Wednesday, February 28, 2007
Tackling cancer with a vaccine is a good thing, right?
If you are like most people, you have probably seen television advertisements for a new vaccine called Gardasil. It is being prescribed to prevent cervical cancer, and according to the FDA, it works pretty well. It works by preventing four strains of a sexually transmitted virus, known as human papillomavirus, from ever taking hold. It is these four strains that cause 70 percent of cervical cancers and 90 percent of genital warts. The message: Take the vaccine early and dramatically reduce your risk of cervical cancer.

As we have been reporting this story, however, I have seen more questions than answers emerge. Let me try and tackle a few. One of the big areas of concern is the age at which girls should get the vaccine. The Centers for Disease Control and Prevention recommends the vaccine for girls 11 and 12 years old, but it can be administered to girls as young as 9. That's young, for sure. But, the research tells us that girls between the ages of 14 and 19 account for 25 percent of all of these infections, which are almost always transmitted sexually. That was a bit of an eye opener for me, a father of two girls. So, the age started to make more sense. What about boys? That was another question. Well, it turns out that a vaccine may be approved in the future for boys as well. The thinking is that if you prevent boys from getting the infection, they are less likely to pass it on to girls, which in turns reduces a girl's chance of cervical cancer.

Not everyone who gets HPV will get cervical cancer. If you do get cervical cancer, though, it is one of the deadlier cancers. Yes, the vaccine does appear to be safe based on an average of 3.9 years of follow-up testing. It does not appear to adversely affect a woman’s fertility in the future.

Where it gets sticky is the call for mandatory vaccination. This may be the most controversial question of all. Perhaps, it is our rugged individualism that makes us question anything that is forced upon us. Perhaps, it is the concern about side effects down the road. Perhaps, it is that we don't necessarily want to have conversations with our 9-year-old girls about why they are getting the vaccine in the first place.

As a doctor, and parent, I would recommend the vaccine for my daughters. I feel the ability to protect them in any way, including from cancer, is my primary obligation. What do you think? Would you recommend or get the vaccine? What are the objections?
does the strain of HPV that can lead to dysplasia cause warts on men?
I would agree with the vaccination being made mandatory.I know some patients parents wouldn't like it.But if they are educated about cervical cancer and how it is caused and what is the outcome and how this vaccine prevents it ,....sure they can be convinced to get the vaccine.
Does this encourage earlier sexual activity in young girls ?.......thats another concern.
Thats where patient education in role.
It should be clearly explained that the vaccine protects only against cerivical cancer and genital warts caused by those 4 strains of HPV only.
So the risks of other STD's is still there.

So bottomline ----good patient and parent education will help in more vaccination acceptance rate .
Sure why not? After all HRT was a good thing for women. Oh, wait, wasn't that the one that after women were on it for many years they suddenly had to stop taking it cause it was causing the exact health problems it was suppose to prevent??

Come on folks - these are our young people! When are we gonna start learning from our mistakes? Test this vaccine for about 10 years, then get back to us on it.

By the way, what's the mercury content of this vaccine?? Bout the same as the flu shots??
I have already paid to have my daughter vaccinated with Guardisil. Three doses at $186 Canadian each is a small price to pay for her to be protected in the future. I would like to see it mandatory here in Canada. As for promoting sexual activity...get real! Girls are not stopped from having sex with the fear that they will get cancer from HPV...it's not even on their radar! A vaccine is NOT going to either promote OR prevent young girls from having sex. Good parenting and education regarding how to make good choices is far more effective.
Why do we necessarily need to tell the girls why they are getting shot? When I was young, my mom and/or doctor would say, "time to get your shots updated"! They didn't say, ok young lady I am sticking you with this needle to protect you from hepatitis which is contracted by...". The same should go for the HPV vaccine. Tell your daughter she needs another shot. Then at a time a parent feels the child is mature enough-- explain to her what the virus is all about.
I'm not sure how drastically things have changed since I was a child, but I had no concept of why I was getting the vaccinations I was getting when I was young. I knew they were intended to keep me from getting sick. That is all I knew and I didn't question it. I'm not sure why we are concerned about having to explain to 9 year old girls that this vaccination has anything to do with their sexual activity.
My objection is noone knows the long term effects or problems that may arise in 5-10 years from now from this injection. So to make it mandatory right now to me seems a little bit too soon. I think that should be left up to the parent for now.
Dr.

You mention that the ideal age for this vaccine is around 11 or 12 and girls as young a 9 can be administered. What about older girls? Is it too latee if they are say 15 or 16 if they are not yet sexually active? Even if they are, can it still prevent th3e virus if they have not contracted it yet?
I would get the vaccine but since I'm 35, I cannot. It's unfortunate since I experienced an HPV scare 3 years ago (my former partner was infected and even though condoms were used 100% of the time - it does not protect against HPV - luckily I did not get it). I think the vaccine should be available to every female regardless of age. There are so many strains of HPV, even if a woman has HPV, it doesn't hurt to try and prevent catching those known four strains.
I don't think that 3.9 years of follow up is sufficient evidence to convince me to give this vaccine to my daughter. While the short term data may looks promising, I am more concerned with the long-term effects for my daughter. Do we even know how this would affect future live births? Is this data to support positive outcomes over an extended period of time? I have seen nothing to convince me that there are not any negative outcomes long-term.
Would similar arguments be made if there were a vaccine for HIV? The health of future generations should not be reduced to a squabble over sexual education. I don't think anyone worries about the hepatitis vaccines in this way, either, and its causes are similar. Girls and boys should both be given the vaccine at the youngest age possible so neither groups have to suffer the pain of the resulting cancer (or warts).

In an ideal world, these problems would not exist. The thing is, we won't live in that ideal world unless we take preventative measures ourselves. No one else will do it for us.
As someone who has HPV and is dealing with tests, repeat pap smears, and the overall stress and fear that I have something in my body that can potentially lead to cancer, I strongly support this vaccine and EDUCATION about the virus. Most men don't know about it, and because it doesn't necessarily cause symptoms, are unaware of the role they play in transmitting the virus.
It seems ludicrous to me that society wouldn't want its daughters vaccinated against a cancer-causing virus that is so widespread.
I having suffered with HPV and precancerous cells of the cervix the last two years and there is no way I would give my daughter the vaccine. There has not been enough research done to clearly show the out come of this new shot. My concern is what is really in the shot that they are giving these girls.Who is to say that a form of the virus is not in the shot, which could cause more problems.
I personnal know the affects of HPV and cerivcal health and I feel more research is needed before we start giving our daughters ( which I do have one)a shot that has not been thoughly tested.
I more than anyone wish that HPV and cerivcal cancer was not an issue but it is and we need to deal with it, but giving our childern a shot that no one really knows about is not the way to solve this problem.
As long as the vaccine's safety record remains clean, my husband and I definitely intend to have our daughter vaccinated.
I have little patience with people who oppose the vaccine "for moral reasons." Just as with HIV, people can become infected without engaging in promiscuous sex. Should they not be protected?
I have mixed feelings about making the vaccine mandatory, particularly without a long-term safety record to reference. Also, this is a very expensive vaccine that's often partially or completely uncovered by insurance. I think the government must address those issues before requiring the vaccine.
As far as explaining why they're getting the vaccine all you have to tell them is that it helps protect against one of the many kinds of cancer. You don't have to go into detail about everything. Most girls find this stuff out at thier first gyno exam and a doctor really is the best person to explain it since alot of parents do not understand it themselves.
This whole thing about it encouraging sexual activity in girls at younger ages is bunk and nothing but an excuse to not give it. They're going to do what they want anyways regardless of a vaccine or any other kind of protection. Many teenage girls don't understand what HPV is, what it can do or why they should have the vaccine at all even though they are already sexually active. I think it's very important that girls get vaccinated and I too would like to do so.
I have a question and a comment.

Question: If you have HPV but do not have any of the 4 strains that cause cervical cancer, will getting the vaccine still help in reducing your risks for contracting any of those 4 strains?

Comment: I feel that people's opinions on mandatory vaccination depends on more than whether or not they want to talk to their daughters about STDs or even protesting against anything that is forced upon them. If a law is passed that mandates all girls to get these vaccines, who will be paying for it? As there are many positive reasons to be vaccinated, I am sure that the majority of Americans may simply be unable to afford them. I think the best solution is to offer the vaccine with government-pay assistance (not just coverage under insurance because many Americans do not have health insurance). In addition, there should be more programs that teach our children about having safe sex (when that child is ready), as opposed to just abstinence.
Hi Dr. Gupta,
My only concern for this vaccine, can be found in your own words. 3.9 years follow-up? Does not APPEAR to have side effects? Where have we heard these words before, only to be wrong. I'd say give it to those that want it, but don't rush to make it mandatory. That's just my opinion. Take Care
February 28, 2007

Dear CNN,
I am writing in response to the discussion about the HPV vaccine. I do agree that we need not just accept the word of pharmaceutical companies without question, however this is a vaccine that could potentially save the lives and fertility of many young women. I agree that there is a lot of corruption in the pharmaceutical industry. I am a social worker who has been privy to �office talk� about doctors accepting gifts from pharmaceutical representatives and so forth. I also believe that prescription drug costs are through the roof because of the exorbitant salaries, commissions, and bonuses given to the drug reps instead of capping salaries and putting that money back into research.
On the other hand, so many great strides have been made by the same industry. I believe that this HPV vaccine is one of the great ones. I understand the point about testing it out more before requiring the youngest of our girls to have it administered to them. I am a cervical cancer survivor, and at the time of my diagnosis testing for HPV was not available. I will never know if I had HPV, but I am very passionate about this issue. I lost the one part of my womanhood that makes it possible to have children, and I could have lost my life.
I was the victim of a medical mistake that resulted in the diagnosis of cervical cancer twenty-two days before my 31st birthday. One week after my 31st birthday and eight months after the birth of my first son, I was admitted to Memorial Sloan-Kettering for a radical hysterectomy and ovarian transposition.
What happened? I had at least two pap-smears that were misread by cytotechnologists. The pap-smear results were reported to my ob/gyn as �normal�. Here�s how it all unfolded:
After the birth of my son in March 2000, I began to experience symptoms, and I say �symptoms� in hindsight. Nobody really tells women what to expect physically after giving birth, and I attributed the problems to being post-partum. I was bleeding on and off, and when I would get my period in those early months the bleeding was heavy at times. I remember getting up to get my son out of his crib and ending up hunched over the side rail, calling my husband to help me, and needing to sit down because the bleeding was so heavy. When I was a teenager my periods were heavy, and I thought that my body was reverting back to that. Also, I am a redhead, and I had been told by my nurse in the hospital after giving birth to my son that I should not get up to go to the bathroom without calling her because redheads bleed more. I had no idea that my symptoms were related to cancer. Why would I? There is virtually no education available to women about what the signs and symptoms of cervical cancer are.
I was also pre-occupied at that time because my mother had been diagnosed with breast cancer, and I was making the hour and a half drive back and forth to my mother�s home to help her after surgeries and bringing her to chemotherapy.
I was feeling extremely tired, which was not surprising because I had a newborn. I was surprised, however that I was feeling more uncomfortable as time passed. I also started to have a discharge that began to worry me. One day as I was getting ready to head out to my mother�s house to bring her to chemo, I thought that I got my period. (I picked her up, drove to the doctor�s office, and as we waited to make a left turn into the parking lot, we were rear-ended by an 18 year-old girl who was driving a large SUV.) Later that night I realized that my �period� was gone.
One night in early November as my husband and I walked through the mall after taking our holiday pictures, I looked at him and said, �Something�s really wrong with me.� I called my ob/gyn, and visited her office shortly thereafter. Upon examining me she saw it right away, a mass measuring 4 centimeters. She thought that it was a prolapsed fibroid, and reserved operating room time to remove it. Before the procedure my last question to her was, �Is this going to affect my ability to have more children?�. She assured me that it would not. I woke up in the recovery room to the pained faces of my doctor and my incredibly sweet husband. My doctor shook her head and said, �it doesn�t look good�. The pathology results confirmed, �squamous cell carcinoma�. My doctor said that she did not understand this because the pap smears done before and after the birth of my son reported normal results. She called the two separate labs that reported on my last two pap smears, and ordered that the slides be pulled and reviewed. Both pathologists reported that the slides had been misread. I learned that doctors do not read pap smear slides; cytotechnologists do. Doctors did not see my slides until after I was diagnosed with cancer.
I did pursue this legally, but after four years of a comedy of errors, doctors and lawyers fighting, and $3500 of my money that could have been spent in numerous other ways, my case was dismissed.
I am doing my best to use my life to make a difference in the lives of other women who rely on pap smears to diagnose cancer. Pap smears alone are not good enough to detect abnormalcy. Following my surgery I wrote to senators and congress members about my ordeal. One local senator contacted me, and he proposed a bill to intensify the continuing education requirements and the oversight of cytotechnicians. I testified before the NJ Senate House Committee on this bill, and it was passed at that level. Pathologists and lab administrators state that requiring pathologists to read each slide will bring the reading of pap-smears to a screeching halt because there aren�t enough pathologists to do the job. Technicians reading mammograms would be unheard of! Technicians are not even allowed to read the results of an x-ray of a broken finger.
The HPV vaccine and testing for HPV will save our girls lives and reproductive rights. All of the critics of the vaccine who say that �it will give girls the wrong message� about having sex are incredibly ignorant. Girls are having sex at younger and younger ages because of the way sexuality is portrayed in our world today. People think that if you sweep something under the carpet, it will go away. All the while, an STD is running rampant. A good parent will sit down with his or her daughter and educate her about sex in developmentally appropriate ways throughout her life, and hopefully explain the reasoning behind the vaccine as well. In addition, girls should know that condoms do not protect against HPV.
I�m now in my 6th year post-diagnosis, and I am still cancer free. I�m also still under the care of the pain service at Memorial Sloan-Kettering to treat nerve damage that occurred as a result of my surgery.
I have written to GMA and many other television shows in the past without response. Every time I see a story about the HPV vaccine controversy I still get this nagging feeling that I haven�t done enough to let women know that they need to be in charge of their health care. I need to tell my story. I believe that I went through this in order to give it a voice. I have to trust that there is a grander plan.
I lost my fertility at a very young age, but that does not need to happen to other women. As we have seen with the strides made in breast cancer research, there is power in numbers. We have a collective voice that can move mountains. We can wipe out this disease! Girls don�t have to go through what I went through! I can�t tell you what the loss of a uterus can do to a woman. It is a huge loss, and women suffer in silence because there is no outward sign of disfigurement.
On a more positive note, my husband and I have not let this get in the way of growing our family. In May 2003 we adopted the most beautiful baby boy, and the adoption was finalized in November 2003, three years to the day of being diagnosed with cervical cancer. We would love to adopt again, and we are looking forward to starting the process again in the near future. (I believe that medical insurance should cover the cost of the addition of a child to a family, no matter how the child joins the family, however that is a whole other issue.)
Thank you so much for reading my letter and for the opportunity to tell my story. I appreciate it more than you�ll ever know.
A little over 3 years ago, I was diagnosed with HPV, and I was very angry. I was not promiscuous, and I always used protection - I actually got it from an ex-boyfriend, who didn't know he had it either. I was angry because I didn't even know it existed. My gynecologist had never discussed it with me, but when I got it, he didn't seem surprised (which made me even more angry). My mother was always open with me about sex and protection, and she likewise felt like she failed me. About 6 months after this, I started hearing all kinds of things about it. When the vaccination came out, I cried. The constant fear and worry (not to mention years of biannual, painful trips to the gynecologist's)and the stigma of having an "STD" is something that no women - especially not a young woman at the beginning of sexual understanding - should have to endure. Through close monitor over the years, it eventually cleared up. But the emotions still remain.

Because of this, I can't understand the "ethical" argument being pushed by certain parents; that is, that they don't want to promote promiscuity among young girls. You know what? You can't monitor your daughter 24/7, but you CAN keep them safe - isn't that enough? This vaccine alone doesn't promote promiscuity - if parents are doing their job, their daughter should be concerned with more than 1 STD. What about herpes? HIV? The risk of PREGNANCY? I fail to see how a vaccine that prevents cervical cancer somehow sanctions any of these things OR promiscuous sex. These parents should be less concerned with preserving chastity and more concerned with their child's overall well being. If this happens to her, her well being could be shattered - both physically AND emotionally. Cervical cancer is REAL and this vaccine is realistic - the idea that the risk of HPV alone will keep a woman from having sex is NOT.

I personally don't think the vaccine should be mandatory because of the potential risk of side effects we may have yet to discover, and I think parents (or women) should be able to decide for themselves. But I want to shout its benefits from the rooftoops so not ONE more woman has to go through what I did. I want to tell every woman I know about it. And I want parents to stop worrying about things they can't prevent and start acting on things they CAN.
We live in a society that is so over medicated that people need to wake up and not be so quick to inject their children with something that hasn�t been tested for any substantial length of time. Pharmaceutical companies have way too much power and they know exactly where and how they can make millions of dollars by preying on the fears of women. In researching this, I read where the Merck lobbyist once worked for the governor of Texas (the first state to mandate this) � hello, doesn�t this raise a few flags! Mandatory or not, I will not be giving this to my daughters because I care too much about them and won�t let them be guinea pigs at this early stage.
From what I hear this new vaccine will save a lot of lives. My daughter will be getting the vaccine. I hope the cost does not become a road block to some.
Just a little bit of information useful to everyone... there is an age limit in which you can receive the vaccine. You must get the first of three shots BEFORE you turn 27. After you turn 27, you will be ineligible. I'm not sure why. Also, if you attend a university/college and have insurance through them, you may want to call the health center to ask for student assistance programs for the vaccine. They are $150 for each shot, but on the program, it comes out to be $6. It wouldn't hurt to call and to think about getting it. Best Wishes.
If this vaccine was so great, don't you think people would be busting down their doctors doors to get vaccinated? If is so good, why do we have to have it mandated? People would want to get it, not be forced to.
Dear Dr Gupta:
I could not believe that Merck used this scared tactic to bail out its Vioxx debacle. The FDA, NIH etc ... praised Vioxx and then su�denly Merck had to pull Vioxx out. The patients were left holding the bag in the Vioxx case. Merck is the only one produce this vaccine, there is no competition.
The long term effect of this vaccine is unknown. Girls should take this vaccine only if all the female at Merck,FDA,NIH and all the female doctors took it first. I don't want the girsl in Texas be Guinea Pigs. By the way this vaccine only dealt with 2 out of 9 strains. This 2 strains can easily be fixed with vitamin A and folic acid not by a $300 shot year after year. You should be ashamed of yourself
Dr. Gupta:
Of course, give the vaccination to the girls! But I agree this vaccination should also be given to boys as well. It takes two to tango and this disease may very well be part of the dance.

In addition, I believe that the Governor of Texas took an opportunity to exploit the vaccination for his own gain with Merck. Making something manatory gets people crazy.
I THINK THAT IF THIS WERE A VACCINE THAT PROTECTED BOYS FROM GETTING TESTICULAR CANCER EVERY BABY BOY IN AMERICA WOULD HAVE IT BY THEIR FIRST BIRTHDAY--IS IT BECAUSE WOMAN ARENT SUPPOSED TO HAVE SEX BEFORE MARRIAGE AND ITS OKAY FOR MEN TO?
I've been through the whole HPV scare thing now. My abnormal pap smears and subsequent biopsy showed that I had, at worst, precancerous cells (CIN I, ASCUS). I definitely had HPV lesions from which the biopsies were taken. I was able to get a friend to do the HPV genotyping, and the results came back as HPV 66, very low viral load. I assume that my most recent pap smear results were negative (because I didn't get a phone call asking me to return for another colposcopy), and the gynecologist told me that the inflammation seen at the time of the colposcopy/biopsy was gone.

I'm not completely out of the woods yet, because not enough is known about HPV 66 to make a determination as to which risk category it should be placed in. HPV 66 is a very low-prevalence strain.

I don't like having to go for pap smears and pelvic exams 3 times a year, but that's because I find the speculum uncomfortable, and I always have. I also don't like having to take time out of my day to go to the gynecologist.

I'd get the vaccination if I was eligible, but I'm not. I'm 48.

Still, you just learn to deal...
I have a REALLY hard time giving this to my daughter. I've VERY concerned about the long term effects that NOBODY knows about and I don't want to find out in 10 years that my daughter is unable to get pregnant cuz of this vaccination, nor do I want to find out that it could possibly cause birth defects. In 2006 3700 women died of cervical cancer, yet 79,560 women died of lung cancer. When the government bans NO SMOKING, than I will "think" about vaccinating my daughter. But unfortunately the government is "bought" by the pharmaceutical and nicotine companies. Any politician that mandates this is NOT working for the American people but for the "special" interest groups that donate so $$ to their campaigns.
I am very glad that this article was posted because people need to be talking about this vaccine. As a medical student and a 22 year old female, I am so upset when parents use the excuse of "promoting promiscuity" for not having their daughters vaccinated. All children are vaccinated against Hepatitis B and that is a sexually transmitted disease. This country is so backwards when it comes to sex education. Children should really be taught about sex early when they are between 10-12 because sex is everywhere in our society. Our country has the most abortions than any other country in the world. This is because so many people get pregnant because there are not educated about sex. People get so up in arms about abortion, but does these same people help educate young women about how not to get pregnant? But back the vaccine, I see that people are upset about not knowing long term effects, but this vaccine is the first ever to prevent a cancer. Many research studies that have been extremely effective were stopped prematurely so the public could benefit from it. For example, most people take aspirin to prevent heart attacks and strokes. Do these same people know that the study that discovered the benefit of aspirin therapy was stopped 3 years premature because of the obvious benefits of aspirin therapy? Just because this vaccine does not have long-term facts, it does prevent cervical cancer and that is enough for me. Hopefully it will get approval for the use in men, even though many doctors use it off label to vaccinate men because it is believed that certain types of anal cancer are linked to HPV. Other diseases, like base of tongue cancer are also linked to HPV. If parents truly love their children, then there is no excuse for them not to have their daughters and hopefully soon, their sons vaccinated because cervical cancer is a terrible disease that kills at women in their 20's, 30's and 40's.
What about boys? They may not be at risk for cancer but why cant a boy take the treatment to prevent HPV. It is a disease that I cannot imagine anyone being happy about living with boy or girl. This is an opportunity to improve the health of our entire population by eradicating HPV and protecting women from cancer.
For the poster who was concerned about the possibility of more problems being caused by the virus in the shot: there is no virus in this vaccine! The HPV vaccine (and some others, like HepB) only contain the outer coverings of the virus. Your immune system learns to recognize these outer coverings, which look from the outside like the same thing as the real deal. There is no viral genetic material in the vaccine, so there is no chance of becoming infected with anything.

I'm all for this vaccine and have already gotten my first dose, but I would maybe hold off on making it mandatory until Merck's patent expires.
From Wikipedia.com:
Two polio vaccines are used throughout the world to combat polio. The first was developed by Jonas Salk, first tested in 1952, and announced to the world by Salk on April 12, 1955. It consists of an injected dose of killed polio virus. Thereafter, Albert Sabin produced an oral polio vaccine using live but weakened (attenuated) virus. Human trials of Sabin's vaccine began in 1957 and it was licensed in 1962. The two vaccines have eliminated polio from most of the countries in the world and reduced early cases from hundreds of thousands per year to only 1000 worldwide in 2001."

Although Dr. Grupta has stated that there is only 3.9 years of study on the efficacy of the HPV vaccine, that does not mean that 3.9 years ago Merck started developing this vaccine. It takes years of pre-human research trials before drugs (or vaccines) are even allowed to be tested on humans.

Why do I bring up polio? Because it was affecting millions of people world-wide at an alarming rate. In some cases polio meant death. And ten years after Salk first tested his vaccine, it was available to the public. Remember that his work came before some of the landmark work by the FDA to insure the safety of vaccines and drugs offered to the public. Now, 45 years later, is nearly eradicated world wide.

HPV is no joke. I am not the only HPV "survivor" in my family. 13 years ago, my mother lost her ability to have children at the age of 30. Women, can you imagine that? I can. I was diagnosed with HPV during my freshman year at college. I was freaked, because I knew what my mother went through, and my first thought was: "I will never have children." Luckily for me, we have devoted time and money to research ing the causes and treatment for this disease, and today, I can say that I will be able to have children and I am HPV-free.

Parents, save your daughters from this epidemic. And it is an epidemic. If you are 18-25 and a woman, you have a 75% chance of contracting HPV. That is 3 in four women. Why let your girls become a statistic?

Yes, it is early in the game, but I ask you to at least educate yourselves about HPV, the risks, the outcomes, everything. And then decide if vaccinating is right for you. I know it is right for me. And luckily for me, I have another five years before I have to think about diapers, and another 10 after that before thinking about vaccinating my daughter. Hopefully by then, HPV will not be a haunting statistic. Hopefully by then, HPV will be this thing, that we used to worry about, but through the hard work of dedicated researchers (especially those employed by NIH grants) HPV will be a thing of the past.
I am in agreement with some of the others concerning this vaccine. It sounds beneficial right now, but it should definately be a parents decision whether to vaccinate their child. Making it mandatory is unnecessary, especially since we have not been able to see the long-term side effects it may have on these girls.
3.9 years of testing is not enough time. And I sure wouldn't give it to my 9 yr. old daughter without longer testing. Let it be the choice of each parent and 16 year old daughter. Parents need to get their heads out of the sand and TALK WITH their sons and daughters about safe sex. Stop leaving it up to the schools to teach them about what's safe.
I also think the vaccine should be made mandatory for the protection of our daugthers. Thanks to research and Doctors.
I am a nurse and I really like Dr. Gupta's reporting but in this particular case I think he might have missed some of the information regarding the helath problems which HAVE been reported with the Gradasil immunization. From a report on 2/21/07 "PRNewswire-USNewswire/ -- The National VaccineInformation Center (NVIC) today released a new analysis of the federalVaccine Adverse Event Reporting System (VAERS) reports of serious health problems following HPV vaccination (Merck's GARDASIL) during the last six months of 2006. Out of the 385 individual GARDASIL adverse event reports made to VAERS, two-thirds required additional medical care and about one-third of all reports were for children 16-years-old and under, with nearly 25 percent of those children having received simultaneously one or more of the 18 vaccines that Merck did not study in combination with GARDASIL. NVIC is calling on the FDA and CDC to warn parents and doctors that GARDASIL should not be combined with other vaccines and that young girls should be monitored for at least 24 hours for syncopal(collapse/fainting) episodes that can be accompanied by seizure activity, as well as symptoms of tingling, numbness and loss of sensation in the fingers and limbs, all of which should be reported to VAERS immediately. "Because Merck only studied GARDASIL in fewer than 1200 girls under age 16 in pre-licensure trials, it is critical that doctors and parents be made aware of the nature of the initial adverse event reports coming into VAERS and
that they report serious health problems after vaccination when they
occur," said NVIC President Barbara Loe Fisher. "


I would suggest anyone thinking of vaccinating their young daughters with anything they should first research it thoroughly. For example the aluminum content of all three shots. I am a mother of an Autistic daughter (diagnosed at age 5 a month after her 4 Kindergarten vaccines were given) but neurotypically developing up until that time and another daughter who started showing signs of 3 autoimmune disorders and was diagnosed with leaky gut at the age of 11 months after getting her first flu shot. After 16 months and over $20,000 later of chelating out the toxins which were found in their bodies BOTH of my daughters are recovering from the devasting illnesses I believe were brought on by something which was injected into their bodies causing toxic overloads, gi disturbance, brain swelling and immune systems dysfunction.

I will not be giving my daughters the vaccine and I am HPV positive. I am not anti-vaccine I am just not sure that the effects of the vaccines have been tested in combination with each other or the toxins we come in contact with in our daily lives. Many children can not excrete effectively the amount of toxins they are coming in contact with in our society and add an additional substance injected into their fragile systems only makes for a possible tragic and unknown event now let alone before they even think about having sex.

This vaccine makes about as much sense to me as giving a newborn the Hepatitis B vaccine which many of our children were given in the 1990's as well. My daughters were guinea pigs once they will not be again.
A mandatory vaccination for a sexually transmitted disease, are you kidding me, this is not a communicable disease. Aren�t we all jumping the gun a little bit. I would not let my young daughter have a vaccine that had not been tested for at lease 10 years. Can you say how a drug, given in three doses during puberty, is going to affect reproduction later on? Why is this push for mandatory vaccination happening, can you drug company lobbyists? First they bombard us with commercials geared at scarring the heck out of us, then they hit up the bureaucrats they have in their pockets to make it mandatory. Wow how much money does Merck make off this little venture?
I am a 26 year old woman who was diagnosed with squamous cell carcinoma in November of 2005. I had a 7 centimeter size tumor in my cervix. I have had chemotherapy, internal and external radiation, a radical hysterectomy, a colon resection because the radiation caused obstruction and I had a colostomy for two months, two stints put in my right ureter due to radiation that caused an obstruction. 2006 was a year from hell for me. Thank goodness God blessed me with one child. I can't have anymore. I know deep in my heart that I got this from my ex-husband from his cheating on me. So I think this vaccine is a good thing, for men and women. I have gone back and forth wondering if parents would think that it would promote promiscuity. I have to agree with some of the other comments. You can't worry about that. If you talk to your kids about sex and tell them the risks involved, that's all you can do. You can't monitor them 24/7 and smother them. If you do that, then that's when they start to do things that hurt them. Always let your kids know that they can come to you with anything. Don't be harsh and negative but do your best to sway them not to do something that will harm them. I don't mean to preach, but if I could prevent just one person from going thru what I did, that would make my day.
I am 22, going on 23. I am not sexually active and have no intention ever of having sex. I am not getting the vaccine. I have a gynecologist who is affiliated with a fellow gynecologist who is full of herself. I cancelled my appointment. I have a feeling he would push for me to get the vaccine, even though it's not necessary. Besides, I feel like I should have a say if I want the vaccine or not. I just hope that my new gynecologist doesn't push the vaccine on me.
When the drug companies & the FDA could show me 20 years of test results on their own daughters, I may consider it. The standard of health care of women in this country is not what it sould be. This drug may be considered "safe" now, but will it be proven to harm us in the future?
I am a registered nurse and work part time giving IV chemo-cancer treatment and in a college student health dept.
I am happy to report that we are recommending this cancer prevention vaccine in my college (first one)and I am very happy to give it; since I see the ill effects of advanced cervical cancer in my clinic, young females dealing with infertility issues, losing their hair, colostomy bags, and undergoing radical abdominal surgery. Why face all that when we have a vaccine to prevent it? My comment HURRAH for women!!!!
As a young woman without children, I can not begin to imagine what it is like to want to protect the young ones from everything, including cancer. My concern is that perhaps instead of injecting our children with vaccines we should be teaching abstinence and safe sex. The more open we are with the young generation about the consequences of sexual relationships, the better educated the children will be. And yes, they probably will have sex anyway, but at the very least we can teach them to use safe sex practices. We have to stop hiding behind uncomfortable talks and be honest with ourselves and our children.
I wholeheartedly approve of this vaccine. While I don't think anything should be mandated by the government, I would almost suspend my beliefs in this case. I had HPV before I even knew what it was--it's that prevalent! Virtually EVERY sexually active person has it. Condoms do nothing to prevent it. If I had a daughter I would take her to get the vaccine with no hesitation.
To the argument that this will make children more likely to be sexually active--most kids having sex don't even know about this disease. It won't make a difference in sexual activity-- only education can do that. However, you can educate people to use condoms to prevent certain STD's but condoms don't stop HPV! And the threat of STD's has rarely if ever stopped anyone- especially not teenagers who "know that things like this won't happen to them".
No HPV clinical study was done on women, age 9 to 13.. so, why is the FDA and other states recommending the vaccine to the girls as young as 9 years old?
Making this vaccine mandatory is an absurd suggestion in my opinion. There are many moral americans who do practice abstinence and only have sex within a marriage which is the only moral way to do so. We have absolutely no chance of catching this virus as an STD. We do however have a chance of possible side-effects of this vaccine which hasn't been tested over a long period of time. I also think it's unfair to make us spend money on a drug from which we recieve no benefit whatsoever. If we have no chance of ever contracting the virus in the first place, then there is no reason to get the vaccine. It's basically forcing us to help Merck's stock to rise and their profits to soar.
I hold an MPH and PhD in Public Health, and I wanted to address some of the questions folks have posted.
First, there's really no such thing as a "mandatory" vaccine. Making a vaccine mandatory brings to bear the weight of public funding to reduce or eliminate the cost to certain populations. There are virtually always "opt-out" clauses. This is what makes it possible to have unvaccinated children that you usually hear about during mumps or measles outbreaks every few years.
The data on this vaccine is now actually about 5 years old. The technology was developed by an Australian company in the mid-90's.
I'm of the opinion that this is a public health break-through, and should be regarded as such. Vaccines have been used for hundreds of years and have saved billions of lives. And ask anyone what the follow up of a single abnormal pap smear costs, and the financial advantages for this particular vaccine are immediately apparent.
God Bless.
No, already with condoms and birth control pills girls feel it's safe and O.K. to have sex. Instead, in this day and age of over 500 sexually transmitted diseases and AIDS. Sex should be understood that it can kill. It it for marriage and committed relationships. If girls are warned properly and by not endorsing sex then there is a better chance of her survival. What other sexually transmitted diseases that are rampaging our bodies that scientist havn't discovered yet. It's a loaded gun. More parents believe that teens should wait to get married until they mature. Well, I would rather have a live immature married daughter with no STD's, than a dead or sick with STD's mature girl. We should be endorsing early marriage.
Dr Gupta,
Is it true that a new drug which can cure most cancers has been found but since its cheap and has no patent, media is not covering it due to pressure from drug companies???

I found these on the web
http://www.newscientist.com/article/dn10971-cheap-safe-drug-kills-most-cancers.html

http://media.www.studentprintz.com/media/storage/paper974/news/2007/01/23/Opinion/Scientists.Cure.Cancer.But.No.One.Takes.Notice-2667600.shtml

this is the best place i could think of posting this. Dr Gupta, fellow viewers, can someone please give me more information on this and tell me if there is any truth in this new development? Thanks a lot!
I find it quite amusing that most people and even Dr Gupta are spouting off that Gardisil will prevent cervical cancer. The commercials and our legislators all say we should get this vaccine to protect against cervical cancer. Wake up people, "GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer, so it is important to continue regular cervical cancer screenings." That quote is directly from the Gardasil website I added the bold for your benefit. If Merck the makers of Gardasil (and Vioxx now in a lawsuit) say it will not protect you from cervical cancer all the time and you will still have to take the same precautions as if you didn't take the vaccine why are you people touting it as a cure-all for cervical cancer?
Another note, Gardisil, with the exception of the Hep B vaccine is the only vaccine to use Virus-like particles to get a response from the immune system. Do you think less than 4 years research on post puberty girls is enough research to say that it wont adversely affect our daughters fertility in the future?
Plus just because someone is vaccinated against a particuliar disease does not mean that they are now protected from that disease. There were several outbreaks last year throughout the country of diseases that we normally are vaccinated for, the problem wasn't that these students were not vaccinated because they were and yet they still contracted the disease. How these outbreaks from last year happened we do not know, but I find most interested is the number of vaccinated people who still contracted the disease.
So go ahead and poke your daughters with a vaccine that may protect, for an unknown length of time, against only 4 of several strains of a particuliar virus that may lead to cervical cancer produced by a company in the middle of lawsuits for another drug they produced. Vaccines and medications should be treated with extra special care and should error always on the side of safety for all, because they affect us all.
National Vaccine Information Center The information they have compiled is definitely worth a read.
Oops - look they also made a mistake about kids cough medicine! Gosh are we all surprised. And the reason we should trust this vaccine is the great track record of those telling the rest of us what's safe??
I have already posted and after reading some more posts, I have more to say. For the people who believe in abstinence, which is something I believe in as well, it is NO GUARANTEE. Have you ever thought about what happens if your daughter gets raped? God forbid that ever happened, but if it did, she would most like contract HPV. What there is infidely in the marriage? Since people usually only get tested for HPV when there are suspicious finds in Pap smear, many people do not know they have it. There is research out there that you can contract the disease without actually having sexual intercourse. If a person has the virus and has genital worts which is one of ths symptoms of HPV, even sexual contact, without actual intercourse, can spread the disease. While this is rare, it is an example how STDs can spread without sexual contact. So while you may wait to actually have sex until you are married, but participate in other sexual acts, even touching, you are still at risk. I do agree boys should get the vaccine as well and there currently is testing being done on men. The vaccine was tested on women first in order to get it to market faster since men do not get cervical cancer for obvious reasons. For the parent who commented on the giving to the vaccine to a 9 year old even when it hasn't been tested on that age range, do this person know that almost all the medication sold over the counter and for prescription, especially children's cold medicine is tested on adults and then the doses are just reduced for children. It is very rare that everyday medications given to your children were actually tested on children.
I think the HPV vaccine is a very good thing and women of all ages should take advantage of it, However, I think making it mandatory for young girls is a bit intrusive.

Although this is a vaccine that will help protect against cancer, because the virus is transmitted sexually it should be left to the parents to decide if/when their daughter(s) should receive it.

While I think overall this is definitely step in the right direction, with regards to women's health, I think one key aspect is being overlooked. Women who currently have, or will have, HPV aren't contracting it by themselves. Why is so much attention being focused on women who have this virus and not the men from whom they're contracting it?

If we're going to educate young girls and women on how to protect themselves from a potentially deadly virus, we need to educate young boys and men as well.

Ultimately, my question is: What's being done to educate and/or vaccinate young boys and men from HPV so that they are no longer the carriers of this virus?
Michael from Richmond VA - well said! Excellent! I wish the powers that be would take into consideration the points you make. You raise very serious questions about not just this vaccine but all of them. Thank You!
I'm of the opinion that it should be made mandatory. The vaccine may protect against a disease considered to be an STD, but the method of transmittal in no way diminishes the effects of that disease.

Some may argue that this is legislating morality, but that could not be further from the truth. Legislation mandating a vaccination would not take the morality of the American populace into account, assuming nothing. The goal is not to please a parent unwilling to accept statistics, hoping that one's daughter was raised in such a manner as to limit sexual activity. The goal is to eradicate HPV, and the most effective way to accomplish this goal is to mandate that all women (and men when it becomes available) receive the vaccination.

If the American community reacts negatively to this vaccine which prevents a disease that can be sexually transmitted, I will weep when considering any possibilities for eradicating herpes, HIV, and their ilk when vaccines for those diseases are developed.

Explaining the reason for vaccination is no different from explaining an MMR. The answer is as simple as "this shot prevents a disease that causes cancer." It starts and should end with that simple statement.

Even as an individual who is extremely phobic of needles, I would gladly accept such a vaccination in order to eliminate the possibility of transmitting the disease. I don't plan on sexual activity, especially with multiple partners. However, I believe in being safe.

Vaccinating your child against STDs does not signify any failing as a parent. It signifies responsibility as one, and admitting that one cannot completely control one's child's actions. That's even assuming the sex is consensual. Would you want to answer to your daughter as to why you didn't vaccinate her against HPV if she caught it when she was raped?
I�m glad to see others are questioning why boys are not getting this also. As a mother of both I would have no problem giving them all the vaccine. And I don�t remember talking to my kids about getting any of their vaccines other than this is what we all have to do to prevent diseases. And cancer is a disease yes? Parents who choose not to have their kids get this vaccine are probably also the ones who choose not to have their kids vaccinated against other diseases either.
i know that there are many parents that are concerned about this vaccination promoting sexual activity and some who have concerns about the negative effects it may have in the future, but honestly, i WISH they had this as a mandatory vaccination when i was in grade school. the idea of Cervical Cancer being caused by and STD didn't even occur to me until this past year, and i myself, have kept putting off getting the vaccination due to the cost. all this only to go to the doctor and find out that i, a 24 year old, has already contracted HPV. i say it's better safe than sorry, and i only wish that this had been mandatory when i was younger, now i wouldn't have to live with a disease for the rest of my life. to the parents, do you really want to roll the dice with your childs health and just HOPE that they WON'T come in contact with it. you can't keep them from having sex, and, according to research done by Planned Parenthood, "HPV is the most common sexually transmitted infection in the U.S. and up to 20 million Americans are currently infected with it. It is estimated that 75% of men and women of reproductive age have been infected with genital HPV at some point in their lives. The highest rates of genital HPV infection are found in adults ages 18 to 28.". Please parents, do you really want your child to be just another number in a growing epidemic? Help nip it in the bud before they even come in contact with it so they can live normal and happy lives!
I'll expect CNN to have Dr. Sanjay Grupta share his view on the Indian Doctors participating in terrorism. How would these events impact Hard-Working and Honest doctors from India, Pakistan, and other countries?

CNN has aired over and over the story about Nigerian Scam "How to rob a bank" without regards to how it affects the Honest and Hard-working Nigerians around the world. Many Nigerians will lose their jobs because of that story and most of these companies will begin not to hire professional Nigerians who have worked very hard to earn their degrees in various fields. Average Nigerian in the U.S. holds about two college degrees and graduated on top of their classes. Nigeria is very big country and bound to have more Doctors, Professors, Engineers, Accountants, Lawyers, and more criminals like any other society.

I am sure that things will never be the same for foreign doctors in Western World because of the UK incident. Does this make all Indian & Arab doctors terrorists?
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