HPV Vaccine for Girls Oversold?
BC govt's claims for $39 million shots program challenged.
Immunization said to 'prevent cervical cancer.'
Victoria author and massage therapist Julie Paul's daughter will soon be eligible for the human papilloma virus vaccine. But with questions remaining unanswered about safety and whether the vaccine really will prevent cervical cancer as the provincial government claims, Paul's daughter won't be getting the shots.
This week Health Minister George Abbott announced the vaccine will be available for free next year to every girl entering Grade 6 or 9. The $39-million push to immunize B.C. girls against HPV using Merck Frosst Canada Ltd.'s vaccine Gardasil is part of a national campaign that got a big push from Merck lobbyists last year.
Health observers said it is odd the provincial government is saying the vaccine prevents cervical cancer, when that is still unproven. The claim makes the government, which has been arguing that financial sustainability should be a principle of the health system, appear more like a pharmaceutical marketing firm than the provider of evidence-based health care.
"It really struck me we're testing these things on our children," said Paul. She's read a lot about the vaccine, she said, and she remains unconvinced it's a good idea. "It just confirmed a lot of my beliefs about the risks involved . . . To me the risk is greater than the benefit at this point. I just feel like it's a bit of a gamble."
Paul acknowledged she may be more critical about vaccines than most parents are; her eight-year-old daughter hasn't had any vaccines yet. Still, she said, despite health officials' cheerleading, many of the parents she talks with are doubtful about this latest push. "My peer group generally does not support it."
Marketing claims
To Victoria drug policy researcher Alan Cassels, the British Columbia government's announcement of funding for the vaccine sounded more like pharmaceutical marketing than sober public health policy. The announcement made claims that are yet to be proven, said Cassels, the author of two books on drug marketing, including The ABCs of Disease Mongering.
The headline read, "New Vaccine Program to Protect Girls Against Cancer" and Health Minister George Abbott called it "an opportunity to vaccinate against the vast majority of cervical cancers in women." He added, "We want parents and students to know that this vaccine protects girls and women from cancer."
The thing is, said Cassels, while it takes decades to develop cervical cancer, the trials for Gardasil were held over just two or three years. It's too soon to say if the vaccine actually prevents cancer, he said. "There were no cancers prevented in any of the clinical trials. I can say that with a certain amount of confidence."
He compared using the vaccine to taking a cholesterol-lowering drug. For most people taking such a drug, the important thing is whether or not it prevents heart attacks and strokes, not whether it lowers their cholesterol. "I think that's the same question we need to be asking about the vaccine . . . . It's still not a slam dunk in terms of what you're really doing it for."
The outstanding questions do bring B.C.'s motives into question, he said. "If you're going to say point blank, 'this vaccine prevents cancer,' you're misleading the public," said Cassels, who has an 11-year-old daughter who he will discourage from taking the vaccine. "Why would you do that? The headline, it's like a slogan. Why would public health officials be repeating a slogan that isn't true?"
Federal money
Provincial Health Officer Perry Kendall said providing the vaccine is good public health policy. The link between the virus and cervical cancer is clear, he said. "You don't get cervical cancer unless you've had a long standing infection with human papilloma virus."
There are 100 or so strains of the virus, he said, but two of the four strains in the vaccine are related to 70 per cent of cervical cancers. Preventing the virus should also prevent the cancers, he said.
The B.C. spending is part of a $300-million federally funded campaign to give Gardasil to young women. Kendall said the province's $39-million share has paid for some research and will fund the vaccination program for two years. After that the province will fund the campaign itself, he said. It costs over $400 for the three shots necessary to protect a person against the virus.
The national campaign met some skepticism in health circles when it was announced in March 2007, just eight months after Gardasil was approved. It remains the only HPV vaccine on the market, though GlaxoSmithKline has a competing product in the approval stages.
An August 2007 article in the Canadian Medical Association Journal said it is too soon to launch into a $300 million vaccination campaign. The authors wrote, "A careful review of the literature, including that submitted by the manufacturer with its application for approval of Gardasil, reveals a sufficient number of unanswered questions to lead us to conclude that a universal immunization program aimed at girls and women in Canada is, at this time, premature and could possibly have unintended negative consequences for individuals and for society as a whole."
Lobbying push
The Toronto Star drew connections in an Aug. 16, 2007 article between vaccine maker Merck Frosst Canada Ltd. and governments in Ottawa and Ontario. The company hired public relations firm Hill and Knowlton "to push the immunization strategies using some well-connected lobbyists," the Star said.
They included former policy adviser to Prime Minister Stephen Harper, Ken Boessenkool, as well as Bob Lopinski and Jason Grier, who had been high-level staff in Dalton McGuinty's Ontario government. Lopinski and Griers tasks included pushing the HPV immunization program and getting it funded.
In B.C., the company has also actively lobbied many politicians, including Health Minister George Abbott and Premier Gordon Campbell. The company has seven people registered as active lobbyists, including a former aide to Abbott and other Liberals, Steven Vander Wal. Vander Wal left the government in 2006 to work for Hill and Knowlton.
According to documents filed with Elections BC, Merck has given over $11,000 to the B.C. Liberal Party since 2005.
More screening needed
In B.C. there are 143 cases of cervical cancer a year, and 55 deaths from it, according to the province's announcement. The number has been falling for years, largely because pap tests detect cancers early enough that they can be treated successfully.
"It's a proven technique for detecting early cervical cancer," said Cassels. But many women -- predominantly those who have low incomes, who are aboriginal, immigrants or live in rural communities far from health facilities -- never get the test. Rather than provide the vaccine, Cassels said, the province would be better to increase its efforts to make sure every woman gets screened.
And while the government calls the vaccine "safe," Cassels said there have been deaths associated with it. "The whole risk question is still a question mark," he said. "Vaccines are never 100 per cent safe."
In tests of Gardasil a certain number of people did get sick after being vaccinated, said Kendall, but there was no clear cause. "There's no reason to believe [the illnesses] are caused by the vaccine," he said, adding he believes it is safe. "It met the standard of other vaccines we've implemented."
Kendall said the screening program will continue; at the very least it will still be needed to pick up the 30 per cent of cervical cancers related to other strains of the virus. About 75 percent of women get regular pap tests, he said, and the B.C. Cancer Agency is making efforts such as a mobile screening program to make it more available.
Of the 500,000 women who get a pap test each year in B.C., he said, around 8,500 will get an "abnormal" test back. Vaccination should cut that number, he said, and the worry that goes with it.
Low uptake predicted
Those who want the vaccine will doubtless appreciate the help paying for it, said NDP health critic Adrian Dix. It's not clear, however, how it became a priority for the federal and provincial governments amid so many demands on the health care system, he said. People with various illnesses and needs will want to know, he said, "How Merck Frosst got such quick action on their proposal when others have to wait."
In Ontario, which was one of the first provinces to adopt the campaign, fewer than 50 per cent of those eligible chose to accept the vaccine.
Kendall said the aim in B.C. is for 90 per cent to take it. "I don't know if we'll get there. I hope so."
Author Paul said she doubts even 50 percent of the parents she talks to think the vaccine is a good idea. They won't encourage their daughters to get vaccinated, she said.
"My feeling is the population in B.C. is a hell of a lot more skeptical," said Cassels. "I think the uptake's going to be very low."
Related Tyee stories:
- New Concerns over HPV Vaccine
Vancouver's chief medical officer wants to begin 'mass use.' - The Media Doctor Is In
Alan Cassels takes on the 'disease mongerers.' - What Should We Pay for Drugs?
Critics say BC's new pharma panel, stacked with drug firm reps, may erode safety, raise costs.
![[Tyee]](http://thetyee.cachefly.net/ui/img/ico_fishie.png){kind=small}
nwells
08-05-2008
There may be a lot of good
There may be a lot of good information in this article, but framing it with the opinion of someone who doesn't vaccinate her child at all damages its credibility, somewhat. It seems likely that she has an agenda in claiming that no one will use the vaccine, and it isn't useful information for the rest of us, since of course someone who doesn't like vaccines won't like this one.
James Burns
08-05-2008
Propaganda
I take extreme issue with the trajectory of this article, particularly featuring an parent who has not vaccinated her child as being some kind of authority. It lends credence to an exceptionally dangerous practice among some parents who foolishly do not vaccinate their children. I consider such a decision on the part of a parent to be not only stupid, but negligent. The only thing that prevent more death from disease than vaccination is proper sanitation followed by proper nutrition.
If the parent in question has ever allowed her child to ride in a motor vehicle, then she has put her child at far greater risk of death than any vaccination ever could.
There is little I loath more than the anti-vaccine idiocy out there that seems to proliferate on the internet, and amongst airy fairy new age nutbars who'd rather rely on crystals, and chanting to "cure" disease.
The issue here should be corporate for-profit influence on public health. Vaccines are far too important to public health to be left to profit driven enterprise.
DPL
08-05-2008
I'm no expert on this drug
I'm no expert on this drug so have to rely on comments by doctors. The article of yesterday in the T/C says it really isn't a good idea. Gordo is on side no doubt because the fed will be paying most of the bills
Susan Fletcher
08-05-2008
$80 million for what?
Not only is it unknown if Gardasil can prevent cervical cancer, it’s also questionable that HPV is the main cause of the cancer. Despite Dr Kendall’s claim, HPV is not found in all cervical cancers. It’s more likely that the many risk factors, chief of which is smoking, are the main cause. With Merck’s aggressive sales pitch having been successful worldwide, how is the relative predominance of the 150 (some say thousands) of HPV strains changing? How long will Gardasil be effective against HPV infection, let alone any possible efficacy against cervical cancer?
$39 million for two Grades vaccinated for two years, plus research? A Canadian Press article of Sept 20, 2007, announced BC Gardasil funding for 50,000 Grade 6 girls with no mention of Grade 9. The yearly cost of the vaccine alone with no administrative costs would be about $20 million for all Grade 6 girls and more like $80 million for Grades 6 and 9 for two years.
Kumakun
08-05-2008
Propaganda?
Not many people would disagree with you James if you were talking about proven vaccines. This is not a proven vaccine and it comes at a cost. There are many things that could use the money in our health care system. This is not "anti-vaccine idiocy", this is a very expensive vaccine that has not been proven. People are asking very reasonabale questions here. Considering my doctor just laughed and rolled his eyes when we talked about the HPV vaccine, what does that tell you?
ME2
08-05-2008
Experiment ?
If this vaccine is as unproven as some claim, then this program at least borders upon being a mass trial / experiment.
That being the case, it would seem imperative to me that monies dedicated to long-term follow-up would accompany the program.
I see no mention of that being the case.
UnCivilizedEngineer
09-05-2008
Hogwash
This article just screams paranoia and pseudo-conspiracy theory and has very little scientific merit. Not very well-balanced in terms of evidence presented, and riddled with political innuendo vs lab results.
Trying to claim Merck has a powerful lobby with...
Wow. $11 grand over three years. That must buy at least two plates at fundraising dinners.
The real point is that if the vaccine wasn't safe, Health Canada wouldn't have approved it. The one thing we still don't have in Canada is the US fast-track system of getting drugs to market before they're proven. Although a few slip through I would imagine that the benefits outweigh the costs, ie. more people can be cured of/control illness than die from it or from drug side-effects.
Susan Fletcher
09-05-2008
You "would imagine that the
You "would imagine that the benefits outweigh the costs."? Doesn't sound very scientific to me. Are you aware that Gardasil was fast-tracked for approval by the FDA? And, after that, it was fast-tracked by the Canadian Government when it was allotted $300 million in the Feb, 2007 budget, five months before receiving approval from Health Canada! Meanwhile, the final report on post-marketing studies required by the FDA is not due until 2018.
mopled
09-05-2008
Ah, Burns
This thread is about vaccines and you don't seem to be able to understand that Bill C 51 is:
"An Act respecting foods, therapeutic products and cosmetics"
Herbs are both foods& therapeutic products.
“sell” includes offer for sale, expose for sale or have in possession for sale — or distribute to one or more persons, whether or not the distribution is made for consideration —
The Act relies not on science or proven danger, but the "Minister's opinion".
Maybe you'd like to read the thing before defending it.
Then, how many "adverse reactions" do you need to tell you something strange is happening? 5 deaths aren't enough?
Why is the reporting of an adverse reaction
to a vaccine or medication voluntary
both in Canada and the US? How deceptive is that?
How many deaths from not having been vaccinated as opposed to deaths FROM VACCINATIONS in Canada?
Well, we can't really know since nobody is keeping track of it.
All of your assumptions about vaccinations need to be updated.
http://www.909shot.com/myths.htm
James Burns
09-05-2008
Rumsfeld
Ah right the old Rumsfeldism "the absence of evidence isn't evidence of absence." What a colossal joke.
Reporting is voluntary, so you make the claim that because it is voluntary physicians and anyone associated with health care are involved in a conspiracy to suppress the true and terrible nature of vaccines. Why? Who the hell knows. I'm sure you can come up with a tin foil hat theory to justify your nonsensical claims. But to go on and say no one is keeping track of it is also nonsense. Reporting is voluntary remember. There is a system in place. Here is the website of one in the US:
http://vaers.hhs.gov/
I'm sorry mopled, but where vaccines are concerned you are so colossally misguided that I have to question your ability to think rationally on the subject. Clearly all the scientific evidence in the world, and especially the fact that vaccines are used by billions worldwide with nary a reported adverse effect in comparison makes no difference to you.
As for bill c-51 why don't you read it? Theraputic products should be regulated. Tell me, can't you see the dissonance between your position on vaccines, which are carefully tested in clinical trial prior to their use on the public, yet theraputic products, many of which make incredibly outlandish claims of their health benefits, should have no regulation at all? In fact you are willing to scream blue murder over any attempt to ensure the safety of these products.
Frankly, I find that dissonance creepy. Vaccines which are exceptionally safe with simply enormous health benefits you attack relentlessly, while products that largely rely on the placebo effect for positive benefit, and may cause considerable harm due to contamination you want to have no oversight whatsoever.
ME2
09-05-2008
James Burns
I think you are wrong, Mopled, in linking GWest with James Burns, since he has supplied you with a link that destroys Burn's silly hypothesis that "voluntary" reporting by the medical profession constitutes a suitable replacement for tracking by an impartial gov't agency.
http://www.whp-apsf.ca/en/documents/adrBackground.html
There is no arguing that modern vaccines have resulted in the virtual eradication of many childhood diseases oommon in my childhood such as Polio, Measles, Mumps, and Diptheria, and prior to that, Smallpox. The list is long.
Beyond question, there are are occasional - and quite rare - deleterious side-effects from vaccines, but given the odds, any parent would be very foolish not to risk them.
But James Burns very deliberately ignores the overwhelming evidence that times have dramatically changed in the Health Care industry, as our gov'ts pursue the Ayn Randian ideal of turning all gov't services over to industry. If by some chance he cannot see that, he's self-delusional.
For at least twenty years, Gov't has been in the business of shutting down its labs and agencies which once provided the public with confidence in the drugs offered, and Burns draws heavily on that still-lingering confidence, while ignoring the mounting evidence that Big Pharma is short-circuiting testing as it tries to get its products on the market before its competitors.
One of the results of that is doctors experimenting upon their patients with different drugs. The outcome of this is, some claim, perhaps >250,000 deaths annually in the US as a result of mis-prescribed drugs, as part of what we now call iatrogenic medicine.
We've seen the problems which have arisen from over-prescription of mood-altering drugs such a Prozac, and the counter-productive results of over-prescribing anti-biotics.
These and other findings have NOT arisen a a result of the pharmaceutical industry or the medical professions policing themseves, as J Burns would have us believe, but rather from independant researchers in Universities and gov't, often in the face of near-terrorist activities by Big Pharma. And J Burns wants these shut down too, to save us money.
mopled
09-05-2008
You are correct ME2 and
my apologies to G.West for not having made the distinction between a style he often employs on other threads and his posting on this one.
One of the dangers of vaccination has been the "hot lot" problem. Occasionally a batch will be defective and dangerous. Without compulsory reporting, these lots may escape official notice until after a great deal of damage has been done.
Instead of a common sense measure being employed to prevent real danger, we have Health Canada trying to sneak past the outrage of Bill C-51 which will subject harmless products to draconian legislation.
It really doesn't seem to matter what party is in power, drug companies rule the roost at Health Canada.
James Burns
10-05-2008
Misrepresentation
ME2, I do believe I focused on vaccines did I not? The efficacy of vaccines we seem to agree on.
But the rest of your diatribe against me is utter trash. I hold none of the positions you accuse me of, and I challenge you to show where in what I've written that I do. If you cannot support those accusations then I suggest you retract them.
ME2
10-05-2008
Rertaction
You are 100% correct, James Burns. In your post above, WHAT VICTIM?,you state :
"I will, say, as I've said before, vaccines are far too important to be left to research, development and ownership by for-profit corporations. Doing so means the interests of public health take a backseat to profit. That is a big mistake."
Clearly, that is the exact opposite to the imputations I made re your motivations, and I unreservedly withdraw them and apologise for the unwarranted and unfair attack upon your credibility.
Since as I recall, this is the second time I've made this error with you, and since I usually try to be more careful, I've tried to figure out why I've made the same mistake twice. I think it's because some time ago I assessed the tenor of your postings wrongly, and those preconceptions have remained.
So please be assured that while I retain the right to disagree with you, I will in the future approach your posts using an entirely different perspective.
Again, my apologies.
City Person
11-05-2008
Mandatory Immunization
Whenever a new vaccine has come into society, there is always a very vocal minority that opposes it. That has even included the Salk vaccine for polio. Remember sanatoria with dozens of rooms filled with iron lungs? Remember the panic when a whooping cough epidemic hit a school, when panicked parents would keep their kids home? Well, I do.
There is no point getting into much detail but there have always been a very motivated band of lay people trying to tell the rest of society that their model for anything is better and that we should disregard the opinions of academics and other professional bodies.
If we, as a society, listened to screeching naysayers we would still live in caves.
James Burns
11-05-2008
Thanks
ME2 thank you.
One of the reasons I had such a strong reaction to your accusations is that I've done volunteer work in the past for open source medical publications. The primary purpose of these publications is to combat the influence of pharmaceutical corporations on medical research, and the reporting of research.
I think the influence of the pharmaceutical industry on the medical profession is corrupting and exceptionally dangerous. I do not think the pharmaceutical industry has public health as its foremost concern, and that has led to abuses by industry.
Government has obviated its responsibility of oversight with the misguided notion that by offloading the responsibility on industry they are saving money, when in fact all they are really doing is externalizing the costs by eliminating a line item from their balance sheet. The fact they end up adding more costs in the form of public disability and death due to improperly tested and regulated prescription medicine doesn't seem to bother many in government, which both baffles and angers me.
Now admittedly I can be exceptionally aggressive on certain topics. Vaccines are one, because they have been a godsend for public health. I tend to go on the attack when people knowingly or unknowingly misrepresent vaccines, because there is little I loath more than misinformation that results in real harm and loss of human life.
But again, thank you for taking the time to understand my position.