A surprisingly good column from Mr. Saletan today!

The policy of only recommending the HPV vaccine for girls is, perhaps, a cost-saving measure to get good value for dollars spent. But, if the recent healthcare debates have taught us anything, I think it would be that maximizing value is not the same as maximizing health (or, for that matter, justice). Saletan points to two of the main assumptions underlying the "vaccinate girls" strategy.

First, it assumes that women, more so than men, can be counted on to take responsibility for their bodily health and that of their partners. This happens in other ways relating to sex, such as the lack of funding and research on male hormonal contraceptives relative to women's hormonal contraceptives (even though some women, with family histories of heart disease or certain cancers, may be advised not to take hormonal birth control, and they'd benefit from their partners doing so instead). A dependence on women's responsibility also happens in other realms, as Saletan points out - obviously there are exceptions, but today it is still the case that straight men heavily rely on women to do housework, make doctors' appointments, plan healthy meals, etc, much more than the other way around.

The second assumption here is heteronormativity - that everyone is straight, and, if sexually active, is having hetero sex. If that were true, then a policy of vaccinating only men or only women would make a lot of sense, since either they or their partners would be vaccinated. The current policy, however, basically only ensures protection to women, and to men who have sex with women. In some sense - whether intentional or not - the policy penalizes men who have sex with men, by (1) obscuring the fact that HPV can cause ill health in men (it's not all about cervical cancer!), and (2) further obscuring the possibility that such men COULD benefit from getting the vaccine. I wouldn't be surprised if health insurance companies don't cover the HPV vaccine for men, which further penalizes (i.e., discriminates against) those men who have sex with other men. In short, while vaccinating women against HPV may be a cost-saving measure, it's certainly not ensuring the greatest health for the greatest number of people - and certain people will bear that cost much more than others.

It is understandable that the vaccine came out for girls. Cervical cancer death rates are 2.5 per 100,000 in the US. Anal cancer death rates are only 0.2 per 100,000. So cervical cancer kills over 12 times the number of women from cercvical cancer than it does men from anal cancer. So if I were developing the vaccine, I would target the one that kills the most first.

Now, that being said, men who have anal sex are 35 times more likely to get anal cancer. Up to 80% of anal cancer is associated by HPV 16, one of the HPV virus targetted by the current cervical cancer vaccines. So, logically, it makes sense to offer this to boys. But I dont believe this is discrimination or gender politics offering this to girls. The highest risk population got offered the vaccine first. Logically, research is now occuring for other lower risk groups.

Perhaps a little more patience to allow for the scientific data to develop is in order. After all, I dont think men will be against self protection. I dont think drug companies will be against doubling their target patients for the vaccine. We just need the data to support this choice and I presonally believe we will see it.

I'll admit - I took Saletan at his word that the HPV vaccine could prevent certain cancers in men (and I think someone mentioned a respiration problem for infants that could result, too?). If the research isn't there, it complicates things a bit - I agree with you that drug companies probably will not be shy about finding new markets for their products, especially when those markets tend to have income and health insurance!

Saletan is probably right and these vaccines probably will work for men. But the science isnt as strong for this yet as it is for women.

Even if the vaccine does work for boys, you're never going to vaccinate everyone. If you assume massive promiscuity, then vaccinating the boys only will not protect the girls. The girls will f*ck around in college (or junior high) hook-ups with enough boys that they eventually get HPV, and then cervical cancer.

If you vaccinate only the girls, then the boys who f*ck around will eventually get HPV from one of the few unvaccinated girls, but their risk of cancer from HPV is smaller, so the benefit of vaccinating them as well as girls doesn't provide as much bang (no pun intended) for the buck, compared with alternate ways of spending our health-care money.

Vaccinating 50% of the girls and 50% of the boys still leave 50% of the girls at risk of cervical cancer.

Due to the impossibility of vaccinating 100% of any population, and assuming massive promiscuity, it really is an economic decision.

After all, I dont think men will be against self protection.

if this is the case why haven't we seen male contraception yet. i remember them talking about research in that department in the eighties. we can map the genome, but we can't make better strides in contraception for males and females both?

there is definitely something to be said about where the research money goes and why. and i think it's not just who benefits most. sexual politics play a part in most things of this world whether we are aware of it or not.

Probably because temporary male contraception is difficult to do. The men that really want it are left with invasive surgery.