and Members of the Virginia Legislature Health Committee,
In response to the recent marketing blitz by Merck to sell their new HPV vaccine, there has been a lot to talk and news about various state legislatures considering passage of bills to MANDATE giving Merck's new HPV vaccine Gardisil to all young girls as a requirement for school entrance. If someone in Virginia tries to write such a bill, please understand why this would be an awful idea.
1. Since the widespread use of pap smears over the last 50-80 years, cervical cancer has been pretty much eliminated as a significant cause of death in the US. Only about 4,000 women in the US die each year from cervical cancer. And if one looks at those women who do die from cervical cancer, the large majority have not had pap smears for several, sometimes many years prior to their diagnosis. Women who get their annual pap smears almost NEVER get cervical cancer. In the past 20 years the only 2 cases I've seen of cervical cancer were in women who had skipped pap's for 5 and 10 years. One said "I'm not that sexually active so I thought I didn't need to get pap smears." Great logic.
So pap smears have already cured the cervical cancer "epidemic", in patients who actually get them done. Do we really need a way more expensive cure for something that is already pretty well controlled?
2. If one wishes to decrease death from cervical cancer even further, what you have to do is go find the women who are skipping their pap smears. Problem is that one of the main reasons that women do not get pap smears is economics, of course, or other extenuating circumstances like lack of child care, etc.
3. Cervical cancer is indeed an STD, caused by various strains of Human Papilloma Virus.
4. There are about 200 known strains of HPV out there currently and HPV has been around since the Bible.
5. Merck's vaccine only protects you against I think 4 of those strains. And those 4 strains only account for 70% of cervical cancers. The other 30% are caused by other strains that the vaccine does not protect you against. Further, you can still contract and spread the covered viruses, the vaccine just helps you clear it faster so it's less likely to cause changes in the cervix. So this vaccine will not eradicate the virus. Further, since it is only partially effective, you still have to do regular pap smears to screen for the viruses that the vaccine does not cover.
6. Currently vaccines are only being recommended for girls. Why not boys too? I don?t' think HPV is getting spread by toilet seats! This is very sexist indeed. ("Let's test it on lots of young girls for a few years and then if it doesn't hurt them too much, we can give it to our precious boys.")
DOWN SIDES OF MERCK'S VACCINE:
1. It's only been studied for 4 years. We have no idea if there will be any serious side effects that show up years later. You are probably aware that many believe there is a link between the MMR vaccine and autism. No proof of course, but significant suspicion.
2. Merck does not know how long the vaccine will give protection.
3. It requires a series of 3 shots, sometimes causing fever and malaise with temps up to 101.
4. The series of shots costs $360 just for the vaccine, not including cost of giving the shots.
5. This vaccine has not been shown to save lives, and it likely will not save ANY of the lives that are currently lost to cervical cancer, since women who don't get pap smears are probably not going to shell out $700 for a series of 3 shots, and then still get annual paps anyway. In contrast, by making this process so much more costly (by adding the cost of this expensive vaccine to the cost of annual screening), it is likely the this vaccine will even result in more cervical cancer, since the cost of doing all this will be prohibitive. There will be less money available for routine women's health care if we begin dumping all this money into Merck's pocket for this vaccine that we don't need. Just think of the windfall! I can see the Merck CEO salivating now!!!
6. Who is supposed to pay for all these unnecessary vaccines? Taxpayers? I hope not. I certainly don't want to pay for any vaccine if there is no evidence that it will actually prevent death or even improve quality of life for anyone other than Merck employees and stockholders. All this vaccine will do is make Merck even more wealthy and powerful than it already is and suck even more money away from the routine women's health care that has been proven over the years to be useful.
Therefore, please do not let the Virginia legislature mandate this vaccine for our girls. I certainly don't want to test this vaccine out on my daughter. And I guarantee you she will never get cervical cancer, though at some point she will likely encounter HPV (Many years from now of course!!!) Pap smears are entirely adequate to protect her and all other girls from cervical cancer. All we have to do to prevent cervical cancer is just make sure everyone gets pap smears. If the legislature wants to do anything at all to reduce cervical cancer death, I suggest increasing public funding for pap smears and required follow-up of abnormal paps for the indigent.
Thanks for taking the time to read this. If you have any questions, please give me a call or fax.
Donna Hurlock, MD
Gynecologist, Alexandria, VA