On guard against Gardasil

Gardasil is a vaccine against human papilloma virus. HPV can cause genital warts, cervical cancer, and a variety of other diseases, including penile and anal cancer.

Gardasil is marketed by the pharmaceutical giant Merck, and costs about $500 for the three shots necessary to establish immunity. A couple of years ago Merck sponsored a legislative campaign to make Gardasil one of the vaccinations girls would have to receive in order to attend school. This campaign proved controversial, and only Virginia and the District of Columbia passed this legislation. Now, Merck is pushing to have boys and men vaccinated with Gardasil.

The National Partnership for Women and Families discusses this situation in its Daily Women's Health Policy Report issued yesterday. This report is based on an article in that day's edition of the Washington Post.

According to the Post:

When a vaccine designed to protect girls against a sexually transmitted virus arrived three years ago, the debate centered on one question: Would the shots make young girls more likely to have sex?

Now the vaccine's maker is trying to get approval to sell the vaccine for boys, and the debate is focusing on something else entirely: Is it worth the money, and is it safe and effective enough?

Like most generalizations, this one has some exceptions. For instance back during the summer of 2007, I found this post over on AlterNet. It's the first part of a four-part series on the politics and PR of cervical cancer by Judith Siers-Poisson.

Siers-Poisson writes:

Given the anxiety of most people about cancer and the number of people infected with HPV, it is not surprising that what is touted as the first vaccine against cancer has been largely greeted with acclaim. But despite having been affected personally, I became concerned by the headlong rush to not only approve the vaccine, but to mandate it for middle-school aged girls. It is also worrisome that a vaccine may give a false sense of security, which could lead to a decline in the very reliable and proven diagnostic tools available, including Pap tests. Decisions affecting millions of young women should not be made lightly, and certainly not without examining the marketing, PR, and profit motives of a corporation like Merck.

Apparently, HPV is incredibly common, so common that more than half of all sexually active people acquire it at some point. By age 50, 80 percent or more of all women will have become infected with genital HPV. But most people fight off the infection on their own. There are more than 30 strains of HPV, a few of which cause cancer. Merck claims that its vaccine protects against the strains that cause 70 percent of cervical cancers and 90 percent of genital warts.

Siers-Poisson argues that the most effective preventative measure against cervical cancer is a regular Pap smear. Unfortunately, poor women, women of color, and women in non-industrialized countries often lack access to regular medical care, including Pap tests. Furthermore, cervical cancer causes far fewer deaths than do heart disease and breast cancer. While not minimizing the threat of cervical cancer, Siers-Poisson wonders if Gardasil is vastly more important to the health of Merck than it is to the health of women.

Meanwhile, let's go back to the Washington Post. The Post article raises the question of whether it might be sexist to consider cost-effectiveness in the case of Gardasil:

"The cost-effectiveness studies are really important, but I don't think they should be the sole driver of public health policy," said Gregory D. Zimet, a professor of pediatrics and psychology at Indiana University. "This is a vaccine that principally benefits women's health. I wonder if it was the reverse, and there was a vaccine for women that helped prevent prostate cancer in men, this would be as much of an issue."

For me, the real question is, are we protecting the health of patients, or are we protecting the health of giant corporations? We're often told that universal health care is unaffordable. But it's not always true that the most expensive treatment is the one that is most effective. If we can find a way to spend our health care dollars in the most cost-effective way, maybe we could afford health care for everyone. If that requires more government intervention in the free market, that's really not such a bad thing.