I use Twitter not only to tweet about my favorite sports teams, but to see what’s being said in science, medicine, politics, and anything interesting. I actually have a list (you can read by list if you want) that I call “Pseudoscience” that are tweets from the biggest anti-science medical people around. Today, I received the following tweet:
— Kilikina (@XtyMiller) January 13, 2012
So that lead me to a post at “Natural News” (OK, I’ll admit that my skeptical radar fired up) entitled, “Medical journal openly questions science, ethics of HPV vaccinations.” As an aside, Natural News’ url for the article is “vaccinations_quack_science_medical_journals.html”; not very subtle are they?
First a little background is necessary before starting this story. Gardasil (Merck’s brand name) is a vaccine against human papillomavirus (HPV), a sexually transmitted virus. In early stages, HPV only results in mild symptoms like warts in the genital and anal areas, but in some cases can lead to cervical cancers. The vaccine not only prevents the transmission of the disease but seems to reduce the long-term risks of cancer.
But, I digress. Imagine my reaction to the article. “Oh no, HPV vaccinations are unethical!!!!!” Call the police. I’ve been all wrong about vaccines. Oh wait, let me look up the original article, because even very unbiased news sources like the Wall Street Journal and New York Times sometimes get medicine wrong. Let me run over to the article before I post my mea culpa about vaccines.
The article, Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?, published in the Annals of Medicine in December 2011. The authors, Tomljenovic and Shaw are associated with the University of British Columbia, Department of Ophthalmology. I don’t want to degenerate into some sort strawman fallacy, but I question why two individuals in a medical specialty, ostensibly involved with the eyes, are so obsessed with vaccines. Furthermore, they have a long history of anti-vaccination papers, most published in low impact journals. For example, they recently published an article correlating aluminum with autism, though the correlation is specious and providing no causality. One of the worst mistakes of research is conflating causality and correlation.
Moving on to the article, their abstract states:
All drugs are associated with some risks of adverse reactions. Because vaccines represent a special category of drugs, generally given to healthy individuals, uncertain benefits mean that only a small level of risk for adverse reactions is acceptable. Furthermore, medical ethics demand that vaccination should be carried out with the participant’s full and informed consent. This necessitates an objective disclosure of the known or foreseeable vaccination benefits and risks. The way in which HPV vaccines are often promoted to women indicates that such disclosure is not always given from the basis of the best available knowledge. For example, while the world’s leading medical authorities state that HPV vaccines are an important cervical cancer prevention tool, clinical trials show no evidence that HPV vaccination can protect against cervical cancer. Similarly, contrary to claims that cervical cancer is the second most common cancer in women worldwide, existing data show that this only applies to developing countries. In the Western world cervical cancer is a rare disease with mortality rates that are several times lower than the rate of reported serious adverse reactions (including deaths) from HPV vaccination. Future vaccination policies should adhere more rigorously to evidence-based medicine and ethical guidelines for informed consent.
I won’t go through each point, but a couple are important to refute:
- Uncertain benefits. The Centers for Disease Control disagrees.
- Clinical trials show no evidence that HPV vaccination can protect against cervical cancer. This is partially true, since HPV-related cancers can take from 15-25 years to arise. Epidemiological data takes time. However, we know that HPV is the cause for several types of cervical and other cancers, so preventing HPV is a logical choice to make, given the prevalence of the virus.
- Vaccination polices should adhere more rigorously to evidence-based medicine. It does already. Pretty strongly. Anti-vaccination, as best as I can tell, is based on fraudulent journal articles (see anything by Andrew Wakefield).
HPV vaccine is safe and efficacious. If you need more information on the HPV vaccine safety, the good researchers at Science Based Medicine did a great article called, The HPV Vaccine (Gardasil) Safety Revisited.
Let me make this clear. Every single medical procedure, pharmaceutical, and device has some risk associated with it. Can you get an infection at the injection site? Yes! Can you be allergic to the injection? Yes! Can it cause paralysis? No. Can it cause a broken leg? No, though if you did a random study, you’d find a large percentage of young girls who broke their legs within six months of being vaccinated, so obviously correlation is equivalent to causation. Or it doesn’t.
If Tomljenovic and Shaw could prove either no benefit with some measurable risk, or little benefit with large risk, then there is an ethical issue with the HPV vaccine. But actually, there is a high level of benefit with almost no risk, or risk that actually is imaginary rather than shown in evidence based medicine. You see, just because you use “evidence-based” in your article title, it doesn’t mean you actually follow it.
HPV vaccine should be recommended for all young men and women (yes, I said men too), reducing the future risk of cancer and it’s burden to the family, individual and health-care system.