Silver-level articleConservapedia:HPV vaccine FAQ

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This is a point by point rebuttal to the Conservapedia HPV vaccine "FAQ", a product largely of the fevered imagination of Andrew Schlafly, MD PhD JD.

General conclusions - Technical notes - Footnotes

Conservapedia's "Answers"

"Reality Based" Responses

1. Does the HPV vaccine prevent cervical cancer? Has cervical cancer ever been proven to be prevented by this vaccine?

[edit] Answer 1

NO. The HPV vaccine merely provides temporary protection against some diseases that have been found people who develop cervical cancer. No cause-and-effect has been shown, and the vaccine probably wears off long before the cancer develops.

[edit] Response 1

Yes. The HPV vaccine is a vaccine against certain oncogenic[1] strains of human papillomavirus (HPV). HPV is a very common sexually transmitted viral infection. Twenty to forty million Americans are likely infected at any given time, with college age women being particularly hard hit (estimates of a sixty percent infection rate).[2] HPV causes painful genital warts and is also the largest contributor to cervical cancer.[3] The strains that this vaccine protects against cause about 70% of cervical cancers. The vaccine has proven effective.[4] Cervical cancer will develop in half a million women every year. The death rate is as high as 40 percent in countries with modern medicine and even higher in those without.[3] Mountains of evidence prove that HPV is the primary cause of cervical cancer and no serious evidence against the causative link exists. Anything that decreases the number of women infected with oncogenic strains of HPV will decrease the number of cervical cancer infections. Other than Pap smears, which catch HPV disease after a person is already infected, the vaccine is the only way to prevent HPV infection and subsequent cancers.[5][6]

2. Why does Merck propose to give it to eleven-year-old girls? Why not give it to adults?

[edit] Answer 2

Adults know enough to refuse the vaccine. 11-year-old girls are guinea pigs who won't refuse. That's all. Teachers' unions do not allow mandatory vaccination of teachers. But students at the very same schools are subjected to mandatory vaccination.

[edit] Response 2

The HPV vaccine is, like most vaccines, a primary prevention measure, and is only known to be effective if given before someone becomes sexually active. Because of the very high incidence of the HPV virus, the majority of sexually active women are likely to be infected. Any benefit from the vaccine in age groups where women are already sexually active will therefore be very limited. Younger girls as a demographic will receive the largest possible benefit from the vaccine.[7] Because this was well known at the start, the primary age group that was tested in medical trials of the vaccine were from the ages of 9-26. Since that was the age group tested, the FDA has only approved the vaccine for that age group. Testing is now ongoing for older age groups, and in the future the vaccine might be recommended for a larger age group.[7]

3. How many girls has the vaccine been tested on? Do you think the primary motivation behind these mandates (for some) is to use these girls as test subjects?

[edit] Answer 3

Testing has been grossly inadequate. No reported tests were done on rats to check for whether it causes cancer, or birth defects when given during pregnancy. Why doesn't the manufacturer report those tests? Self-interest: manufacturers of drugs want to do as little testing as possible. They never want to do tests that might reveal flaws in their product.

Fewer than 12,000 females received this vaccine during tests, and they were monitored for adverse effects for only a short period of time, without checking for cancer or effects on pregnancy. Among young, pre-teenage girls who are receiving the vaccine, perhaps only a few hundred were tested.

[edit] Response 3

The HPV vaccine has gone through the full FDA approval process for verification of efficacy and safety that all drugs used on humans must go through. This testing involves on average 12 years of total testing, with extensive animal and pre-clinical testing before even beginning human trials. Human trials go through 3 phases and at the end will have tested on 11000+ individuals.[8] Out of the thousands and thousands of drugs initially tested by drug companies less than 0.02 percent make it the market. This is extremely extensive and intensive testing. To deny the safety of the HPV vaccine is to deny the efficacy of all drug testing done. Such a denial would immediately mean that aspirin and cough syrup should be pulled from the shelves everywhere. The pregnancy example is a complete straw man and shows how desperate Schlafly is to latch onto anything questionable. The fact is that the HPV vaccine is not prescribed for pregnant women so would only be administered in a small number of accidental cases. Even in this case the research done to date on the HPV vaccine and pregnancy has shown no ill effect on mother or fetus.[7]

4. Does Merck even know how long the HPV vaccine will be effective?

[edit] Answer 4

This type of vaccine is unlikely to remain effective for more than 5 years. Children in the 9-year-old age group have been monitored for 18 months, and there have been no studies of possible longer-term risks of the vaccine. Merck, the manufacturer of the vaccine, doesn't know because it hasn't tested it. Girls who receive this vaccine at age 13 are unlikely to be protected by it at age 18. The average age of diagnosis for cervical cancer is 48!

[edit] Response 4

This is false. The length of time that a vaccine is effective is usually not known at the start of mass availability. Schlafly quotes the 5 year mark as if it is the maximum --- this is false: the 5 year mark is the current minimum length of time we know the vaccine is viable.[9] Booster shots that bring viability of a vaccine back to baseline are common for most vaccines. These booster shots will become available when it is known at what time they will be needed. It is also important to keep in mind that the HPV vaccine is most useful when it is protecting women during their high-risk periods. As women age and enter into longer term relationships, the risk of HPV infection decreases. Also, the risk of cervical cancer developing in response to an infection will decrease with age (a woman infected at 45 may not live long enough for the virus to cause the cancer). The average age of diagnosis of cervical cancer is a meaningless number in relation to how long the vaccine must protect for.

5. Which states have vaccine mandates for Gardasil or have considered a mandate?

[edit] Answer 5

Merck poured millions of dollars into a phony "Women in Government" group designed to push for mandates in all the states. Last year, an uprising by the grassroots stopped that plan right in its tracks, and only Virginia passed mandatory HPV vaccination, and it does not go into effect until the 2008-2009 school year. On Thursday, February 21, the Education and Health Committee of the Virginia Senate killed HB188, a bill sponsored by conservative Delegate Bob Marshall (R-District 13) that would have postponed the effective date of the mandate so that further studies could be performed.[10]

Merck and liberals are still trying. In February 2008, there has been a big push in Kentucky, for example. Also, the District of Columbia passed a requirement, but it must be considered and approved by Congress before becoming effective.[11]

In February 2007, "the Associated Press reported that Texas Governor Rick Perry, who had just required HPV vaccinations for all girls entering sixth grade, had accepted $5,000 from Merck’s political action committee the same day that Perry’s chief of staff met with key aides about the vaccine."[12]

[edit] Response 5

Mandatory vaccination is a complicated political issue that extends well beyond the safety and efficacy of the HPV vaccine. Many important arguments, such as herd immunity and protecting children from the stupidity of their parents, would point to the need to mandate important vaccinations. So far, the campaign to mandate the HPV vaccine has not been a great success. This is not really something to be proud of since the “anti-vaccination” campaigns have been led by the ignorant, misogynistic and plain evil Schlaflys of the world. The arguments against the vaccine (as seen above) are based on a twisting of a few isolated facts and outright lies. While groups such as Women in Government are clearly astroturf, the supposed “grass roots” campaign against the vaccination is just as much a manufacture of right-wing anti-science cranks and their fear mongering.

6. Why are some concerned with Gardasil's liability and cost? How much does it cost to vaccinate one girl or woman?

[edit] Answer 6

"The retail price of the vaccine is $120 per dose ($360 for full series)."[13] Tack on administrative costs, including medical office visits in connection with the vaccine, and the overall cost for the full series is about $500 per child. Accordingly, the cost of vaccinating 100 children will be about $50,000, but only 3 out of that 100 will ever be exposed to the HPV types targeted by the vaccine. The average age of diagnosis of cervical cancer is 48 years old. Accordingly, the cost is $15,000 to $50,000 per child to possibly protect her against a cancer over 30 years in the future. Most states cannot afford this.

[edit] Response 6

The math here (like most of what Schlafly does) makes little to no sense. If we assume $500 per series and assume the worst case scenario of the need to perform a booster shot every 5 years for 30 years the absolute maximum cost is $3,000 per child. The 5 year mark is the minimum and is probably significantly longer. Also, a booster shot will not need to be the full 3 series of shots, so the cost will be much less. A more realistic per child cost is between $500-$1000 over the course of a lifetime. Certainly not a budget breaker. The rest of the argument here seems to rest on the fact that the number of women who are potentially affected by HPV is small. As stated above, the actual number of women that could be helped by this is very large.

A study published February 28, 2007 in the Journal of the American Medical Association (JAMA)[14] disclosed that about 3% of women are infected in their lifetime by the particular types of HPV (Types 6, 11, 16, 18) targeted by the vaccine. If generalized to the American female population at large, this would be approximately 5 million women (the size of a large American city). If generalized to the highest-risk age groups of women, the number of affected American women is probably closer to 2 million. This is not a trivial number of infections to prevent. The cost of Pap smears, colposcopies, and cervical ablation procedures needed to prevent cancers in these women is quite high.

It is also likely that after the vaccine's patent expires, its cost will drop dramatically. Additionally there's the ethical issue with this objection: who decides when a life is too expensive?

7. Is there any legislation currently under consideration?

[edit] Answer 7

You have to watch what your state legislature is doing. This is happening at the state, not the federal, level. Every state is different.

[edit] Response 7

If there is, don't be fooled by the ignorant fear mongering that will build up around it! Contact your representative and tell them to support any effort to increase the availability and use of this life-saving vaccine.

8. What do medical groups say?

[edit] Answer 8

The Association of American Physicians and Surgeons, the Texas Medical Association and the American Academy of Pediatrics do not support making this vaccine mandatory. Dr. Jon Abramson, a member of the CDC's advisory committee on immunization practices, said in a report published in the Washington Times that "I told Merck my personal opinion that it shouldn't be mandated. And they heard it from other committee members."

[edit] Response 8

The first thing that should be noted is that the Association of American Physicians and Surgeons is not a real medical group and is a cesspool of quacks. The other groups have merely come out against mandating the vaccination at this time. For example, the American Academy of Pediatrics has merely expressed concern that there are more pressing issues that should receive attention with pediatric care. However, all of the major organizations that have come out against mandating the HPV vaccine do encourage its widespread use. The Advisory Committee on Immunization Practices, which is the central body for vaccine recommendations and whose recommendations are used by most insurance plans when deciding coverage, is in full support of the HPV vaccine.[15] In addition the HPV vaccine is included in the vaccine schedule for 7-18 year olds, this schedule is based on the recommendation of the Center for Disease Control, the American Academy of Pediatrics, and the American Academy of Family Physicians.[16]

9. What are some risks of the HPV vaccine? Why isn't the media talking about them?

[edit] Answer 9

There have already been deaths after receipt of the HPV vaccine. Many girls who receive the shot say that it is the most painful of all injections they get, and that the vaccine itself burns, unlike the "other shots [that] tend to hurt only at the moment of the needle stick, and not after the vaccine plunges in." Many girls have been known to pass out from the pain.

[edit] Response 9

The only sources reporting on deaths associated with the HPV vaccine are far-right anti-vaccination groups and media such as World Net Daily. There is not a single credible report of a death associated with the vaccine — not a single one. The CDC has collected all of the complaints associated with the vaccine and over the course of one year of vaccines 542 health reports were made. This is a very small portion of the total vaccines administered. All of the reactions were mild and consisted of soreness at the injection point, dizziness, and nausea. The soreness was reported as mild (despite the unsourced anecdotal fear-mongering of Schlafly). The number of girls that fainted post-injection was not greater than for other common vaccines.[17]

10. What do you say to those who equate Gardasil with the polio vaccine as being a lifesaving tool?

[edit] Answer 10

There are much more effective ways to save lives than requiring people to receive the HPV vaccine. In fact, it's unclear that this vaccine will save any lives, and it may actually cause an overall loss of life.

[edit] Response 10

Sure, there are more effective public policies that could be created to save lives, such as gun control and universal health care (and we all know how Schlafly feels about these). But luckily we are not stuck in an either/or position. Wide scale use of the HPV vaccine will not deter other efforts to save lives. The claim that lives will be lost is unsourced and clearly wrong. No credible link has ever been found between the HPV vaccine and even one death. The number of women whose lives could be saved by this vaccine are in the hundreds of thousands per year.

11. Will this give girls and women a false sense of security? Do they still need regular pap smears to check for cervical cancer?

[edit] Answer 11

Promoters of this vaccine may like the way it misleads children about risky lifestyles. The more effective medical tests will still be necessary.

[edit] Response 11

All responsible medical authorities recommend continued Pap smears. The vaccine does not mitigate the need for other screening, but will reduce the number of positive Pap smears, and the number of women who progress to cervical dysplasia and cancer.

This right here is the root of the issue for Schlafly. The misogynists of the world are mad at this vaccine because the infection originates from the woman having sex. The need to vilify and control sexuality, particularly female sexuality, is the true reason behind their visceral reactions. Though he won’t say it, Schlafly feels that sexually active women “deserve to get cancer” and that it is “God’s just punishment for their sins.”

12. What percentage of girls are receiving the HPV vaccine voluntarily?

[edit] Answer 12

Perhaps 10% have received one dose,[18] and the percentage would be much less for all three doses. Young girls are frightened into receiving this painful and potentially risky vaccine by pamphlets describing the STDs it supposedly protects against. They are often given misleading information which makes the vaccine sound like foolproof protection against cervical cancer.

[edit] Response 12

Perhaps 10% have received one dose, and the percentage would be much less for all three doses. Young girls and their parents are frightened into not receiving this safe and extremely effective vaccine by pamphleteers and blowhard ministers describing twisted facts and outright lies about the supposed dangers. They are often given misleading information which makes the vaccine sound like a painful or dangerous procedure, but in reality the detractors are motivated primarily by a deep hatred of female sexuality, and a desire to have others conform to their idea of morals, regardless of public health consequences.

[edit] General conclusions

Opposition to this vaccine is inordinately vehement due to its location at the nexus of the anti-science movement and the anti-sexuality movement, and has little or no support from legitimate science or experts on human sexuality.

[edit] Technical notes

  • Wikilinks from the original have been removed for simplicity.
  • The footnotes in the original have been preserved, and marked as such.
  • From the original's history: "11:33, 23 February 2008 Aschlafly (Talk | contribs) (completed)" Some more minor edits were made to result in the version that has been faithfully copied here.
  • Copyright: the original is reproduced here in its entirety for context, fair use claimed for purpose of rebuttal. The original is still copyright, in some Schlafly sort of way, 2008 Conservapedia.

[edit] Footnotes

  1. RW ref.: "Oncogenesis is the process of malignant transformation leading to the formation of a tumor (tumorigenesis). It is characterized by a progression of changes on cellular and genetic level that ultimately reprogram a cell to undergo uncontrolled cell division, thus forming a malignant mass." from Wikipedia
  2. RW ref.: Rutgers HPV information
  3. 3.0 3.1 RW: Human Papillomaviruses and Cancer: Questions and Answers
  4. RW ref.: Future II Study Group, . (2007). Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical LesionsNew England Journal of Medicine, 356(19), 1915-1927. http://content.nejm.org/cgi/content/full/356/19/1915
  5. RW ref.: Ho, G.Y., Bierman, R., et al, . (2007). Natural History of Cervicovaginal Papillomavirus Infection in Young WomenNew England Journal of Medicine, 338(7), 423-428. http://content.nejm.org/cgi/content/full/338/7/423
  6. RWref.: Kumar, Robbins, and Cotran. Pathologic Basis of Disease, 7th ed., Chapter 22. Elsevier, Inc.
  7. 7.0 7.1 7.2 RW: CDC: who should get the HPV vaccine?
  8. RW ref.: Phases of FDA approval
  9. RW ref.: CDC: efficacy of the HPV vaccine
  10. CP ref.: http://www.sunherald.com/447/story/387099.html
  11. CP ref.: http://www.kentucky.com/454/story/323426.html
  12. CP ref.: http://c-ville.com/index.php?cat=141404064431134&ShowArticle_ID=11430402083894410
  13. CP ref.: http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm#hpvvac4
  14. RW ref: JAMA 297(8):813-819, February 28, 2007
  15. RW ref.: ACIP Recommends Quadrivalent HPV Vaccine
  16. RW ref.: Vaccine schedule for 2008
  17. RW ref.: CDC Says Gardasil's Side Effects Minor, Additional Warning Labels Unnecessary
  18. CP ref.: http://www.msnbc.msn.com/id/22492557/
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