I don't see why Spiesel is surprised more parents aren't getting the HPV vaccine for their daughters.

There's a growing group of parents not getting their kids the standard vaccines due to autism fears (which are not supported by a scientific, causal relationship). Of course parents are reluctant to add a new (and non-mandatory) vaccine to the list.

We also don't know the long-term effects of the vaccine--another reason to be wary.

Finally, there are probably a lot of parents who don't even know about the vaccine.

Not all parents of non-vaccinated girls are afraid the vaccine will turn little Suzie into a raving sex maniac. There are legitimate (and not-so-legitimate) reasons not to vaccinate against HPV.

After reading the article and this post, I don't see any really legitimate reasons. Any vaccine you can get for any disease ought to be a no-brainer.

I think the fact that there have been no longitudinal studies (the longest was perhaps six and half years) is a pretty darn good reason.

I would encourage anyone considering this vaccine, and reading this article to check out a recent article in the New York Times:

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As someone who received the vaccine based on many assumptions and the hype at the time, I feel very conflicted and a little violated now. I don't have children, but for me personally, I might not do it again based on a few points that stuck out at me from the article:

1) It was rushed through some of the authorizing processes and doesn't fit the traditional pattern of vaccines as they generally gain acceptability among doctors.

2) They still don't know how long immunity will last. This to me seems incredibly irresponsible, especially since the whole cancer prevention thing is based on the immunity you receive when you get the vaccine. Now it seems as though wer're going to be medicating people excessively to ensure immunity (draining medical system), or exposing women to risk of HPV if we don't.

3) On the grander and more broad scale, the whole advertising campaign strikes me as fear mongering and exploitative. Especially when you consider the risk of cervical cancer in comparison to over forms of cancer. I have a lot of ethical problems with our capitalist medical system and treating healthcare as a commodity, and this strikes me very directly as a co-oping of women's health and bodies for profit. I'm very conflicted on my role in it.

4) If I could, as a woman who has very easy access to pap smears and who has spent a lot of time abroad with women who have NO access to primary care, I would in a heart beat give my vaccine to one of those women.

So there, I'm not entirely sure regret getting the vaccine, but I do feel used by the whole system, and see this as positive medical advancement that, like many unquestioned medical fads, swept people away in the hype for the profit of Merck, rather than our health.

Yes, but how long immunity lasts wouldn't really matter if we could wipe those strains of HPV off the earth (which is the goal of vaccines). Too many people see vaccines like medicine or vitamins. Their goal is not to keep you from getting sick or make you better. The goal is to keep the human race from getting sick and wipe out entire diseases. You're not just making a selfish decision for your child, but also any children your child becomes a disease vector for.

Immunity does matter. If you only have immunity for 5 years, and 6 years after you get vaccinated you get exposed to HPV, the whole point of the vaccine was null.

Also, the goal of vaccines is not to keep the whole human race from getting sick. Most vaccines widely utilized in the US get utilized rarely or not at all in poorer countries. The only vaccine ever to fully eradicate a disease EVER is the small pox vaccine, and the actual eradication process was invasive, at times violent, and debatably ethical, alluding to the fact that the actual eradication of disease via vaccines is incredibly difficult and nearly impossible.

Also: HPV is THE MOST expensive vaccine, and if a woman has universal and easy access to pap smears, its unclear whether or not it would even be necessary. I'm not saying that people shouldn't get the vaccine, but rather that before the entire medical community and the government pushed many women and girls into the vaccine (at the behest of Merck) these things should have been considered.

tthomas48:

Yes, but how long immunity lasts wouldn't really matter if we could wipe those strains of HPV off the earth.

There's no long-term study showing the HPV vaccine does that. There are legitmate scientific reasons to be concerned about the safety and efficacy of the HPV vaccine.

I read the NY Times article, and I thought it skipped over some major issues with cervical cancer. Yes, it's true that in the US, most women who get regular pap smears don't die of cervical cancer. But the treatments for cervical cancer are not trivial. They range from scraping off layers of your cervix all the way up to hysterectomy. It can lead to infertility, or there can be other complications. These treatments may be successful for the most part, but they aren't trivial. (Not to mention how difficult it can be to get regular pap smears when you're uninsured or underinsured. The safety issues are certainly serious and should be considered, but I thought the NY Times article was awfully dismissive to say that "women in the US don't die of cervical cancer" without saying "but they may have to have lengthy, painful treatments if they get it".

That is a really good point. I think you should write a letter to the editor. Seriously. :)

I agree with the previous poster. The treatment for pre-cancerour lesions on the cervix is can be extremely damaging. At the very least, it can easily result in scarring of the cervix, which can lead to an obligate C-section for any future children. And you won't know that you need a C-section until you're trying to deliver and the cervix fails to expand the way it should, because of the invisible scar tissue. Talk about dangerous.

Personally I think it's much much safer to take my risks with the vaccine.

"I think the fact that there have been no longitudinal studies (the longest was perhaps six and half years) is a pretty darn good reason."

Really? Why? We fielded almost every other vaccine without such studies. The vast majority of vaccines have immunity windows measured in decades, do you have some reason to think this one will somehow be the only one with a short window? Do you only take vaccines or medications with longitudinal studies? If so, do you really limit yourself only to those treatments that have been around for 30 years? I doubt it. No, you are holding this vaccine to an unrealistic standard that you don't hold any other medical treatment to and you are doing it for a reason other than what you are stating.

If we were really trying to eliminate HPV with this vaccine, we'd be at least offering it to older women, and, much more importantly, it would be available to males. While men cannot get HPV, they can carry and spread it, making it just as important to give to them as to women. I'm a 23 year old woman who has not gotten the vaccine because if it's not safe enough for them to give to guys, it's not safe enough for them to give to me.

I'm sorry, you're clearly not a doctor, and not a recent parent. The newest "universal" vaccine before Gardisil is the chickenpox vaccine which -- surprise! -- had breakthrough cases in some kids within 3 years of them getting it. Turns out the chickenpox vaccine needs a booster. So does tetanus. MMR? 4 doses.

And with Garidisil, which already is the first vaccine ever to cost society more than it saves, if a booster is required, that will hurt the rationale even more.

Oh, and it appears that it may REDUCE immunity to the 30% of HPV strains that it doesn't protect against.

The doctors have been bought off on this one, but the NY Times and the New England Journal of Medicine this week have been rightly firing back. Hardly the abstinence lobby leading the anti-Gardisil charge...

So, how do you come by the statement that it costs more than it saves?

1. According to the research, the vaccine (like many others) is most effective when given at the suggested ages simply because of the characteristics of the human immune system at that stage of development. Presumably it's much less effective when given after the recipient has A) reached adulthood and B) probably been exposed (though maybe never manifested symptoms) to at least one strain of HPV. [The CDC, by the way, estimates that y the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.] Men can indeed get the vaccine through their doctors, but again, age and potential exposure might make it less effective.

2. Men most certainly can and DO get HPV. They may get genital warts, but they obviously (lacking a cervix) cannot get cervical cancer. Even if you discount genital warts -- which may require years-long or life-long treatment and maintenance -- as a legitimate gripe, I'd still say that men should be immunized simply to avoid being a vector to pass it along to others.

3. Aside from the cost, pain and side-effects of the treatments for cervical cancer (long, expensive, unpleasant), AND aside from the cost and pain of treatment for genital warts, be advised that you and your presumably pure-as-the-driven-snow daughters can be denied health coverage by major insurers (such as Blue Cross) because they have HPV -- even a non-cancer-linked strain. That doesn't mean "denied coverage" for just HPV treatment -- it means denied health insurance, period. The vaccine may be expensive, and HPV treatment more so, but it ain't nothin' on the cost of care following a heart attack. Or a stroke. Or liver cancer, etc. So unless you've got a federally-funded universal health care plan up your sleeve, I'd think twice about dismissing this vaccine.