Tuesday, September 15, 2009

Cervical Cancer "Vaccines"

I have expressed my reservations regarding Merck's Gardasil vaccine from its debut. When Gardasil was first released, I was still in grad school and in one of my classes we had to discuss being for or against it and explain why we chose that stance. I was against it more for the message it might send about cervical cancer prevention than anything else and that the marketing was in my opinion misleading. By this I mean, regular screening exams by a physician who can do a pap smear will detect any abnormal cells that may be pre cancerous. Having the vaccine does NOT mean that one can avoid the illness altogether, that condoms are not necessary or that PAP smears are not necessary. The vaccine may protect against some strains of the human papillomavirus which is one of the main risk factors for getting cervical cancer. There are numerous strains. If one already has been exposed to the virus, the vaccine does not protect against it. That being said the vaccine is best for people before they begin sexual activity.

So initially it was meant for young girls. Obviously, men do not get cervical cancer. (BTW when it was being targeted to women Merck called it a cervical cancer vaccine, but when they wanted to persuade the FDA to approve it for boys they called it what it really is - an HPV vaccine). It is unsettling to think of vaccinating the young against a sexual transmitted disease, but then most vaccines are given to children. Merck tried to make the vaccine mandatory by law, like some of our other vaccines, for school admittance etc. They lobbied Congress pretty heavily but lost. Then Merck wanted to give it to older persons and then to men and now to boys. Certainly they have a lot to gain if the FDA approves those indications.

The thinking is that an older person may have been exposed to one strain, but not another, so the vaccine can help with that. And men would not realize that they had the virus and could infect women and so men should be vaccinated. Of course, it is better still that little boys get the vaccine as opposed to men for the same reason it is meant for little girls (pre exposure - pre sex).

Even if I agree with all of those arguments, we still need to practice safe sex and have annual screenings for the detection and removal of precancerous lesions.

So this was all I was already thinking before today. Today I scratch my head wondering why we need TWO HPV vaccines. Especially as we have discussed recently that there has to be some new indication before a second medication is approved to treat an already treated disease.

Enter Cervarix by GlaxoSmithKline. Cervarix is close to FDA approval for the same HPV prevention in young women or children. It proposes to hit the same strains as Gardasil plus a few more and to work longer and also to protect against one type of throat cancer.

You have to make your own conclusions... I am just pondering out loud and as I do not have a young girl in my care and really don't see the vaccine necessary for my non promiscuous condom carrying self, I do not have to decide. (though I must say again, condoms are not 100% effective in preventing any STD)

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