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HPV Vaccine for Boys

A recent announcement is likely to generate a lot of controversy. The Advisory Committee on Immunization Practices of the CDC has recommended that boys and young men be vaccinated against human papillomavirus (HPV). Previously the guidelines said boys “could” be given the HPV vaccine. Now they have recommended that boys age 11 to 12 “should” be vaccinated, as well as boys age 13 to 21 who have not already had the full series of 3 shots. The vaccine can also be given to boys as young as 9 and to young men age 22 to 26.

The vaccine was originally promoted as a way to prevent cervical cancer. Boys don’t have a cervix, so why should they be subjected to a “girl’s” vaccine? There are some good science-based reasons:

  • Boys can transmit the virus to female sex partners later in life, leading to cervical cancer in women.
  • More importantly, boys themselves can also be directly harmed by the virus. It can cause genital warts, cancer of the head and neck (tongue, tonsils and throat), anal and penile cancer, respiratory papillomatosis, and giant condyloma of Buschke and Lowenstein. In rare cases, immunocompromised patients can develop epidermodysplasia verruciformis.
  • There are other unconfirmed concerns: HPV has been associated with cardiovascular disease in one study.

Some of these conditions are not common, and the most common one, genital warts, may sound trivial. But “a picture is worth a thousand words,” so here is a link to a picture of a giant condyloma of Buschke and Lowenstein as an example of what HPV can do to the unvaccinated. The picture is not pleasant. If you are squeamish, you may not want to look at it. If you can’t even stand to look at it, imagine how devastating it would be to have it appear on your own body, and how nice it would be to be vaccinated against it.

The patient is a 45 year old man who had a 1-year history of discomfort when sitting. The picture shows a cauliflower-like verrucous mass around the anus, measuring 15cm in diameter. It required surgery. These lesions are rare, destructive tumors that mostly affect men under the age of 50. They are benign, but they destroy adjacent tissue, and malignant transformation can occur. They are caused by one of the types of HPV infection that can be prevented by the HPV vaccine, HPV type 6, which was confirmed by DNA analysis in this case.

Before anyone accuses me of relying on “anecdotal” evidence, that’s not what this is: this is an illustration of a rare but serious complication of HPV infection. If it appears alarmist, maybe that’s just what science needs to get its message across, to counteract all those emotionally laden stories of patients who were allegedly hurt (“Schoolgirl, 14, Dies After Being Given Cervical Cancer Jab”) and the lies that are continually published (“HPV Vaccine Kills At Least 21 Girls So Far”). Maybe science should fight back with headlines like “Failure to Get HPV Vaccine Causes Giant Flesh-Eating Wart!”

Gardasil is a quadrivalent vaccine that protects against HPV types 16 and 18, which are responsible for about 70 percent of cases of cervical cancer, and against types 6 and 11, which are responsible for 90 percent of genital warts. It also produces some degree of cross-immunity with other HPV strains. Overall prevalence of HPV in women in the US is 26.8%, although the prevalence of the types targeted by the vaccines is only 3.4%.  Most studies of HPV in men have reported a prevalence of least 20%, and some have reported much higher, up to 72.9%.  Prevalence data are misleading, because they do not reflect lifetime incidence or cancer risk: many infections resolve spontaneously, and it is the persistence of certain serotypes that leads to precancerous and cancerous lesions. By one estimate, between 75 percent and 80 percent of females and males in the United States will be infected at some point in their lives.  There is an alarmingly high incidence of new HPV infections in the teenage/young adult population, the group targeted for vaccines. Vaccines are most effective when given before initiation of sexual activity. These concerns have led to recommendations for legislation to facilitate vaccination.

The vaccine is very safe. Most reported side effects are mild, mainly local reactions with an occasional fainting episode. Deaths and serious adverse events after HPV vaccination have been reported to the Vaccine Adverse Event Reporting System, but none of these have been causally linked to the vaccine. The vaccine clearly works. Questions have been raised about its effectiveness, but epidemiologist Tara Smith has shown that those questions are misguided.   While it is too early to document its impact on cancers or mortality, there is clear evidence that the vaccine reduces the incidence of precursors for several types of cancer. A recent study in the NEJM confirmed its effectiveness in preventing anal intraepithelial neoplasia, a precursor of anal cancer, in men who have sex with men. The rate of anal cancer is increasing in both men and women, and it is hoped that the vaccine will reverse that trend. The rate of HPV-related head and neck cancer is increasing in young men, and can also be expected to decrease with vaccination.

I won’t get into ideology, cost-effectiveness, or the pros and cons of mandatory vaccination, but the science is clear: for both sexes, the benefits of this vaccine outweigh the risks. In The New York Times Dr. William Schaffner was quoted as saying

This is cancer, for Pete’s sake… A vaccine against cancer was the dream of our youth.

I made sure my daughters got the vaccine. If I had sons, I would vaccinate them too.

 

Posted in: Cancer, Vaccines

Leave a Comment (126) ↓

126 thoughts on “HPV Vaccine for Boys

  1. DrRobert says:

    Penn Jillette, the famous Magician and Bullsh*t caller-outer, was recently talking about this vaccine on the Opie & Anthony show. He conjured up this scenario where the scientists who invented Gardasil are sitting around in their lab, saying “We did it! We cured cancer! We can stop your loved ones from dying needlessly! … What? You…. You don’t want it?”

    As you quoted, Dr. Hall, this is a vaccine against cancer. And people are refusing it? It’s mind boggling.

  2. DrRobert says:

    Dr. Hall, I apologize for double posting. I’ve been struggling with this question: “Why do people want things to be bad?”

    For example: why do they *want* to believe that vaccines are going to cause every possible medical problem? Why do they want to blame MSG for their headaches? Why do they want to believe that OTC supplements will solve all their problems?

    I frequently talk to people and correct some of these misconceptions they have. They all squirm and throw out dozens of hypotheticals asking “well, what if this happened…” It truly is a desperate need to believe that these things are bad for them.

    Why?

  3. WilliamLawrenceUtridge says:

    Science is tricky, complicated, probablistic and requires considerable investment in time just to understand what is being talked about. It also challenges assumptions and implies a certain amount of uncontrolable inevitability in sickness, suffering and death. It is not normally comforting.

    Paranoia, conspiracy theories and CAM platitudes are simple. They attribute human motivations to things, and anyone can understand human motivations. They are comforting absolutes – if only you do this, you will be young and healthy forever! And once you’ve made a decision based on these absolutes, it becomes hard to change your mind, because the brain is very good at justifying choices it has made and very poor at admiting it’s made a mistake (cognitive dissonance). All those people squirming and throwing out hypotheticals are probably just doing their best to convince themselves they’ve made the right decision, and that they haven’t put their child (or themselves) at risk because they fell for a snake oil salesman. Or in the case of MSG, that they’ve avoided delicious all-you-can-eat Chinese buffets for years based on a mistake. People hate changing their mind. But sometimes they do – just ask Michael Shermer.

    I’ve a personal theory that much of the CAM nonsense that exists stems from a genetically-ingrown purity fixation, the kind of evolutionary driver that urged us to stay away from the ugly, sick, old and rotting. Now that we’re mostly healthy and our garbage is trucked away regularly, it’s misfiring. Disease is replaced with squalene, rot is replaced with food additives including SUCROSE!! CITRIC ACID!! CALCIUM CITRATE!! I DON’T KNOW WHAT IT IS SO IT MUST BE BAD!!! Never mind that they preserve and flavour food, and make canned tomatoes firmer.

  4. superdave says:

    If I had not recently aged out of the recommended group, I would definitely get this. The benefits clearly outweigh the risks. I do think that sanity will prevail here, especially when enough girls have received the vaccine to make meaningful and clear drops in cancer rates.

  5. rjcDO says:

    May experience has been that HVP vaccine has been better accepted for girls than boys.
    There is still some reluctance as some feel a person should not be putting themselves into the situation to contract HVP. I like to point out there are few married couples that have only had sex with each other even if it is because of spousal death or a mistake one made while young.
    The best point is as stated it is an anti cancer vaccine.

    Hopefully the change in recommendation will end the last few insurance companies who do not pay for boys to receive the HPV vaccine which btw Dr Hall includes TriCare and yes my senators and president have heard from me on this one.

  6. makita says:

    I had my son immunized when he was 12 (3 years ago). I had to pay for it out of pocket, insurance wouldn’t pay for HPV for boys. As a graduate student at the time, this was particularly tough for me, but I didn’t feel I had much of a choice. Not only am I strongly in support of immunization, but in this particular case it made no sense to me to restrict the immunizations to girls. The boys are the ones most likely to spread the virus, and penile cancer, even if rare, isn’t funny. I lost my 19-year old brother to a rare cancer, my middle child was born with an extremely rare brain malformation. The word “rare” lost it’s meaning to me.

  7. wales says:

    No link to the CDC page on HPV, perhaps it wasn’t alarmist enough.

    http://www.cdc.gov/std/HPV/STDFact-HPV.htm

    Some facts from the CDC site:

    Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.

    The types of HPV that can cause genital warts are not the same as the types that can cause cancers.

    Further…..Cervical cancer is by far the most common type of cancer associated with HPV. About 12,000 cases of cervical cancer are diagnosed annually, of which 70% are caused by HPV, bringing this to 8,400 cases of HPV related cervical cancer annually. This affects about 0.00006% of the female population. The total of all HPV cancer related diagnoses in the US is about 22,000, or 0.007% of the entire population. Statistics regarding head and neck HPV related cancers caution that those cases may be highly impacted by tobacco and alcohol use.

    Only time will reveal if there is any wisdom and cost effectiveness in the recommendation to vaccinate every birth cohort in its entirety, tens of millions of children, in an attempt to protect 0.007% of the population. Since the duration of vaccine-induced immunity is limited, boosters will be necessary.

    The Gardasil package insert states “The duration of immunity following a complete schedule of immunization with GARDASIL has not been established.” But the below article states duration of immunity is about 5.5 years for both Gardasil and Cervarix.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727782/

    One more comment: I note a careful caveat regarding correlation vs. causation here: “Deaths and serious adverse events after HPV vaccination have been reported to the Vaccine Adverse Event Reporting System, but none of these have been causally linked to the vaccine.”…But no such caveat here: “HPV has even been associated with cardiovascular disease.”

  8. DrRobert says:

    WilliamLawrenceUtridge:
    That was a fantastic explanation. Do you mind if I quote you on my own skeptical health blog (link in my username)? It was absolutely beautifully worded.

    wales:

    1. Regarding the Vaccine Adverse Event Reporting System (VAERS): by definition, the VAERS is only useful to establish a temporal or correlation between any adverse events happening and the vaccine. All these events mean on VAERS is that they occurred at some point after being administered the vaccine. In no way does that imply any type of causality. A wonderful anecdote: today I injected someone’s knee. The knee is a synovial joint, and it’s surrounded by a synovial membrane. Immediately following the injection the patient felt light headed and needed to vomit. In no way would you blame the steroid injected for causing the nausea/vomiting. The substance doesn’t leave the knee joint! It’s stuck in there. Impossible to trigger the reaction. Instead, the person reacted to the idea of having a shot and the pain. Likewise, people that report these events after an HPV-vaccine are likely experiencing a reaction to the idea of having a shot, instead of the substance in the shot.

    2. Regarding the caveat on “HPV has even been associated with cardiovascular disease.” They are saying the virus has been associated with cardiovascular disease, not the vaccination.

  9. wales says:

    Yes I understand the association of the virus (not the vaccine, that’s not what I was implying) with cardiovascular disease. Citing an association between the virus and cardiovascular disease was intended as encouragement to seek vaccination. My point was there is no proven causal link between the virus and cardiovascular disease and thus the same careful consideration of correlation vs. causation applies in both cases.

  10. Harriet Hall says:

    @wales,
    You are nitpicking unfairly. Although I did not link to your website of choice, I did include most of the information stated there.

    “Most people with HPV do not develop symptoms or health problems from it.” In 90% of cases, the body’s immune system clears HPV naturally within two years.”
    I didn’t use those words but I did say that many infections resolve spontaneously. It is the ones that don’t resolve that lead to cancer and warts.

    “The types of HPV that can cause genital warts are not the same as the types that can cause cancers.”
    I said that: I made it clear. The main types of HPV that cause genital warts are included in the vaccine.

    “Further…..Cervical cancer is by far the most common type of cancer associated with HPV”
    Yes, so what? This was a discussion of the vaccine for boys, and I pointed out that infected boys can transmit HPV to women who can then get cervical cancer. And while cervical cancer is more common, the other types of cancer are important too.

    You argue about the rarity of cervical cancer deaths. I would argue that even one preventable death is too many, and infection causes harm in other ways, as illustrated by the picture of the ugly giant wart I linked to. I deliberately avoided getting into controversial areas of ideology, cost-effectiveness, and the pros and cons of universal vaccination: I explained that I was limiting my discussion to the science of the vaccine’s effectiveness and risks. Science tells us the vaccine is effective; it can inform public policy but does not direct it.

    “Statistics regarding head and neck HPV related cancers caution that those cases may be highly impacted by tobacco and alcohol use.”
    So what? There is no evidence that HPV related cancers don’t occur in the absence of tobacco and alcohol. We can give a vaccine; we can’t enforce tobacco and alcohol abstinence.

    “boosters will be necessary.”
    Maybe, but why would that be a problem?

    ” no such caveat here: “HPV has even been associated with cardiovascular disease.”
    I didn’t say it “is associated” or “has been proven associated.” It “has been associated” by the authors of the study that I linked to. I did not claim that the association was proven or that it was causal.

    You have been unfairly critical of what I wrote, but you have not said what you yourself think. Do you disagree that the risk/benefit ratio is favorable? Do you recommend against vaccinating boys? Girls?

  11. DrRobert says:

    wales,

    I apologize for misunderstanding you. So you’re beef is that you feel “associated” is a stronger word than “correlated” in terms of two things occurring in parallel but not necessarily one causing the other.

    Is that correct?

  12. S.C. former shruggie says:

    This is a good idea, and I can only hope people will actually use it. My college roommate’s fiancee died of cervical cancer, most likely from HPV she caught from him. They had planned to marry that spring. I’m simpy amazed that people would refuse this vaccine on any grounds.

  13. DugganSC says:

    Out of curiosity, is the age range because the vaccine is more effective at that age and/or after a certain age, it’s not effective at all? Or is this a matter of trying to chase down the kids before they’ve had sex.

    I ask because I’m a 31-year-old male who’s never had sex (combination of religious convictions, the abundant evidence that early sexual activity can negatively impact your odds of stable future relationships, and frankly sheer stubbornness after I got to a certain age) and I’m always curious when these new vaccines come out as to whether it’s worthwhile going in and getting it.

    Secondly, if there have only been 23 cases of adverse reactions (whether or not there’s definitive proof that they were caused by the vaccine) and there are a greater number of cases of cervical cancer that could have been prevented, I can see where this does make a good ROI (assuming, of course, that the additional cost doesn’t result in people with other medical issues getting shorted).

    I think a lot of the resistance is due to people seeing this as preventable. You’d probably get the same thing if we found some way to vaccinate against cancer caused by smoking. Sure, you could have caused it by a youthful indiscretion, or because someone else smoked nearby you, but the primary cause is still people who habitually smoke, so many people would feel opposition against creating a mass vaccination, which would cost everyone, to protect those who choose to pursue activities that they know may harm them.

  14. Oh well, the number of women with cervical cancer may be relatively low, I can attest to the fact that getting treated for pre-cancerous cells is no picnic. In fact it’s a pain in the…well you know. Also, I had a friend years ago that needed to have a c-section due to an outbreak of genital warts during pregnancy. Not only was the condition uncomfortable for her, but the c-section caused increased pain and recovery time.

    Of course I’m too old and monogamously in love to be in the market for a new sexual partner, but if I was younger and unattached I certainly would show preferential treatment to a guy who was vaccinated for HPV.

  15. Anthro says:

    I’ve read all this and looked at the picture (!), but I don’t see an explanation of the age limit. Is there limited effectiveness once sexual activity has begun? Is this affected by number of partners?

    My son is soon to be 25 but has only had one partner (so he says)–should he get the vaccine? Should a 40 year old virgin get the vaccine?

  16. wales says:

    Dr. Robert: Perhaps I did not articulate clearly. My point is that if readers are to be instructed not to conflate assocation/correlation with causation regarding VAERS statistics, readers should also be cautioned not to conflate association/correlation with causation regarding HPV and cardiovascular disease. There shouldn’t be a double standard. That’s only “fair”, no?

    HH: My only recommendation is that readers gather all of the facts and carefully arrive at an informed decision. You say “I did not claim that the association [between HPV and cardiovascular disease] was proven or that it was causal.” No, but you did include it in your list of “good science based” reasons to vaccinate boys…if it is not proven or causal, why is it a good science based rationale for vaccinating boys?

    Lastly you say you avoid “controversial areas of ideology, cost-effectiveness, and the pros and cons of universal vaccination” I would reply that 1) cost effectiveness is not controversial and that 2) medicine and science are themselves laden with ideology.

  17. Harriet Hall says:

    @wales,
    “My only recommendation is that readers gather all of the facts and carefully arrive at an informed decision.”
    That sounds suspiciously like the anti-vaccine mantra.

    The association with cardiovascular disease is based on evidence from a scientific study. At this point it is not proven, but it is something to keep in mind pending further evidence.

    I would argue that cost-effectiveness is indeed controversial: people disagree on what to include and how much is too much to spend.

    Fess up! Would you give your child the HPV vaccine?

  18. daughternumberthree says:

    I’m with micheleinmichigan — I’ve vaccinated my now-18-year-old daughter to keep her from a lifetime of Pap smears followed by colposcopies, biopsies, cryo treatments and LEEP Cone procedures, which can undermine the ability to carry a pregnancy to term. I’ll be interested to hear what type of boosters are required, though.

  19. wales says:

    I was wondering how long it would take for the typical SBM “suspicious, anti-vaccine” brush to be brandished. Since you’re already “suspicious”, what difference does it matter whether or not I would vaccinate my child? If I say “yes” I will be met with responses of congratulatory agreement, if I say “no” I will be branded as an anti-vaccine ignoramous. If choose the middle ground and say “I don’t know, I want more long term safety and efficacy data on the vaccines” I will still be branded as ignorant, and advised of how harmless the vaccines are.

    It’s unfortunate that the concept of informed decision making has become synonymous with an “anti-vaccine” stance in some minds. Similarly, some equate “pro-choice” with “pro-abortion”, another clumsy mistake. An analogous concept, informed conviction, is discussed in legal circles. This is the idea is that juries should be informed of sentencing terms when deliberating upon criminal convictions. If I said I was in favor of informed conviction would I be characterized as anti-prison or anti-punishment? Possibly, especially by those with an axe to grind regarding mandatory sentencing guidelines.

    Jumping to conclusions is the antithesis of carefully informed thought. I agree with you that there are many things to “keep in mind pending further evidence”.

  20. wales says:

    This article discusses the study cited above regarding a possible link between HPV and cardiovascular disease…the study involved about 2,450 women, no men. The article concludes with these qualifying remarks.

    http://www.nytimes.com/2011/10/25/health/research/25theory.html

    “A researcher not involved with the study, Dr. Lori Mosca, director of preventive cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center, said: “I’m definitely intrigued by this. The biological argument is highly plausible and deserves further investigation.”

    But she emphasized that plausibility is not enough; the history of medicine is full of ideas that made sense and turned out to be wrong. The type of study that Dr. Fujise did, in which scientists look for associations in a mass of data, is good for generating ideas for more research, but it does not prove cause and effect.
    Finding an association does not even tell which condition came first. In theory, heart disease could have come first and made the women more vulnerable to HPV. Or some other unknown factor could have predisposed some women to both HPV and heart disease.

    “We need to proceed with caution,” Dr. Mosca said. “We need to go on and do more rigorous kinds of research that would answer the question more definitively.”

    She said that many researchers were studying possible links among cancer, infections and heart disease, but that so far no infection had been proved to cause artery disease.

    Dr. Fujise’s work, she said, “has the potential, if it does pan out, to further inform the public about the potential benefits of vaccination for HPV.” But she added that the findings were too preliminary to be used as evidence in favor of vaccination. “

  21. passionlessDrone says:

    Hello friends –

    I was late afternoon and poking around elsewhere and ran into this posting.

    http://blogs.discovermagazine.com/crux/2011/11/14/should-boys-be-given-the-hpv-vaccine-the-science-is-weaker-than-the-marketing/

    To achieve the 98 percent efficacy claim, Merck excluded from analysis anyone who “violated” the study protocol. In other words, all real-world problems that arose were excluded from analysis. Problems like girls who refused to take a second or third shot after they became sick and (correctly or incorrectly) blamed the vaccine. Or doctors who incorrectly gave the vaccine to someone who shouldn’t have received it. While it’s worth knowing how effective the vaccine is when it’s used exactly as it should be, for a public-health decision, it’s not as relevant as its real-world effectiveness.

    Merck says that in males, the vaccine is 89 percent effective against genital warts and 75 percent effective against anal cancer. On closer inspection, some of the numbers don’t just deflate, they evaporate. First off, let’s define the problem: The annual number of deaths from anal-rectal cancer among all men in the U.S. is 300. And how did Merck get its happy statistics on efficacy? Once again, they reported an idealized benefit by excluding from analysis 1,250 study violators out of 4,055 total test subjects. When the real-world analysis was conducted, the numbers plunged—right down to plum nothing. After evaluating tissue changes in male genitalia that were suggestive of a cancer precursor, Merck reported that vaccine efficacy against such lesions “was not observed.”

    Ouch.

    Food for thought.

    - pD

  22. wales says:

    Note that the ACIP recommendation for boys does not apply to Cervarix, only to Gardasil, for some reason.

    http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20111026acip-hpv-hepb.html

    The main reason for expanding recommendations to include boys appears to be lackluster uptake for girls.

    What changed the ACIP’s opinion to revise their recommendations from “permissive” use to “routine” use of the vaccine for boys? Oddly, it is anal cancer, which strikes only 0.0018% of women and 0.0014% of men.

    “In 2009, the ACIP recommended against the routine use of quadrivalent HPV vaccine to prevent genital warts in boys and young men. Instead, the committee voted at that time to support the “permissive use” of Gardasil, Merck & Co. Inc.’s quadrivalent HPV vaccine, allowing males ages 9-26 years to decide, in collaboration with their health care professionals, whether they wished to be immunized.

    “Since that time, clinical efficacy data on prevention of the precursors of anal cancer have come out that were very striking, highly effective against that very severe type of cancer for which we don’t have routine screening and for which we don′t have very effective treatment.”

  23. DrRobert says:

    passionlessDrone,

    That seems like unfair criticism of that study. Of course they can’t determine the efficacy of something that wasn’t properly administered. If you provide antibiotics for someone, and they only take them for a 1 day out of a 10 day prescription, is it fair to say that they don’t work? If you bake a pie for 5 minutes instead of 30 minutes, is it fair to say the recipe was bad? Likewise, Gardasil requires three injections. It’s unfair to criticize it for not working if given incorrectly.

  24. Harriet Hall says:

    “Note that the ACIP recommendation for boys does not apply to Cervarix, only to Gardasil, for some reason.”

    The reason is simple: Cervarix is a bivalent vaccine against only two HPV strains that cause cervical cancer. Gardasil is a quadrivalent vaccine that includes the two major strains that cause genital warts.

  25. WilliamLawrenceUtridge says:

    DrRobert, you’re welcome to quote me with or without attribution though there are luminaries on this blog alone who are far more worthy. Note that WLU isn’t my actual name, if that matters. If you’re really interested in my comments about cognitive dissonance, I recommend Mistakes Were Made (But Not By Me) for an easy, if repetitive overview of the topic.

    wales, you’re engaging in a variation of what’s known as “concern trolling”. As in, “I’m just concerned, so I’m just asking some questions.” Vaccines as a whole are a well-validated mechanism for reducing incidence, prevalence, morbidity and mortality of diseases. The HPV vaccine is one of many vaccines, with a low risk profile and significant benefits. The idea that there is an “acceptable” number of deaths from any preventable disease is pretty contemptible. As DrRobert said above, we essentially have a cure (or even better, a preventive intervention) for some types of cancer. How can you not be ecstatic about this? The number of ugly, painful diseases that can be prevented through a relatively harmless intervention went up by one. I’m thrilled. And you’re saying “only 0.007%” of the population can be protected. So we should just hope we’re not one of the 20,000+ people not getting cervical cancer? Or that our daughters don’t catch it? Perhaps we’re jumping to the conclusion that you’re an antivaccination lunatic who isn’t worth listening to based on minimal data (assuming we ignore the other posts you’ve had here) but even on the face of it, your arguments are pretty shoddy – there might be side effects, so I’m willing to let 20,000 people get cancer. Horseshit. Vaccines work, have minimal side effects, and thankfully we’ve now prevented sufficient major killers we can start working on some of the other causes of totally unnecessary suffering. Yay for fruit that hangs higher!

  26. Harriet Hall says:

    @wales,
    “My only recommendation is that readers gather all of the facts and carefully arrive at an informed decision.”

    How carefully have you gathered all the facts when you didn’t even realize that Gardasil covers the strains that cause genital warts and Cervarix doesn’t?

  27. wales says:

    Where did I state that I have gathered all the facts? I did not.

    By the same token…I expect a physician promoting science based medicine to have gathered more facts before listing a possible association of hpv with cardiovascular disease in women as a good science based reason for universal vaccination of boys. The cardiologist in the NY times article does not believe there is sufficient evidence to promote that association as a rationale for vaccination.

    I do not claim to be an expert…just a thoughtful decision maker.

  28. weing says:

    “My only recommendation is that readers gather all of the facts and carefully arrive at an informed decision.”

    “Where did I state that I have gathered all the facts? I did not.”

    Hmmm. Do as I say, not as I do?

  29. Harriet Hall says:

    @wales,

    You have nit-picked, mostly unfairly, and I have responded. The only valid criticism you have made is that I should have stressed that the connection with cardiovascular disease is unconfirmed. I agree. My intent was not to present it as proven, and my wording left that unclear. I have edited it to read “There are other unconfirmed concerns: HPV has been associated with cardiovascular disease in one study.”

  30. DugganSC says:

    ^_^ As fascinating as it is to see the feud go back and forth, are there any words on whether the vaccine only works for younger children or if it’s worthwhile to look into as an adult?

    So many vaccinations that we didn’t get because they either weren’t fully developed or simply weren’t in vogue yet, and there seems to be no hard data on whether we should try to “catch up”. I mean, the boat has long since sailed for chicken pox for me, but should I get the Hepatitis B vaccine? Meningitis vaccine? HPV vaccine? Or at my lofty age of 31, would they be the equivalent of taking supplements, things my body doesn’t need and can’t use?

  31. Janet Camp says:

    Golly, I thought my question was way more worthy of a response than Wales’ obvious baiting (trolling?) Sometimes I really wish people had to use their real names on blogs.

  32. @DugganSC, I think the vaccines you need as an adult depend somewhat on varied health factors, jobs and lifestle. You could check out this CDC quiz.

    http://www2a.cdc.gov/nip/adultImmSched/

    Then discuss with your doctor.

  33. Harriet Hall says:

    @DugganSC,

    I don’t think we have any data to answer your questions. Unless the vaccines are tested in older age groups, we can’t know whether they will stimulate comparable immunity and/or have more complications than when given to children. Current recommendations are for unimmunized adults to get meningitis and hep B vaccines only if there are risk factors. See http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/mmwr-adult-schedule.pdf

  34. DrRobert says:

    Question:

    On the age ranges for Gardasil, etc, are these because epidemiological data suggests past these ranges you’ve already likely been exposed to HPV, etc? Just my guess. What’s the reason behind the ages?

  35. wales says:

    “You have nit-picked, mostly unfairly”…don’t take it personally. Being “fair” has nothing to do with my comments.

    Ah weing, my old friend. Always a day late and a dollar short.

  36. Harriet Hall says:

    “Being “fair” has nothing to do with my comments.”

    LOL! It sure doesn’t! You didn’t even do me the courtesy of reading my article carefully: you cited facts from the CDC website as if I had not included them in my article, like the fact that different strains cause cancer and warts.

  37. DrRobert says:

    wales, it truly seems like you constantly move the goalposts, challenge people because you misunderstand things, and criticize based on semantics. I don’t believe you are interested in “getting to the truth” of things. It seems like things are about to turn nasty, so I’m out.

  38. Reductionist Nurse says:

    After getting the information provided by Dr. Crislip’s podcasts, I asked my doctors office for the HPV vaccine two years ago before it was indicated for males (I was 23 then). I was pleased to find out then that Merck was fully reimbursing males who got the vaccine at the time, so I got protected for free just for asking. Let me take the subject manner today to say thanks to SBM for getting me the info I needed before it made headlines. I would be happy to spend the extra cash to protect myself and others, but saving money at the same time gives just a little extra satisfaction.

    Also, in comparison to any other vaccine, in *my* experience, the HPV vaccines were some of the least bothersome. I can’t recall any pain or soreness from them at all.

    Thanks Dr. Hall for readdressing this issue, men might not be the most vulnerable demographic for HPV infection, but we are certainly responsible for it’s proliferation, and thus should be held equally responsible for preventing it.

  39. DrRobert says:

    WLU: Thank you for the heads up on the book. I just looked for it and downloaded it from iBook store.

  40. weing says:

    @Janet Camp,

    I could not find your question.

  41. Dawn says:

    I don’t have pictures like Dr Hall linked to. But when I was a midwifery student, in the gyn clinic, I saw a young girl, about 16 (IIRC) who was complaining of bleeding and problems urinating. Upon exam, you could not even identify her external sexual organs, nor visualize her urethra due to the HUGE overgrowth of condyloma. If you touched her, she bled, the skin was that friable. The condyloma extended from her mons pubis back past her anus, and hung down. The girl denied noticing them, or feeling anything different about her body. Because some of the condyloma were blocking the urethral outlet (she had about 600 ccs of residual urine in her bladder after valiently trying to urinate), we ended up admitting the poor girl for surgical excision under anesthesia. I don’t know what happened to her after that, as my clinical rotation ended a week or so later. But it gave me nightmares for weeks.

  42. rork says:

    The cost effectiveness for this situation is an interesting case study. Don’t think I’m against this vaccine, I’ve wanted to ask every young man to get it from day 1, as a public service, and also cause we study head and neck cancers and have been horrified for quite a while about increased incidence, and that we’re seeing HPV in there. I was hoping we’d have cheaper, more convenient, and better vax by now, and be able to make the argument that it is cost-effective. Cost includes quality of life when I say it. That calculation will be a mess, but what other alternative is there, besides saying we are ignoring it.

    Data or even informed opinion on transmission chances would be greatly appreciated. What do we know about the risks of various oral sex acts or even just kissing? Our frisky young people need information. They tend to think it’s all very simple. I am sympathetic about how hard it is to estimate transmission rates, and that perfect studies may not exist. You sure aren’t gonna randomize or blind folks for certain behaviors, nor get people to kiss through dental dams. Sounds difficult.

  43. wales says:

    HH: Actually I read the post all too carefully, hence my “nitpicking”.

    On the subject of fairness…. it is “unfair” to promote vaccine use by using scare tactics (cancer risk and alarming photos) without full disclosure that all of the HPV related cancers in total impact far less than one half of 1% of the US population. It is also “unfair” to say that “many infections resolve spontaneously” without disclosing the CDC’s estimate that 90% of infections resolve spontaneously. Nitpicking? Sure, “many” and “90%” paint a very different picture.

    Also your condyloma occurs in about 0.1% of the general population, and the “giant” version occurs far less often (due to patients not seeking earlier treatment).

    It is misleading for SBM to use actual statistics when it suits a purpose, but to resort to vague approximations when it suits another purpose… or no approximations at all (i.e. your list of 3 “science based reasons” for vaccinating boys shows no incident rates). I am only following SBM guidelines to delve deeply and research the actual statistics, a practice which SBM seems to promote only when criticizing “anti-vaccine” or “CAM” media.

    As far as nit-picking goes, that is a hallmark trait of the SBM “deconstructions”…and double standards are decidedly unfair. A tactic that is good for SBM is good for its readers as well.

  44. wales says:

    Oh yeah, Dr. Robert, you are entitled to your opinions, I have my own.

  45. wales says:

    WLU: just saw your lame attempt at “concern troll” outing. When are you people going to get over that old saw? It’s trotted out any time anyone has legitimate criticisms of SBM. You can characterize a thorough analysis of the facts as “contemptible” if you like.

  46. wales says:

    From Wikipedia: Application of the term troll is subjective. Some readers may characterize a post as trolling, while others may regard the same post as a legitimate contribution to the discussion, even if controversial. Like any pejorative term, it can be used as an ad hominem attack, suggesting a negative motivation.

  47. Mark Crislip says:

    Re: HPV and CV diseases. The is a growing and interesting literature on acute infections from pneumonia to shingles leading to acute vascular events: stroke, heart attack, and pulmonary embolism. The idea is infection leads to inflammation leads which is pro thrombotic which leads to vascular events. Probably why the influenza vaccine is associated with decrease in heart attacks. It prevents that chain of events. There is another chain of papers on people being admitted with acute infections having increased deaths compared to non infected admits, although the streams have not crossed showing those deaths are vascular in nature; perhaps infections leads to more car accidents. The literature on chronic infections is not as rich, the best studied perhaps are HIV and gingivitis. It is an interesting literature, and it is consistant: almost all infections studied, by one path or another, lead to vascular events. No surprise that HPV would have the same results. Not Spector level proof mind you, but a compelling preponderance. Clinically there is not yet anything to do as an intervention: asa or coumadin, but if I had extra money, I would invest in the the non warfarin anticoagulants. The future looks bright for their widespread use.

  48. wales says:

    MC: That’s interesting information. By “acute” do you mean the typical definition of “short course”? Because the NY Times article above quotes the physician conducting the study as saying “Even if further research confirms the connection, most people who contract HPV would not be at special risk for heart disease. Dr. Fujise said that if the link is real, heart disease, like cancer, would be likely to develop only in people with lingering HPV infection”.

    What would account for the lingering or long term HPV infection contributing to CVD?

  49. wales says:

    WLU: just a nitpicking correction to your comment above regarding “20,000+” people getting cervical cancer. 12,000 diagnoses annually, 70% HPV related…resulting in 8,400 HPV related cervical cancer diagnoses.

  50. WilliamLawrenceUtridge says:

    On the subject of fairness…. it is “unfair” to promote vaccine use by using scare tactics (cancer risk and alarming photos) without full disclosure that all of the HPV related cancers in total impact far less than one half of 1% of the US population.

    That’s still thousands of deaths and millions of hours of completely unnecessary suffering eliminated. The realistic consequences of HPV infection are cancer and growths that are unsightly and painful. Citizens of the modern world are at incredibly low risk of dying from an infectious disease because we’ve controlled most of them with nearly harmless, highly beneficial vaccinations. When your daughter, wife, mother or sister is part of that less than 1% population, how much comfort is it to know that 99.5% of the population isn’t at risk? The point is – even that less than 1% chance can be reduced to ultimately nothing. Vaccination is these days always numbers game that reduces statistical risks, and very rarely do most of us see a result. The chances of dying of polio is now incredibly low in North America – I’m still strongly supporting polio vaccination as a regular thing. It ultimately comes down to the fact that we can prevent cancer – and you’re arguing against it. Why? Apparently because it’s not killing enough people.

    just saw your lame attempt at “concern troll” outing. When are you people going to get over that old saw?

    When antivaccination nutters get over objecting to vaccination for spurious reasons. Your criticisms aren’t legitimate criticisms of SBM. Your “thorough analysis” started with your conclusion and worked backwards. Death by cancer and massive anal warts are actual outcomes of HPV infections, outcomes that are preventable through relatively simple, low-risk vaccination. These vaccinations are recommended by experts who know the data, and I trust them a whole hell of a lot more than people who have already made up their minds that vaccination is an inherent evil. And these vaccinations would be a whole lot cheaper and more available, we’d probably have more of them, if it weren’t for the spurious concerns of antivaccination nutters clogging up court systems on the belief that autism was caused by “vaccine injury”.

    Also, here’s a fun game to play – that set of figures you quote, 12,000 cases of cervical cancer per year, 8,400 caused by HPV. What happens if you extend that figure outside of the United States, in particular to the countries without cervical cancer screening? HPV vaccination could stop a lot of people in Africa, India and China from dying of cervical cancer, do you support their use of the vaccine? What about the fact that you’re talking about incidence rather than prevalence? How about lifetime prevalence? How about the millions of people that won’t have cervical cancer over the course of an entire generation? You may be talking about 0.07% of the population protected, I think the more important figure is the number of deaths prevented. Imagine yourself at the foot of the bed of a woman in the late stages of untreatable cervical cancer, morphine dripping in and urine dripping out while the respirator wheezes and the EKG beeps, and saying “we could have prevented this, but I don’t think it was worth it. This is much better.” Balls to that.

    A vaccine that prevents cancer is a good thing. There’s a reason why experts believe vaccinations are the best thing to happen to human health ever.

  51. wales says:

    WLU: Your fantasy anecdote is rather interesting, comparable even to anecdotes about children injured or killed by severe vaccine reactions.

    Who is going to pay the $360 per head for HPV vaccination in developing nations? Granted, there would probably be better uptake in an uneducated population. Maybe Mr. Gates will pony up the cash…though it could also be put to good use in feeding hungry, jobless and homeless Americans.

    I am not arguing “against” anything. I am articulating the desirability of informed choice and full disclosure in medical media which is intended to be persuasive.

  52. wales says:

    WLU: BTW, according to your ad hominen attack above, you are engaging in prohibited feeding.

  53. wales “Who is going to pay the $360 per head for HPV vaccination in developing nations? Granted, there would probably be better uptake in an uneducated population. Maybe Mr. Gates will pony up the cash…though it could also be put to good use in feeding hungry, jobless and homeless Americans.”

    Huh? I thought you said that cost effectiveness is not controversial.

  54. Th1Th2 says:

    Death by cancer and massive anal warts are actual outcomes of HPV infections, outcomes that are preventable through relatively simple, low-risk vaccination.

    Outbreaks.

    By August 14 this year, Judicial Watch, a non-profit interest group which has monitored the vaccine’s progress since it was released. reported “21 deaths and 9749 adverse reactions, including 78 outbreaks of genital warts and 10 miscarriages”.

  55. wales says:

    Michele, to me it’s not controversial. When people are homeless and starving the money should be allocated there first.

  56. DrRobert says:

    wales,

    I’m just failing to see your point. Is it that the HPV vaccine doesn’t save *enough* lives to justify its use?

    Isn’t one person dying from an easily-preventable-with-a-harmless-vaccine disease enough? What is your argument? That it increases the cost of healthcare too much? (It’s not mandatory.) That the vaccine is dangerous? (Prove it.)

    It’s fact that HPV can lead to certain types of cancer that can kill people. Indisputable. It’s fact that any parent can have this vaccine administered to their child to prevent this very real and possible form of cancer death.

  57. WilliamLawrenceUtridge says:

    Wales, vaccines would be cheaper if pharmaceutical companies didn’t have to set aside large amounts of money in anticipation of class action lawsuits by parents consumed with the belief that vaccination caused harm to their child.

    No, you’re not arguing against anything. You’re just asking questions. I’m not feeding, I’m pointing out flaws and points of disagreement in your assumptions. To compare, you’re “just saying” that HPV vaccination only protects nearly ten thousand people per year. I’m arguing that over the lifetime of a generation, that represents a whole bunch of ugly premature deaths prevented.

    Also, if you’re saying I’m feeding a troll, you’re admitting you’re a troll. Semantic arguments are annoying.

    Final question – what would make you willing to take your child out to get the HPV vaccine?

    Th1Th2 – association is not causation. Give enough people a spoonful of water and you’ll see associations with convulsions, heart attacks, choking to death on popcorn, getting married, hippo attacks and a curious tingly sensation in your left thumb. I’m also curious how vaccination causes genital warts. Live polio vaccination causing polio I can understand. Hollow viral particles causing genital warts, less so.

  58. DrRobert says:

    Th1Th2:

    I posted this earlier: Regarding the Vaccine Adverse Event Reporting System (VAERS): by definition, the VAERS is only useful to establish a temporal or correlation between any adverse events happening and the vaccine. All these events mean on VAERS is that they occurred at some point after being administered the vaccine. In no way does that imply any type of causality. A wonderful anecdote: today I injected someone’s knee. The knee is a synovial joint, and it’s surrounded by a synovial membrane. It’s self contained. The membrane produces synovial fluid that stays in the joint and doesn’t go anywhere else in the body.

    Immediately following the injection the patient felt light headed and needed to vomit. In no way could you blame the injected steroid for causing the nausea/vomiting. The steroid doesn’t leave the knee joint! It’s stuck in there. It’s impossible to trigger the reaction. Instead, the person reacted to the idea of having a shot and the pain caused by it. Likewise, people that report these events after an HPV-vaccine are likely experiencing a reaction to the idea of having a shot, instead of the substance in the shot.

    The idea of someone dying because of the HPV vaccine is ludicrous. Prove it. In fact autopsies had said they were in no way related to the vaccine. Also, the VAERS numbers even admit that they can’t verify half the deaths that have been reported, etc. The whole thing is just so absurd.

    I just don’t get the molestation of science by anti-vacciners. They love to be super selective. Ie, pick and choose. Pick the one set of alarmist information that supports their statement, or the one quote from a fringe doctor that supports their ideals, and ignore everything else. It’s mental dishonesty. (Sorry I’m in a rush. Back to the clinic.)

  59. wales says:

    Dr. Robert: I have stated my point several times, I am sorry you don’t understand. It’s about informed decision making and full disclosure. That is my main point, and my “nitpicking” was done in order to point out the lack of full disclosure. All the other points are ancillary.

    WLU: I have “admitted” nothing, troll labeling is subjective, you are entitled to your opinion. Do I think I am a troll? No. You apparently do, so the question as to why you are engaging when you introduced the subject is your issue, not mine. You are right, this topic you raised is annoying. Semantics, well, that is a necessary part of communication.

  60. Wales, I think you should look up the definition of controversial. I don’t think it means that everyone should just agree with you (or me for that matter). For instance, I might be certain that the money you allocated to pay for the device you are communicating with should have been allocated to feed the homeless and hungry…Should I call that uncontroversial?

  61. ConspicuousCarl says:

    wales said:
    Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.

    90% of incidents not causing health problems sounds pretty good, until you remember that 80% of the population will get infected.

  62. ConspicuousCarl says:

    wales on 23 Nov 2011 at 12:36 pm

    Michele, to me it’s not controversial. When people are homeless and starving the money should be allocated there first.

    And yet we still homeless people even as Bill Gates is sending vaccines to Africa. This is called controversy.

  63. wales says:

    Michele, yes even the word controversy is subject to nuances and subjectivity.

  64. wales says:

    “They love to be super selective. Ie, pick and choose. Pick the one set of alarmist information that supports their statement”….like giant warts perhaps?

  65. Also @ wales. Twenty years ago the treatment for my pre-cancerous cells cost quite a bit more than $360. Before taking the cost of vaccine and saying “hey! we should use this for the needy.” Shouldn’t you compare the cost of not vaccinating against the cost of vaccinating and determine which costs more? If you want to make an informed economic decision, that is, rather than an ideological one.

  66. ConspicuousCarl says:

    passionlessDrone on 22 Nov 2011 at 4:02 pm

    Hello friends –

    I was late afternoon and poking around elsewhere and ran into this posting.

    http://blogs.discovermagazine.com/crux/2011/11/14/should-boys-be-given-the-hpv-vaccine-the-science-is-weaker-than-the-marketing/

    “To achieve the 98 percent efficacy claim, Merck excluded from analysis anyone who “violated” the study protocol. In other words, all real-world problems that arose were excluded from analysis. “

    No, that’s not what that means “in other words”. And what would Jeanne Lenzer have them do, include in the stats patients who didn’t take their medicine?

    We have idiots on the Internet telling everyone “vaccines are gonna get you!” Then when test patients believe that nonsense and don’t complete the regimen, the idiots want those people included in the tally of people for whom the vaccine didn’t work in the “real world”.

    That same author also pulls this stupidity:

    “The 44 percent benefit included only those women with the two specific cancer-causing HPV strains found in the vaccine. But when the researchers looked at negative cervical changes from any causes,”

    Now they criticize the vaccine for not preventing cancer it isn’t even intended to prevent! Why this fraud of a product only works against the viruses it is claimed to work against!

    “Don’t wear seat belts!”

    …why not?

    “Because they don’t work!”

    …I thought they were 90% effective.

    “Not in the REAL WORLD where loads of idiots listen to me and don’t wear them! And if you include cancer deaths, seat belts hardly work at all!”

  67. wales said “Michele, yes even the word controversy is subject to nuances and subjectivity.”

    Yes, It seems the “nuance and subjectivity” tend to get worse when the words are used to spin a position rather than to communicate an idea.

  68. wales says:

    Michele, I couldn’t agree with you more. My point exactly with items such as “many” versus “90%”, etc.

  69. wales says:

    Michele said “Twenty years ago the treatment for my pre-cancerous cells cost quite a bit more than $360.” It would be interesting to compare the costs of the annual 8,400 cases of HPV related cervical cancer diagnoses to the cost of over $1,400,000,000.00 it will cost to vaccinate a single birth cohort (not including boosters).

  70. weing says:

    Ever notice that as obesity becomes more prevalent in the US, there are still people starving? Any relationship between starvation and obesity? Are you concerned with that?

  71. WilliamLawrenceUtridge says:

    Dr. Robert: I have stated my point several times, I am sorry you don’t understand. It’s about informed decision making and full disclosure. That is my main point, and my “nitpicking” was done in order to point out the lack of full disclosure. All the other points are ancillary.

    What disclosure is missing from the scientific research about HPV? What safety considerations are missing? What effectiveness information is missing? Are you talking about Dr. Hall’s post or overall research on HPV? If the former, this is a blog designed to discuss recent and interesting science-based medical information in a way that is approachable and understandable for the average person. If you want a detailed review of the effectiveness and rationale and want to criticize that, perhaps you should take it up with the committee that recommended it. Seeing as it’s made up of a large number of experts who specialize not just in vaccination, but many in this vaccine in particular, I would assume they know what they’re doing. And really, it just comes down to the fact that the vaccine is effective and its use could prevent anal, oral and cervical cancers, as well as other unpleasant but not life-threatening consequences. So what’s the issue?

    WLU: I have “admitted” nothing, troll labeling is subjective, you are entitled to your opinion. Do I think I am a troll? No. You apparently do, so the question as to why you are engaging when you introduced the subject is your issue, not mine. You are right, this topic you raised is annoying. Semantics, well, that is a necessary part of communication.

    I think your analysis and criticism is based on a pre-existing opinion based on antivaccination beliefs rather than an even-handed review of the risks and benefits of vaccination. This is based on your comments here, as well as your comments on many other vaccine-related threads in which you have consistently minimized the risks of the diseases and maximized the risks of the vaccine.

    Why do I engage? The same reason I engage with Th1Th2, another committed antivaccinationist – to demonstrate the flaws in your position to any reader who might be tempted your superficially-convincing concern trolling. I consider you a lost cause, but that doesn’t mean your shoddy arguments should stand unopposed.

    By the way, 0.00007 * 300,000,000 = 21,000, total number of people, by your estimation, affected by cervical cancer. The absolute numbers don’t matter, nor does the choice of incidence versus prevalence. What matters is that we can prevent thousands, upwardly to millions, of ugly cancer deaths. That’s good, period.

  72. Wales, ” It would be interesting to compare the costs of the annual 8,400 cases of HPV related cervical cancer diagnoses to the cost of over $1,400,000,000.00 it will cost to vaccinate a single birth cohort (not including boosters).”

    You’re not quite getting it. You don’t just compare the cost of treating the cancers to vaccinating. A lot of cancers are prevented by pap smears, biopsies on abnormal pap smears, and treatment of pre-cancerous cells. When you lower HPV infections you lower the number of abnormal pap smears that will need repeat follow-ups, biopsies and treatment. You also lower the number genital warts cases that need treatment and the incident of thing like cesareans done because of genital warts. Many of these procedure are far more expensive, some more risky and uncomfortable than the vaccine, but you don’t seem to be considering them at all.

    Really, if you have been researching HPV vaccines to inform yourself, you should be familiar with ALL this.

  73. WilliamLawrenceUtridge says:

    Not to mention, how much would you pay to not watch your sister die of cancer? How much would you pay to not watch your daughter get a hysterectomy and eliminating her ability to have children? And do those numbers include the rising number of people with anal and throat cancer? Vaccination is delightful because it means we can forget what it is like to give birth to 10 children and have eight of them die.

  74. DrRobert says:

    Yup, exactly. The $1,400,000,000.00 is just meant to look alarming. It’s a per-kid price of $360, probably cheaper in the coming years. That’s less than an iPhone. That’s a family sacrificing 3 fancy dinners so that their kid won’t get cancer.

  75. Th1Th2 says:

    DrRobert,

    Th1Th2 – association is not causation. Give enough people a spoonful of water and you’ll see associations with convulsions, heart attacks, choking to death on popcorn, getting married, hippo attacks and a curious tingly sensation in your left thumb. I’m also curious how vaccination causes genital warts. Live polio vaccination causing polio I can understand. Hollow viral particles causing genital warts, less so.

    Well because you’re barking up the wrong tree. Have you ever thought that wart formation is caused by exposure to HP viral antigens after minor trauma to the epithelium (i.e. sexual intercourse), right? And that the inoculation with HP viral antigens intramuscularly not only involves minor epithelial trauma that could cause warts from exposure but also other systemic effects?

  76. Harriet Hall says:

    “Try this rebuttal:”

    There was already a link to Tara Smith’s rebuttal in my article.

  77. wales says:

    Not that it matters…but for the sake of nitpicking: the 0.007% is arrived at by dividing the total number of HPV related cancers (20,000) by the population (300 million).

    “I think your analysis and criticism is based on a pre-existing opinion based on antivaccination beliefs rather than an even-handed review of the risks and benefits of vaccination.” Another failed attempt at telepathic knowledge of another’s motives.

    I have explained my motives many times, but some persist in not understanding or in assigning their own presuppositions. Ah well, that’s to be expected on a public forum, everyone brings their own agendas.

    Happy Turkey Day!

  78. wales says:

    Dr. Robert: One last comment, that figure of $1.4 billion is for only one birth cohort, so it would be an minimal annual cost of universal vaccination, for HPV only.

  79. tmac57 says:

    wales-
    My wife lost her 6 year battle with cervical cancer in 2010. The cost of her care was well over a million dollars. Multiply that times 20,000. But in the end,you can’t put a price on the pain and suffering that she went through,as well as everyone else who cared about her.One of her most fervent wishes, was that her granddaughters be immunized against HPV,and she wistfully told me that she wished that the vaccine had been around to have benefited her,but it was then too late. It is not too late now for a new generation of young people who could benefit from it.
    How many people would have died from say polio,or small pox,if there had been ill-informed naysayers such as yourself around to introduce unfounded doubts in the minds of people who were deciding whether or not to vaccinate their children. This is not some sort of internet game we are involved in here.This is about the real cost in real human lives and real suffering,and yes…real financial costs too,but above all,it’s about saving lives.
    Think carefully about that,before you talk about things that you have no personal experience in.It makes a world of difference.

  80. weing says:

    “Not that it matters…but for the sake of nitpicking: the 0.007% is arrived at by dividing the total number of HPV related cancers (20,000) by the population (300 million).”

    Looks like you are really following your motto of “Do as I say, not as I do.” Since when is the US population only women?

  81. WilliamLawrenceUtridge says:

    tmac57, I’m sorry something that painful had to be played out as a hypothetical rhetorical chip in a blog post. My sympathy isn’t enough, I offer it anyway.

  82. WilliamLawrenceUtridge says:

    Th1Th2:

    Well because you’re barking up the wrong tree. Have you ever thought that wart formation is caused by exposure to HP viral antigens after minor trauma to the epithelium (i.e. sexual intercourse), right? And that the inoculation with HP viral antigens intramuscularly not only involves minor epithelial trauma that could cause warts from exposure but also other systemic effects?

    Knowledge fail – the vaccine is a hollow viral particle, it can’t reproduce and therefore can’t cause warts. This sort of thing was an actual concern with the more effective but more dangerous live polio (Sabin) vaccine which actually would revert to the harmful wildtype in a very small number of cases. Because this risk was recognized, when polio was no longer a global pandemic and the risk of catching polio was less than the risk of developing it from the live vaccine, they switched to the killed polio (Salk) version. This is an example of how actual experts using empirical rather than rhetorical means will make decisions – actual risk to benefit.

    With killed vaccines like the HPV, barring a failure of the killing process itself they can’t cause an actual infection. A wart from sexual contact is caused by the viral particle penetrating and multiplying within the tissues. Killed viral particles can’t multiply as they have no RNA that can be used to program ribosomes to produce more viral particles. The whole point of vaccination is to prime the immune system by using something similar but less dangerous than the actual infectious agent. Live is better at this, but has risks. Killed is not as good as live, but is generally safer. In either case, immunity is the desired and beneficial result. For those who like metaphors, it is akin to worrying about getting hit by a car that has had the engine removed. If you like extended metaphors, it’s like teaching your child to cross the road by pushing a hollow car shell down the street. In the past Th1Th2 has attempted to turn this into an elaborate and inaccurate rape metaphor which assumes without evidence vaccines are actively harmful.

  83. tmac57 says:

    WLU- Your sympathy is much appreciated.My purpose in telling my story is to put this discussion in a human context.The debate on vaccines tends to become a tit for tat of facts and statistics,and sometimes people forget,or don’t know about how this plays out in real life.I feel like I owe it to my wife’s memory to help others to understand why it is worth trying to avoid what she had to endure.

  84. Janet Camp says:

    @HH (way back in the queue)

    You answered my question in your reply to DugganSC. I changed my screen name to my real name and forgot that I did that when I posted. Sorry for the confusion and thanks for noticing my boo-boo.

  85. Th1Th2 says:

    WLU,

    Knowledge fail – the vaccine is a hollow viral particle, it can’t reproduce and therefore can’t cause warts.

    Haha. Dumb. Infection precedes replication. Since the HPV vaccine is non-replicating, it does cause non-transmissible infection.

    This sort of thing was an actual concern with the more effective but more dangerous live polio (Sabin) vaccine which actually would revert to the harmful wildtype in a very small number of cases.

    You’ve failed again. The OPV does NOT revert to the harmful WILDTYPE. It’s called VDPV, an OPV revertant and is genetically different from WT poliovirus. So thanks for the OPV instead of eradicating the disease, it has created another monster causing another disease (something the IPV is incapable of doing).

    The whole point of vaccination is to prime the immune system by using something similar but less dangerous than the actual infectious agent.

    How ignorant are you not knowing that “priming” is based on primary infection, which is the basis of immunological memory in both natural infection and vaccination. So you will just keep on talking about “priming” but in reality, you don’t know what it means. I see.

  86. weing says:

    You all realize that Th1Th2 has no idea what disease or infection is. Listening to his description is equivalent to listening to a 4 year old describing orgasm.

  87. WilliamLawrenceUtridge says:

    I have to disagree weing. All of Th1Th2′s points are accurate, in the same way that wales points are accurate – semantically and superficially, but not substantively. Despite having the incorrect details, the main point is essentially unaffected. It’s the equivalent to criticizing my spelling then claiming to have refuted my original argument on that basis. Killed-viral particles do “infect” but can’t spread and thus can’t do anything beyond “prime” the immune system to react if exposed to the real thing. Live polio vaccine reverts to a harmful variety but not the same strain and genes as the wild polio virus. Vaccine-derived immunity is based on non-transmissable infection.

    Of course, the killed vaccine still can’t produce warts. The live polio vaccine is still an effective preventive agent for acute polio infection that is no longer used because the risk is greater than the benefit (due to the hugely effective vaccination campaigns that have eliminated endemic polio in much of the world). Vaccination still allows the immune system to learn and react to a relatively harmless antigen in order to prevent much more serious consequences from infection by endemic viruses. Like most antivaccinationists, the purpose is to Gish-gallop, hand-wave and hair split minor points in the hopes nobody notices the major points are unrefuted.

    Detail fail, substance win!

  88. Th1Th2 says:

    Vaccine-derived immunity is based on non-transmissable infection.

    Wrong. Vaccine-derived immunity is always an infection-induced immunity. This is the principle behind acquired active immunity. The infectious agent (from natural infection or vaccines) is acquired (through exposure or inoculation) and the body responds actively against the offending foreign agent regardless whether the infection is capable of transmission or causing symptoms. This first encounter with the pathogen is called primary infection and the resulting immune response is known as primary immune response. So every time you say that vaccines “prime” the immune system is a clear testament that you are indeed an infection promoter.

    “Detail fail. Substance win!”

  89. WilliamLawrenceUtridge says:

    Ah, one thing I forgot to mention about Th1Th2 is that he believes in protecting his precious fluids. Yes, vaccination promotes immune reactions through exposure to relatively harmless antigens. Subsequent exposure to the infectious agent results in “primed” immune system reacting faster and stronger than a naive system. The result is when an individual is exposed to a wildtype infectious agent, it causes minimal to no symptoms, does not harm the body, and if you’re lucky and there are no animal reservoirs, it ultimately goes extinct (see smallpox).

    I’m glad we agree on these points and you have admitted the value to and method by which vaccination works. Congratulations, you now share the same perspective of thousands of brilliant scientists committed to improving the wellbeing of humanity!

  90. Th1Th2 says:

    Ah, one thing I forgot to mention about Th1Th2 is that he believes in protecting his precious fluids.

    Well you have to. You think that’s funny? Your precious bodily fluids are sterile. When was the last time you had a blood draw? Were you aware that the phlebotomist who drew your blood had to protect your sterile blood by applying aseptic technique and collecting the blood specimen only in sterile Vacutainers? How about your precious CSF? Do you know that they are sterile too? Even your muscle tissues are sterile. How come you didn’t know all these?

    Yes, vaccination promotes immune reactions through exposure to relatively harmless antigens.

    Vaccines are antigenic preparation derived only from disease-causing microorganisms hence they are pathogenic. And these vaccine antigens are known to be virulence factors of the pathogen. Also, the immune system does not differentiate between infection caused by natural infection and infection caused by vaccines.

    Subsequent exposure to the infectious agent results in “primed” immune system reacting faster and stronger than a naive system.

    It’s called secondary immune response. Of course, the naive and uninfected were “primed” because they were at an earlier time got infected (primary infection) either by natural infection or vaccines. There’s nothing good about deliberate re-exposure; you’re just promoting the infection all over again and could be worse than primary infection. See atypical measles. But you are infection promoter in the first place so anything bad can happen.

    . The result is when an individual is exposed to a wildtype infectious agent, it causes minimal to no symptoms, does not harm the body, and if you’re lucky and there are no animal reservoirs, it ultimately goes extinct (see smallpox).

    Not every case of primary infection is fatal. See asymptomatic or subclinical infection.

    I’m glad we agree on these points and you have admitted the value to and method by which vaccination works. Congratulations, you now share the same perspective of thousands of brilliant scientists committed to improving the wellbeing of humanity!

    The only thing that we have agreed upon is that you are an infection promoter and vaccines are infection promoting.

  91. lilady says:

    Please do not feed ignorant, delusional, health-care-professional-wannabe, disease-promoting troll. Odious Thingy troll craves attention and engagement and attempts to derail every thread with its brain droppings.

  92. WilliamLawrenceUtridge says:

    Your precious bodily fluids are sterile. When was the last time you had a blood draw? Were you aware that the phlebotomist who drew your blood had to protect your sterile blood by applying aseptic technique and collecting the blood specimen only in sterile Vacutainers? How about your precious CSF? Do you know that they are sterile too? Even your muscle tissues are sterile. How come you didn’t know all these?

    Except for of course, when the skin is punctured by, oh…a sheet of paper, or nail, or gravel, or a stick, or a bite, or spear through the gut, or any other wound. As it often is. Except for when bacteria and viruses penetrate the mucous membranes. Or except when sepsis sets in caused. Or except when you get meningitis from, say a virus or bacteria (such as the ones protected against by meningococcal vaccine). All of which are caused by replicating, not dead bacteria and viruses, which your body can sometimes defend against – much more so if you are exposed initially such as with vaccination.

    Vaccines are antigenic preparation derived only from disease-causing microorganisms hence they are pathogenic. And these vaccine antigens are known to be virulence factors of the pathogen. Also, the immune system does not differentiate between infection caused by natural infection and infection caused by vaccines.

    Exactly, which is why vaccines are so effective – particularly given the treatments viruses and bacteria get in preparation for vaccination. Vis., killed through formaldehyde or heat, or attenuated after being passed through a series of nonhuman entities.

    There’s nothing good about deliberate re-exposure; you’re just promoting the infection all over again and could be worse than primary infection. See atypical measles. But you are infection promoter in the first place so anything bad can happen.

    There’s actually some pretty good benefits from subsequent re-exposure – those who do not acquire immunity from first exposure get it from the booster. Those who get immunity from the first shot get the benefits of second exposure – the response is faster and much, much, much stronger. And when you encounter an actual wild virus, it’s neutralized before it can cause serious health consequences. And like all forms of vaccination, the risk to benefit ratio is heavily studied and the benefits outweigh the risks.

    Not every case of primary infection is fatal. See asymptomatic or subclinical infection.

    Yes, and also see the side effects for polio. Vaccination ensures that the first “infection” (i.e. the vaccine) is essentially harmless. If infections were universally fatal, the disease does not spread or the human race would be extinct. The whole point of vaccination is to ensure when exposed to a wild viral strain, it’s not fatal. Based on the principles I’ve repeatedly explained and you’ve repeatedly selectively quoted.

    The only thing that we have agreed upon is that you are an infection promoter and vaccines are infection promoting.

    All true, but it’s only a bad thing in your bizarre world completely disconnected with the common understanding of the immune system of the world’s biologists, virologists, epidemiologists, doctors, pretty much everyone who isn’t pre-committed to the idea that vaccination is somehow a bad thing. If only you could talk to the parents who have lost children due to smallpox and polio – but you can’t because there’s not really that many left. Because of vaccination.

    Lilady, I do it to for anyone who might be unaware of how vaccination and the immune system works and for whom Th1Th2′s blatantly incorrect summary might be convincing. Th1Th2′s probably never going to change his mind to align with how biologists actually think reality works, but it’s important other people realize he’s a dull pencil.*

    *Two points for Blackadder reference.

  93. lilady says:

    @ WilliamLawrenceUtridge: I used to “engage” Thingy on another blog, because of its unbelievably inaccurate postings. I discussed my experiences during the many years when I worked as a public health nurse in a County Department of Health-Division of Communicable Disease Control.

    During case surveillance activities, I have actually spoken with parents whose children were diagnosed with invasive bacterial meningitis and bacteremia before the availability of vaccines to prevent these devastating illnesses.

    I’ve also described the death from polio of one of my early childhood friends and the life-long neurological deficits experienced by my cousin as a consequence of measles encephalopathy…before vaccines were licensed and available for these vaccine-preventable diseases.

    In an “effort” to determine what Thingy’s education, professional licensing and actual work experiences are in any field of medicine, I “persisted” in posing questions to Thingy. Its reply was “It is none of your business” and “I am involved in the medical field”.

    I still recall Harriet Hall’s patience in dissecting some of Thingy’s more outrageous statements and posing additional questions to Thingy…who categorically refused to answer. Dr. Hall’s conclusion after these exhaustive attempts to elicit responses from Thingy was the analogy “like trying to nail jello to the wall”.

    IMO, Thingy is a “health-care-professional-wannabe troll”, who is germ-phobic and totally unqualified for the most menial of jobs in a health care setting.

  94. weing says:

    lilady,

    Engaging with thingy is like wrestling with a pig. You only get dirty and the pig likes it.

  95. WilliamLawrenceUtridge says:

    I completely agree, which is why instead of trying to figure out what he believes I try to point out the disparity between what he says and, y’know, reality. There’s not much point in trying to figure out what a antivaccination nutter believes, what is important is knowing what actual scientists believe.

  96. Th1Th2 says:

    Except for of course, when the skin is punctured by, oh…a sheet of paper, or nail, or gravel, or a stick, or a bite, or spear through the gut, or any other wound. As it often is.

    Like these are intentional acts for promoting infection and therefore a must? And newborns are oftentimes exposed to these how? I see.

    Except for when bacteria and viruses penetrate the mucous membranes.

    You do know most vaccines penetrate the mucous membranes, don’t you?

    Or except when sepsis sets in caused.

    Like some vaccines cause viremia? (See live vaccines)

    Or except when you get meningitis from, say a virus or bacteria (such as the ones protected against by meningococcal vaccine).

    Like some vaccines cause meningitis? (See MMR vaccine)

    All of which are caused by replicating, not dead bacteria and viruses, which your body can sometimes defend against – much more so if you are exposed initially such as with vaccination.

    Like some non-replicating vaccines can cause encephalopathy, encephalitis and encephalomyelitis? (See DPT vaccine)

    Exactly, which is why vaccines are so effective – particularly given the treatments viruses and bacteria get in preparation for vaccination. Vis., killed through formaldehyde or heat, or attenuated after being passed through a series of nonhuman entities.

    Of course vaccines are effective in causing infection which is why killed vaccines have to be injected. Like I said, infection acquired through vaccination is a must. You don’t have to doubt it.

    There’s actually some pretty good benefits from subsequent re-exposure – those who do not acquire immunity from first exposure get it from the booster. Those who get immunity from the first shot get the benefits of second exposure – the response is faster and much, much, much stronger. And when you encounter an actual wild virus, it’s neutralized before it can cause serious health consequences. And like all forms of vaccination, the risk to benefit ratio is heavily studied and the benefits outweigh the risks.

    And what do you think would happen upon subsequent re-exposure? Do you think the person would feel revitalized and energetic or will he end up in the hospital because of re-infection?

    Yes, and also see the side effects for polio. Vaccination ensures that the first “infection” (i.e. the vaccine) is essentially harmless. If infections were universally fatal, the disease does not spread or the human race would be extinct. The whole point of vaccination is to ensure when exposed to a wild viral strain, it’s not fatal. Based on the principles I’ve repeatedly explained and you’ve repeatedly selectively quoted.

    See killed measles vaccine and atypical measles. Also OPV and VDPV.

    All true, but it’s only a bad thing in your bizarre world completely disconnected with the common understanding of the immune system of the world’s biologists, virologists, epidemiologists, doctors, pretty much everyone who isn’t pre-committed to the idea that vaccination is somehow a bad thing.

    You have admitted that you are an active infection promoter and seriously I don’t see any inherent goodness in it, do you?

    If only you could talk to the parents who have lost children due to smallpox and polio – but you can’t because there’s not really that many left. Because of vaccination.

    1. Smallpox— The USG rescinded the vaccine before the smallpox was “eradicated”.
    2. VDPV —-Still exists because of sole causative agent–the OPV.

  97. Th1Th2 says:

    [...]what is important is knowing what actual scientists believe.

    Edward Jenner was a barber and a chiropodist. Just saying.

  98. Th1Th2 says:

    I used to “engage” Thingy on another blog, because of its unbelievably inaccurate postings.

    How about your inaccurate and laughable diagnosis?

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