmitted disease--is the cause of all cervical cancers!

"The human papillomavirus (HPV) has been detected in virtually all invasive cervical cancers and has been confirmed as the major cause of this cancer.

Transmission. HPV is spread primarily through sex with an infected partner."
Source: University of Maryland Medical Center


The confusion lies in the fact that 80% of all sexually active women--at some point in their lives--will contract HPV.

"Do all women who have HPV get cervical cancer?

No. While an estimated 80% of sexually active individuals will contract HPV at some point in their lives, most HPV infections appear to go away on their own without causing any kind of abnormality."
Source

It amazes me to no end why this information is not common knowledge. It seems vitally important. I just can not understand why the medical community has not made this a major part of their public awareness program. Why is this such a big secret?

HPV causes cervical cancer. There! That wasn't so hard.







"Tests for Human Papilloma Virus (HPV)
HPV DNA Test. The human papilloma virus DNA (HPV DNA) test can detect the presence of HPV. It does not replace the PAP smear, since many women are infected with HPV but do not go on to develop cervical cancer. Relying only on an HPV test would lead to a large number of unnecessary and invasive tests. HPV tests, however, may be very useful in specific cases to improve the accuracy of an abnormal PAP smear. They may be particularly helpful for screening older women or when Pap smear results show abnormal cells but it is not clear if they are dangerous or not." Emphasis added.
Source

"It (the HPV test) is not recommended as a screening test in women under 30 because the test is not as useful in this population—women in their 20s who are sexually active are much more likely to have an HPV infection (most of which will go away on their own), so the results of the test are not as significant and may be more confusing."
Source: American Cancer Society

Basically, doing the HPV test instead of the Pap test will actually increase, not decrease, the number of invasive tests necessary to get accurate screening results.

And, even though doing both tests together will add significantly to the usefulness of the screening, this does not mean that the next screening can be skipped or delayed. There are 2 reasons why. First, if you have a good doctor, you have been told that Pap tests, even when properly done, are highly inaccurate. False negative Pap smear rates can be as high as 50%. The range of false negatives usually quoted is from 10%-29%!
[URL=http://www.sh.lsuhsc.edu/fammed/OutpatientManual/PapSmear.htm]
Source: LSU Health Sciences Center[/URL]
It is only because of the usually very slow growth of cervical cancer (10-15 years), and routine screening, that a 20% failure rate of Pap tests can still catch the vast majority of cancers in an early stage. When you skip or delay a test, the odds of the cancer slipping through those 20% failures goes way up.

Second, there is a very small subset of fast growing cervical cancers that "may occur quickly after cervical smears qualified as normal--within an interval from 12 to 18 months in women less than 50 years old..."
Source: Pub Med


There just isn't any good reason to take the unnecessary risks of skipping or delaying routine testing.


IN SUMMARY


1. The current vaccines only apply to 2 HPV carcinogenic strains. At least 11 cancer causing strains of HPV are completely unaffected by these vaccines.

2. All cervical cancers (100 percent) are caused by HPV.

3. HPV is a sexually transmitted disease.

4. Pap tests have a very high false negative rate (10%-29%).

5. Pap tests should not be skipped or delayed, even if taken with a HPV test.


Thanks for taking the time to read this.