Tuesday, February 6, 2007

Clear Thinking about the HPV Vaccine [Serge]

My feelings about this vaccine have not been solidified at this time, so my thoughts are provisional. I am very uncomfortable with the idea of any "mandatory" vaccine, even if there is a way for a parent to opt out. However, the question I wish to explore is whether the pro-life community should oppose making this vaccine available to parents who wish to have their daughters vaccinated. I also am well aware that many are uncomfortable with the whole idea of vaccinations, so for the sake of this discussion I will assume the vaccine is safe and effective.

First, a description. The HPV vaccine protects against four subtypes of HPV. Two subtypes are known for their association with cervical cancer, and two are associated with genital warts (these are subtypes 6 and 11). When present genitally, these lesions are almost always contracted through sexual activity. However, there are other lesions associated with subtypes 6 and 11 that are not contracted sexually. For example, I frequently remove oral papillomas, which are caused by 6 and 11 and are not contracted sexually (they are frequent in children).

Ed makes this argument in the comments:

We are facing one of those issues in Colorado. For instance, we have a "pro-life" legislator sponsoring a mandatory HPV vaccination bill which will inevitably increase early sexual activity (by making kids feel even more invincible), and thereby also unwanted pregnancy and abortion. He scoffs at the connection, but it's obvious to those of us who see the "life-cycle" of the abortion mindset in young people.
I do not find this argument compelling. I do not believe that teenage sexual activity will increase due to this vaccine. This argument assumes that there are a number of teen girls are staying sexually pure solely in order to avoid HPV. If they are vaccinated, then they will see no reason to be pure, so they will engage in sexual activity thus increasing their risk of pregnancy and subsequent abortion.

The problem is this: where are these girls? I'm not sure any girl is avoiding sexual activity solely to avoid HPV. In fact, I believe that most girls are unaware of HPV, including its method of transmission (which can be skin to skin) and association with genital warts and cervical cancer. If this is the case, I cannot see why these vaccinations will give them the feeling of vulnerability.

Like most health professionals, I have been vaccinated against Hep B, which is spread like HIV and is frequently contracted sexually. My staff have also been vaccinated, and I don't believe the fact that they have been vaccinated have increased their "invulnerability" to sex. I just don't see it.

If the pro-life community chooses to require opposition to this vaccine as a requirement for endorsement, we need far better arguments than this one. At this point in time, I'm not sure a better one exists.

Update: It looks like Eugene Volokh has also chosen this topic to blog about. His analysis is here.

7 comments:

  1. Serge,

    God bless you for sensing my subtle appeal to you for clarity. I agree that there are not vast multitudes of teenagers avoiding sex so as to dodge HPV. I do again stress my personal outrage at the line of commercials that minimize the life changing impact of sexually transmitted diseases by either singing the praises of a medical treatment(genital warts) or by not clearly stating that we are talking about an STD at all.(HPV) I do NOT think that they increase the number of abortions. I do think they trivialize the serious and life altering consequences of aquiring a sexually transmitted disease for the sake of selling drugs. Those are different issues in my mind.

    Jay

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  2. I completely agree Jay. Merck is certainly not an objective agent here. If governments shell out 300 bucks a person by making the vaccine mandatory, their bottom line looks pretty good. They have no reason, other than ethics, to describe the transmission of this virus in accurate ways.

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  3. Is this vaccine made from aborted fetal cells like the chicken-pox and rubella vaccines?

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  4. No Mandi - the vaccine was not developed using fetal cells.

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  5. I don't think this is a pro-life issue per se, but I do think it is a conservative issue. We're talking about girls in eighth grade, here.

    To me, giving this vaccine to girls of this age is very much like giving a condom in its ramifications. I'm not Catholic and am here setting aside the question of whether condom use is wrong in itself. I don't think we should pretend that the purpose of giving this vaccine is to prevent oral papillomas of HPV types 6 and 11 contracted non-sexually. No one would be recommending this wide distribution were it not for the presumed cancer connection, which has to do with sexual transmission and genital HPV. So the whole point here is preventing disease in young girls that they might otherwise contract through sexual activity. If everyone expected the girls to remain chaste until marriage at, say, 21 years of age, the recommendation instead would be that, if the girl is marrying a man who is not a virgin, she get the vaccine just before her wedding. Wouldn't that make sense? Obviously, this is not being recommended because of the expectation of earlier sexual activity, and in that sense it is sending the same message to the kids, ages 11 and up, as "safer sex" education and condom distribution: "We are entirely resigned to the expectation that you'll be starting to have sex very soon, if you're not already, and we're doing this as a favor to you to help you remain physically healthy while doing so."

    I don't think one needs to assert that there are large squadrons of girls out there remaining self-consciously chaste only through fear of HPV in order to argue that this isn't a message we want to send. In other words, the same arguments apply to this practice as apply to the entire "safer sex" approach to interacting with adolescent and pre-adolescent young people.

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  6. Lydia,

    My original post was in response to Ed's assertion that the HPV vaccine would cause more sexual activity because kids would feel invulnerable. Yours is a different argument (I would call it the assumed premarital sexual inevitability argument), and I believe it is a more compelling one. You make good points and I will comment in another post. Thanks for the interaction. And keep warm (I'm in Mt Pleasant today and 7 degrees seems downright balmy)

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  7. Serge,

    My assertion was largely exactly what Lydia said. Because it is either condoning sex, making sex "safer" and/or making the resigned assumption that kids are going to do it anyway, then it lessens the societal taboos against early sex.

    From there, it's not a huge jump from early sex to more pregnancy to more abortions.

    I agree with you that kids aren't generally aware of HPV or other STDs at all. They're grossly under- and mis-informed. But that's partly my point -- kids are naturally inclined to disregard risks in general, and an HPV vaccine becomes an "excuse" to disregard the risks.

    I hope you won't disagree that most kids think they can avoid STDs and pregnancy by wearing a condom -- it's a myth (an "excuse"), but it's also widely believed. How far from there to HPV vaccine = safe sex? Kids don't need many excuses to disregard the risks.

    The degree to which fear of STDs impacts sexual behavior is debatable. But I'm one of those who avoided sex in high school and college, and since I was not a Christian at the time, my reasons were 1) social stigma of sleeping around , 2) fear of unintended pregnancy, and 3) fear of STDs. There is less stigma these days, and there's always the excuse that pregnancy can be resolved with abortions, so fear of STDs was for me -- and probably is for most teens -- the most compelling reason not to engage in teenage sex.

    Obviously, that's only for those who are concerned about and aware of the risk of STDs. But that just brings us back to consider whether we're condoning early sex by making it safer.

    Consider this comment to Volokh's post: "If I'm correct in my suspicion that HPV is far more prevelant in the non-drug-using heterosexual American population than AIDS, then a decision to have sex because of the vaccine is quite rational." or this one: "Perhaps more importantly, several studies (eg Holmes 2004) show that condoms are less effective at reducing the transmission of HPV than they are at other STIs. Therefore, as a highly risk-informed young teen girl, I may feel significant disincentive to have sex with a condom due to HPV, which is eliminated by the vaccine."

    In the mind of a teenager, a mandatory HPV vaccine eliminates some of the risk of teenage sex. That makes it inevitable that more kids will engage in sex in middle or high school, which also makes more abortions inevitable.

    Ed Hanks

    p.s. Although this is way outside my argument, the other primary reason to oppose this is that the clinical tests were not only flawed, but they had a remarkably large percentage of death or life-changing disease (arthritis!) in the trials, which were flawed anyway because of the use of aluminum in the placebo control (which would mask the degree of reaction to the aluminum in the vaccine).

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