Marketing and science clash in Gardasil debate

Gardasil, Merck’s vaccine against the human papilloma virus, the most common sexually transmitted disease, is once again at the centre of political, moral, bioethical and economic controversy after last month’s recommendation by the Centres for Disease Prevention and Control (CDC) that 11 and 12-year-old boys be vaccinated. 

The CDC recommended in 2006 that that girls and young women between 11 to 26 should be vaccinated. Not all parents were happy. Some thought that protecting their daughters against HPV, the most common cause of cervical cancer, was common sense. Others thought that it would encourage promiscuity. The controversy infected Republican campaigns for the presidential nomination. Foes of Texas governor Rick Perry pointed out that he backed universal vaccination although it failed in the state legislature. Michele Bachman was ridiculed for asserting that Gardasil caused mental retardation.

The controversy is back on the boil. Although the main benefit is that vaccinated boys will be less likely to spread HPV to girls and thus promotes gender equity, it also is said to prevent oral and anal cancers associated with oral and anal sex. Parents are even less likely to support a vaccine which assumes that their sons will engage in homosexual activity.

This week science journalist Jeanne Lenzer criticised the vaccine in the on-line magazine Discover. Her complaint was economic, not moral. Merck is promising far more than its vaccine can deliver, she feels, and questions the real-world efficacy of the vaccine in preventing deaths from cervical cancer. “Whether Gardasil will reduce cervical cancer deaths in real-world conditions has simply never been answered. It might—but that would take a long-term study, and one that should be done before it’s widely promoted.”

Similarly, she contends, assertions that the vaccine prevents oral and anal cancers in men who have sex with men are weak. “On closer inspection, some of the numbers don’t just deflate, they evaporate,” she says. On the other hand, “in rare instances, some vaccines may trigger the potentially fatal and paralyzing condition Guillain-Barré.”

Given the risks, is a Gardasil campaign worthwhile? She quotes Dr. Diane Harper, who helped to develop the HPV vaccine. She told the Kansas City Star that the vaccine for boys is “pie in the sky…We’re short of health care dollars. Why should we spend it on that?”

This is a controversy which still has plenty of life in it: politics, vaccine phobias, cost controls, the evils of Big Pharma, the culture wars, sexual politics. Stay tuned! ~ Discover Magazine (blog), Nov 14; New York Times, Oct 25

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