IV. REVIEW OF A POPULAR MEDIA PIECE

VACCINE! VACCINE! VACCINE!

YES, now we have HVP vaccines!

Currently, more than 11,000 women in the U.S. are diagnosed for cervical cancer each year, and cervical cancer become the second most cancer for women next to breast cancer.  Of 70% of cervical cancer is caused by HPV infection.  Vaccines against cancer-causing HPV were developed and approved by FDA, first to Merck’s “GARDASIL” in 2006, and second to GlaxoSmithKline’s “CERVARIX” in 2007.  These vaccines work to prevent from infection by two of each major warts-causing HPVs and cancer-causing HPVs.  For the best results, pre-teen girls/boys receive three dozes of vaccine over a period of six months, before they start any sexual activities.  HPV vaccination in the United States is not mandatory in all states but Virginia and Washington DC, and a half of states (29 states) leave it as optional to individuals.  According to CDC, only 38% of girls aged 13-17 years had received the complete 3-dose vaccination in 2013, and the uptake rate among boys are much lower. 

Don’t do it?!

Earlier this month (June 2015), several online-based published articles warning the safety of HPV vaccines, citing a clinical report presented by Dr. Fangjian Guo et al of University of Texas Medical Branch, at the annual meeting of the American Association for Cancer Research.  One of them was posted on The Healthier Life entitled “Cervarix & Gardasil: Thousands Of Teenage Girls Are Affected By HPV Vaccines.” Below is the copy of the part that the online article referring to Guo’s report:

The latest research from the University of Texas has finally proven that these vaccines won’t protect any girl from the human papillomavirus (HPV) that can cause cervical cancer.

In fact, the vaccine may be helping to cause cancer instead — including some of the deadliest and most aggressive kinds.

Fangjian Guo, a researcher at the University of Texas Medical Branch, dropped a bombshell at a recent meeting of the American Association for Cancer Research.

He found that women who got the original Gardasil shot were infected with high levels of dangerous strains of HPV — the same HPV that can cause cervical cancer… the same HPV that Gardasil and Cervarix is supposed to protect our daughters from.

Guo and his research team analyzed medical records for nearly 600 women in their 20s. And those who were vaccinated with the HPV vaccines were a whopping 40 per cent more likely to be infected with strains of HPV classified as “high risk.”

That means these HPV strains may be more likely to develop into cancer. …..

Don’t allow your daughter to be another victim of this snake oil. A simple Pap smear reveals cervical cancer in the earliest stage when it’s least dangerous and highly treatable… and if you really want to protect your daughter against cervical cancer, talk to her about practicing safe sex.

Our message is clear: Don’t do it. 35,000 reported adverse effects and 200 deaths certainly tell a completely different story to what we’re being told by Big Pharma, paediatricians and the media.

I have read many other new articles criticizing or being skeptical about the effect and safety of HPV vaccines but this one looked a little different because it was referring to a report by doctors at the University of Texas Medical Branch.  I was curious if Dr. Guo really “prove these vaccines won’t protect any girl from the HPV”, and he really found that “women who got the original Gardasil shot were infected with high levels of dangerous strains of HPV”?  So I looked for his article and found its abstract.  Basically, Dr. Guo’s study was about the HPV prevalence, comparing vaccinated vs. non-vaccinated young adult women.  His finding was that HPV vaccine was effective for all vaccine types (HPVs 6, 11, 16, 18) but vaccinated women are more likely to get infected with high-risk type HVPs other than HPVs 6, 11, 16, 18, than non-vaccinated women.  Nothing in his report “prove that these vaccine won’t protect any girl.”  Apparently, the author of the website article does not even know that there are over 100 types of HVPs and not all high-risk cancer-causing HPVs are covered by these vaccine from the beginning.  What I see here is that the author intentionally or unintentionally misrepresented the contents of the report, used this authority to seemingly justify his/her argument, and jumped into a conclusion “Don’t do it.”

What to trust?

Guo’s report is not a pseudo-science, but I thought I should exercise caution when reading any articles citing scientific reports, because they may present such reports in a way to support their opinion.  

Whether we should make HPV vaccines mandatory to pre-teen children is a big question.  Cervical cancer could be effectively prevented by uptaking routine Pap-smear tests.  If so, isn’t HPV vaccine most suitable option for only boys in this country and boys/girls in rather developing countries where an access to Pap-smear tests is limited?  Considering such a high prevalence and a high incidence of the HPV infection worldwide, the herd immunity may be unlikely to be established.  Also, in the course of years of HPV's clinical latency, one could die any way from other cause of death, whether or not the person is immune to HPV.  Unlike other highly infectious diseases such as polio, chicken pox, or measles, 90% of HVP infection could disappear by the body's natural immune system, and its clinical occurrence rate is very low.  Yes, vaccines can reduce the risk of getting cervical cancer, but if the means to prevent the disease are available, should we mandate all of them using our tax?  At some point, we must draw a line what disease be considered as a thread to public health, and be prevented by the government.    

Yet, CDC and the other government organizations back the campaign to uptake HPV vaccines for girls and boys, stating 18,000 women and 8,000 men suffer preventable cancers of the cervix, anus, penis and throat.  But who knows that these government officials may be lobbied by Merck, who are also paying $4500 per seminar to supporting doctors?  

Award winning artistic Merck's poster/advertisement

Cost vs. Benefit Analysis
Whether or not the pharmaceutical companies are conducting aggressive marketing in the medical field, the adequate decision may be lead by the cost-benefit analysis from the aspect of the improvement of public health.  After all, three-time shots in life time save a lot of money compared to routine pap-smear tests from age 21 to 65 (though the Pap test is recommended to those who received vaccine in the past).  What is more, the pap test does not prevent infection but only help detecting the onset of cervical cancer only.  The Pap test cannot detect other form of HPV induced cancer in anus and throat.  If abnormal cells are found in the Pap test, the follow-up treatments will cost more and patients will experience more pain than the prick of vaccine shots.  Also, if women forget to take routine Pap tests, they may end up losing their lives from cervical cancer.  Importantly, male populations can be protected from cancers in throat, anus, and penis by the vaccine.  These cancers are usually hard to detect in men until signs become apparent.  In terms of risks, CDC discloses common side effects of redness or swelling disease  nausea, and headache, and some reported deaths among people who received an HPV vaccine, but also explains that these death cases were further studied and concluded that "there is no diagnosis that would suggest the vaccine caused the death."  Of all or in part of those benefits and risk are considered, researchers calculated the cost per quality adjusted life year gained by vaccination to 12 years old girl be $3,906 - $14,723 in 2005 US dollar.  How much it would cost if not vaccinated and hospitalized etc. is unknown, so whether we consider this dollar amount is high or not will be a matter of politics.  I am more inclined to think that overall benefits outweigh risk and cost of receiving the HPV vaccine and support that the mandatory vaccinations to all pre-teen children from the public health point of view.

As to Guo’s research, the report was interesting because of the higher prevalence of high-risk HVP in vaccinated women, I would like to see further investigations using more simple tissue models, rather than clinical settings because it is often very hard to eliminate variable factors in the clinical settings.  And if his study is proven to be more plausible, the vaccine should include the extra HPV types as well.  

“Cervarix & Gardasil: Thousands Of Teenage Girls Are Affected By HPV Vaccines”

http://www.thehealthierlife.co.uk/natural-health-articles/cancer/cervarix-gardasil-hp-vaccine-side-effects16638/

Fangjian Guo, et al. “Comparison of HPV prevalence between HPV-vaccinated and non-vaccinated young adult women (20-26 years)” presented at the annual meeting of the American Association for Cancer Research.  Apr 19, 2015.

http://www.abstractsonline.com/plan/ViewAbstract.aspx?mID=3682&sKey=7f019f73-accb-484e-becc-5ecc405f8ec5&cKey=e2313b32-d6ac-4443-ab2d-49c368ea3b89&mKey=19573a54-ae8f-4e00-9c23-bd6d62268424#

http://www.cdc.gov/vaccinesafety/Vaccines/HPV/hpv_faqs.html#seven

"Drug Makers’ Push Leads to Cancer Vaccines’ Rise"

http://www.nytimes.com/2008/08/20/health/policy/20vaccine.html?pagewanted=all

"Cost-effectiveness of Human Papillomavirus Vaccination in the United States"
http://wwwnc.cdc.gov/eid/article/14/2/07-0499_article