Vaccines saves lives–HPV scientific evidence part 2
© Copyright CSL, 2013. All Rights Reserved.
Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes, making it easily transmitted sexually or through other intimate contact. While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae). HPV types 16 and 18 cause approximately 70% of cervical cancers, and cause most HPV-induced anal, vulvar, vaginal, and penile cancers. The HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), is marketed by Merck. The vaccine prevents the transmission of certain types of HPV, specifically types 6, 11, 16 and 18.
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Religion vs Gardasil
Although I rarely state it on these pages, I am an atheist. As a scientist, I’ve examined the evidence for a god (any god), and found it lacking. I think religion, especially in the USA, can be dangerous. Religious fundamentalism is behind the attack on teaching of real science, such as evolution and global warming. Although some may argue that trying to block the teaching of evolution, in favor of creationism, is innocuous (though absolutely unconstitutional), most would argue that since evolution is the basis of all biology (and therefore, medicine), it is harmful.
It’s when fundamentalist religion gets involved in medicine, whether it’s therapeutic abortions, vaccines, or stem-cell research, that it’s clear that religion becomes dangerous to human lives. I just want to focus on one tiny corner of the medical world, where religious beliefs block good medicine–HPV vaccinations.
For those of you may be unfamiliar with the HPV vaccine, it prevents infection by the human papillomavirus (HPV), a sexually transmitted disease. The vaccine, known as Gardasil or Cervarix in the USA, specifically blocks HPV types 6, 11, 16 and 18; HPV types 16 and 18 cause approximately 70% of cervical cancers, and cause most HPV-induced anal, vulvar, vaginal, and penile cancers. Cervical cancer, which afflicts 12,000 additional women and causes over 4,000 deaths annually in the USA, is considered the “preventable gynecologic cancer” because of the HPV vaccines.
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Survey identifies reasons for not vaccinating teens
Vaccines are one of the most important and crucial aspects for the long-term health of babies and young children. Except for a tiny, and irresponsible, minority of individuals who are opposed to vaccinations, greater than 95% of children are fully vaccinated for most vaccine preventable diseases by kindergarten. Unfortunately, a recently published article in Pediatrics provided evidence that teens are not keeping up with vaccinations that are critical to avoid infections from serious, and deadly, diseases. The study examines how vaccination rates have changed over the three year study period, and some of the reasons why they are not getting vaccinated.
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I get an email about Gardasil
I get lots of email about my articles that are published here. Sometimes, it’s about grammar or spelling (and the grammar KGB can be uncivil at times). Sometimes, it’s compliments or questions about what I’ve written. Rarely, they’re rude and usually include quite immature comments about the location of my head. However, I recently received an email that is more or less polite, but is filled with so many errors and logical fallacies, that I thought it should be critiqued publicly.
Here are my point-by-point comments about the email:
I stumbled across your blog and could not believe what I was reading about the safety of Gardasil. As a mother of a Gardasil injured daughter, your profuse endorsement made me skeptical. I want to begin by saying I am not anti-vaccine; I am anti-Gardasil.
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HPV–early vaccination maximizes effectiveness
HPV protesters in Texas.
Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes, making it easily transmitted sexually or through other intimate contact. While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae). HPV types 16 and 18 cause approximately 70% of cervical cancers, and cause most HPV-induced anal, vulvar, vaginal, and penile cancers. The HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), is marketed by Merck. The vaccine prevents the transmission of certain types of HPV, specifically types 6, 11, 16 and 18.
Although the safety of HPV vaccine has been thoroughly vetted for safety in studies with large cohorts, the long time period (up to decades) from infection to a diagnosis of an HPV-related cancer has left questions about how to maximize effectiveness of the vaccine which required further research.
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Infections causes 16% of cancers–what?
Ed Yong, a scientist and contributor to Discover Magazine, wrote an blog post, What does it mean to say that something causes 16% of cancers?, discussing a news report that stated that 16% of cancers around the world were caused by infections. Here are some excerpts:
A few days ago, news reports claimed that 16 per cent of cancers around the world were caused by infections. This isn’t an especially new or controversial statement, as there’s clear evidence that some viruses, bacteria and parasites can cause cancer (think HPV, which we now have a vaccine against). It’s not inaccurate either. The paper that triggered the reports did indeed conclude that “of the 12.7 million new cancer cases that occurred in 2008, the population attributable fraction (PAF) for infectious agents was 16·1%”.
But for me, the reports aggravated an old itch. I used to work at a cancer charity. We used to get frequent requests we got for such numbers (e.g. how many cancers are caused by tobacco?). However, whenever such reports actually came out, we got a lot confused questions and comments. The problem is that many (most?) people have no idea what it actually means to say that X% of cancers are caused by something, where those numbers come from, or how they should be used.
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Another bogus anti-vaccination paper
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:
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.
