Skeptical Raptor's Blog hunting pseudoscience in the internet jungle

Manning the barricades against the anti-HPV vaccine barbarians

gardasil-syringe-boxDuring my long years in scientific research and medical device product development, one of the great goals that is often repeated (rarely by the researchers themselves but politicians and the public) is a prevention or “cure” for cancer. Setting aside the simple fact that there are over 250 different cancers, each with its own cause(s), pathophysiology, prognosis and cure(s), and setting aside the fact that we can cure some cancers, albeit with radical treatments, simple prevention and cures have been elusive.

Many people have hyped foods or supplements as “natural” prevention for cancers, but the evidence that any of these things work is missing. Or a myth. Or just don’t work.

But there is one medical discovery that can prevent some cancers. It’s easy to get the treatment. It’s very safe. And it really works.

That prevention is formally known as the HPV quadrivalent vaccine, Gardasil (or Silgard in Europe), and it prevents infection by the human papillomavirus (HPV), a sexually transmitted disease. The vaccine specifically targets HPV subtypes 16 and 18, that cause not only approximately 70% of cervical cancers, but they also cause most HPV-induced anal (95% linked to HPV), vulvar (50% linked), vaginal (65% linked), oropharyngeal (60% linked) and penile (35% linked) cancers. It also targets HPV subtypes 6 and 11, which account for approximately 90% of external genital warts. The viruses are generally passed through genital contact, almost always as a result of vaginal, oral and anal sex. 

Let’s be clear here. Gardasil prevents cancers–serious, life threatening cancers. And frankly, I do not know of any other medical or “natural” treatment that has this much evidence in support of its actual usefulness in preventing not only one, but at least five types of cancer. I don’t believe in “miracles” or making more out of medical procedures than what’s really there, but the HPV vaccination is pretty close to a “miracle.” With it, we could essentially eradicate, or dramatically reduce, some types of deadly cancer.

Despite the fact that the HPV vaccination saves lives, there are groups, even in the medical community, that are opposed to the vaccination and consider it unsafe or ineffective. Drs. Tomljenovic and Shaw of the University of British Columbia, Department of Ophthalmology, wrote a recent article attacking the HPV vaccine:

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.

Before we get to their unsupported points, let me point out something. Tomljenovic and Shaw are strongly supported financially by the key antivaccination donors, very wealthy ones. Although I am offended by the Shill Gambit, which is a logical fallacy that states that financial support from a group can imply that scientific ethics or morals have been purchased, and they can’t be trusted. Well, if that argument is to be used against Paul Offit, about whom we have solid evidence that he invented a vaccine that has saved hundreds of thousands of lives in this decade, then it can be used against Tomljenovic and Shaw whose sum total contributions to medical science are poorly written, poorly designed research.

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.

The irrational, and scientifically unsupportable, anti-HPV vaccine beliefs of Tomljenovic and Shaw have been prevalent in the public discourse about the vaccine for quite awhile. But on 4 December 2013, the anti-HPV vaccine crowd gets a larger audience. Katie Couric, a popular “journalist” with her own morning TV show intends to broadcast an episode today where Ms. Couric interviews a mom who claims that Gardasil killed her daughter. Sadly, Couric claims that she will cover all “sides” of the HPV issue, which means that she has fallen for the false balance issue for the HPV vaccine–there aren’t two sides. There isn’t a debate. There isn’t a conversation. There is simply great science supporting the HPV vaccine, and believing lies, misinformation, and post hoc fallacies.

But in case you’ve come here because you want to find out if the HPV vaccine (and Gardasil specifically) is safe and effective, here’s your handy pocket/smartphone/tablet guide:

  1. The HPV vaccine has been shown to reduce the rate of HPV infections in adolescents and young adults. (Citation)
  2. The HPV vaccine has been shown again to reduce the rate of HPV infections in adolescents and young adults. (Citation)
  3. The HPV vaccine has been shown to reduce the rate of HPV infections in gay men. (Citation)
  4. The HPV vaccine has been shown once again to be effective in reducing the rate of HPV infections in adolescents and young adults. (Citation)
  5. One of the key HPV vaccine researchers did not change her mind about the safety and effectiveness of the vaccine.
  6. The HPV vaccine was shown to have produced no significant adverse events in a large study of nearly 200,000 young women given 350,000 doses of Gardasil. (Citation)
  7. The HPV vaccine was shown to have produced no significant adverse events in an even larger study of 300,000 young women given nearly 700,000 doses of the HPV vaccine. (Citation)
  8. The HPV vaccine does not turn your children into crazy sex maniacs. (Citation)
  9. The HPV vaccine adverse event rate cannot be accurately determined from data from Vaccine Adverse Event Reporting System (VAERS). (It’s dumpster diving.) (Citation describing how to critically examine VAERS and other post hoc data)

If Katie Couric presents data this robust, this highly peer-reviewed, this well accepted, then maybe she can overcome the scientific consensus with respect to HPV vaccines. But until that point, and I don’t expect it would happen, she’s merely pushing the agenda of the anonymous vaccine deniers who think that an hours worth of research on the internet is equivalent to real scientific research, who think that the shilling of Tomljenovic and Shaw is real science, and who try to manipulate heartbreaking stories of people who want to blame vaccines for the deaths of loved ones, but have no evidence that vaccines were involved. 

The science supporting the safety and efficacy of HPV vaccines, including Gardasil, is strong, and almost irrefutable. Until the vaccine haters provide equivalent high quality data, they really have nothing to offer to a conversation, which has evolved to be a “debate” between real science and fabrications. And Katie Couric is buying into it.

 

If you need to search for scientific information and evidence about vaccines try the Science-based Vaccine Search Engine.

 

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