WHEN LOBBYISTS for major drug companies embark on major pushes with politicians, the results are seldom laudable. Though there is reason to hope that a new Merck vaccine, Gardasil, will significantly reduce the incidence of cervical cancer, lawmakers nationwide moved with unseemly haste to require inoculations for all young girls. Their rush seems especially precipitous in light of a new study that has raised questions about how effective the vaccine ultimately will prove.
In drug trials, Gardasil has been shown to be safe and effective at halting the two strains of human papilloma virus that most commonly cause cervical cancer. Key to the vaccine's effectiveness is administering it before a woman is exposed to the virus, which is spread through sexual intercourse. This explains the valid interest in providing the vaccine to prepubescent girls despite the cost of more than $300 per vaccination. ...
...Now, after all the early hoopla, it has become less clear that Gardasil will succeed in nearly eliminating HPV. A recent study in the New England Journal of Medicine indicated that blocking the two primary HPV strains might create an opportunity for other strains to flourish, so that the overall reduction in cancers would be relatively small. In addition, safety in the general population over time often differs from experimental safety — as the Merck painkiller Vioxx tragically illustrated. [Emphasis added]
Now, I had assumed that Merck, the drug company behind Gardisil, was quite actively promoting the drug to legislators. That's what PHARMA does. In this case, however, I had hoped that those same legislators would be savvy enough to look behind the lobbying to the product itself and its incredible benefits. What about this situation has caused the editorialist to get his shorts in a bunch? Is it the high cost of the vaccine, a cost that if not underwritten by the states would put the vaccine out of reach of all but the financially comfortable and/or the insured? A list of questions posed suggests the reason:
Public health officials have not yet grappled with complex issues surrounding Gardasil. If the vaccine prevents only a couple of virus strains, how best to make patients aware that they lack full protection? Given the high cost, is the public getting the best preventive-medicine bang for its buck? Is it right to use schools to force the issue when, unlike polio, the disease cannot be caught through casual contact? [Emphasis added]
The first question is a red herring. Do we halt vaccinations of one kind of hepatitis because we don't have a vaccine for the other kinds? Of course not. Any time we can stop a disease we should do so, even if we can't prevent other related diseases.
The second question, that of the high cost factor, is only slightly more legitimate. The high cost is unconscionable. Let the legislators bring some pressure to bear on Merck, forcing a lower cost on this and other drugs. We've been screaming about this for yarons.
It's the last question, however, which is the give-away: the idea that middle school girls might be having sex, because that's exactly what the question is really about, and what I suspect is really bothering the editorialist.
Oh, I'm red-faced, all right: but not with embarrassment.