Healthy Skepticism Library item: 11407

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cassels A.
Lock up your daughters Gardasil is on the loose
Common Ground 2007 Sep
http://commonground.ca/iss/0709194/cg194_cassels.shtml

Full text:

It’s September and as our kids shuffle out the door to face the teachers, the books and the peer pressure, we parents have another thing to worry about: An aggressive public health campaign gearing up to bully us parents into getting our girls to roll up their sleeves for a good dose of prevention.

This month, in grade six classes throughout the Atlantic Provinces and in Ontario, school nurses will be targeting the girls, armed with a syringe loaded with Gardasil, a vaccine to prevent human papillomavirus virus (HPV), a virus which could lead to cervical cancer. Here in BC, parents may be given a bit of a reprieve; at press time, the BC Ministry of Health was unsure whether or not it would have a public HPV vaccine program in place this fall. But they will for sure next year.
You have to hand it to the scientists who developed a vaccine that has been proven effective at preventing four strains of a virus that women get from sexual activity and which can turn into a deadly form of cancer. It would seem quite reasonable, and even public-spirited, that we’d encourage our girls to be vaccinated; as many as 400 women die every year in Canada from cervical cancer, which it is hoped the vaccine will avoid.

Because the vaccine is only effective before a girl has been exposed to the HPV virus, the vaccine programs must target the young. Now, if you’re like me and you’ve got a daughter about to enter grade six (the vaccine’s meant for girls in grades six to nine), you’ll soon be asked to decide whether your child will get the three recommended shots, at a cost to the public system of about $400.

Despite the promise of the vaccine, however, its introduction has been a lesson in crass political gamesmanship and shameless disease mongering. First, in Texas earlier this year, Republican governor Rick Perry bypassed the Legislature in signing an order mandating that all schoolgirls be vaccinated with Gardasil. This created a huge backlash in the US when it was discovered that the governor has ties to Merck, the vaccine’s manufacturer.

Things have smelled equally stinky on our side of the border. The discovery that Merck lobbyists with connections to both the prime minister and the Ontario health minister were working the levers behind the scenes to get the vaccine paid for created an unmistakable stench of sleaze that has lingered over the whole affair.

During his budget speech in March, Federal Finance Minister Jim Flaherty did an end-run around the provinces and others working in public health with a surprise announcement of $300 million in new money to fund HPV vaccine programs across the country. The Society of Obstetricians and Gynaecologists of Canada, prominent cheerleaders for the vaccine, praised the government’s announcement, no doubt also buoyed by the $1.5 million grant it received from Merck. For educational purposes, of course.

What’s most important to me is not the paid-for marketers pushing the vaccine, but the many questions about the vaccine that are left unanswered: For example, do we know how many young girls used the vaccine in the clinical trials? Do we know how safe is it? Can we be certain how much immunity it will actually provide in the long term to those girls who will have to undergo the three-shot course? And, in the real world, will a vaccine program produce some adverse effects itself – perhaps a false sense of security around preventatives for cervical cancer, so that women start to forgo the one method we have to detect and prevent it: the annual pap smear?

Unlike many childhood diseases for which important vaccines have proven their worth, cervical cancer develops over decades – and like a cold virus, most HPV infections go away on their own. What we don’t know is whether Gardasil even does what the promoters claim: Prevent women from dying of cervical cancer.

Gardasil may help women develop immunity from some major strains of virus that cause cervical cancer, but there are also uncomfortable questions about the vaccine’s safety. As of May of this year, more than 2,000 adverse Gardasil-related events were filed with the US FDA, including 239 cases of syncope (fainting and temporary loss of consciousness) and seven deaths. Whether or not these incidents were caused by the vaccine remains open to study, but suffice to say that any treatment has the potential for adverse effects, ranging from the merely unpleasant to the deadly.
In cases like this, where there is so much medical uncertainty, what do we do? We turn to medical experts and trusted public officials who we feel can be relied upon to give us the straight goods. Sadly, the public is not being well-served on this front either. In fact, what’s most striking about this issue is the crass vaccine-mongering coming from public health officials who seem bent on pushing the vaccine as if there were an imminent epidemic.

As a case in point, Canada’s Public Health Officer David Butler-Jones, in a letter to the Globe, disparaged an article that examined the vaccine’s controversies, saying we should congratulate, rather than criticize, governments for embracing a vaccine program for cervical cancer.
Unfortunately, he doesn’t tell us his take on the controversies over the vaccine’s usefulness and its safety or effectiveness. Instead, he asks us to trust that, given that the vaccine is recommended by the National Advisory Committee on Immunization, the Society of Obstetricians and Gynecologists and a number of chief medical officers and national health authorities around the world, it must be a good thing.

In logic, we call this the fallacy argumentum ad verecundiam (argument from authority) and it implies that a claim is true because of the overwhelming credibility of the source. In other words, “Trust us, we’re experts.” Wait a minute. Didn’t very smart, credible, well-meaning experts also approve and recommend Vioxx, Prepulsid and Rezulin, among other pharmaceuticals recently removed from the market because of mounting death tolls?

Butler-Jones also employs another logical fallacy, the argumentum ad populum (also known as the bandwagon fallacy) when he says that many thousands of Canadians have already had their daughters vaccinated, implying that this is a train that has already left the station and that you should have got on board. But what if that train is headed for a brick wall?

Wonky logic aside, there’s a bigger problem here. With the recommended list of childhood vaccines having grown to almost 20 (from about eight only a few years ago), even public health officials are finding it difficult to convince parents that these newer childhood vaccines are necessary. Have they had to resort to bad logic and browbeating parents? I hope not.

Public health officials and marketers are not the only ones with a difficult task. Scientists shaping cancer vaccines face the challenging fact that cancer often develops over many years, even decades, and may be due to a mix of genetic and environmental causes. Is it truly possible to develop immunity from a disease that may take two or three decades to grow? And what if the vaccines cause other problems throughout those decades, such as increasing our risk of heart disease? Do we end up inoculating millions of people at a cost of tens of millions of dollars to do little but trade the risk of one kind of death for the risk of another kind of death? What if the vaccines don’t work as promised or displace other programs that do work? What if they cause additional harm to the population?

These are important questions. I know that our public health authorities mean well, but ducking important questions and bashing the critics is counter productive. There is no epidemic of cervical cancer and we can afford to wait and see if the vaccine proves its worth. In the meantime, schools should be investing in good health and sex education programs that lower the risks of exposure to the virus and promoting the use of regular pap smears to women who are currently forgoing such screening.

Wouldn’t it be nice if we had vaccines that took away the risks of all the cancers that now plague humanity? Believe me, the scientific world is working on them and you can expect this to be the first of dozens of cancer vaccines coming onto the market in the next few years.

The way the Gardasil file is being handled may actually fuel more public anger and distrust in health officials. If this kind of vaccine-mongering gets further out of control, it may very well add to the growing resistance against the important, basic childhood vaccines now recommended by pediatricians and government officials. And the long-term consequences of that could be disastrous.

Alan Cassels is a drug policy researcher at the University of Victoria and co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. His new book, The ABC’s of Disease Mongering: A Guide to Drugs and Disorders, will launch in October.