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October 07, 2005

Comments

NancyP

Penile cancer, though rare, is related to HPV 16/18, as is anal cancer. Anal cancer is generally rare in HIV negative men but more common in HIV positive men (and common in both HIV negative and positive women).

Hugo

Thanks, Nancy. I just checked the coverage of this story in several other sources from around the world (Reuters, etc.) and all of them mention that boys would be given Gardasil not to prevent their own cancer but to prevent them from spreading HPV to women.

Amanda Marcotte

I do believe that HPV causes genital warts in men sometimes. But medically speaking, those aren't anywhere close to the same cause for concern as cervical cancer.

Lynn Gazis-Sax

Actually, all vaccines are given in part to increase the general herd immunity, and not solely to benefit the recipient. The reason you need to build herd immunity is, first, that no vaccine is %100 effective, and second, that for every vaccine, there will be a few people for whom it is just plain contraindicated for some medical reason. But if all of us get our vaccines for whooping cough or measles, those for whom the vaccine doesn't work or who can't have it gain from the immunity of the general population.

It's true that usually people are given vaccines mainly for their own benefit, rather than mainly because they might infect others, but there are a couple of cases already where vaccines are given mainly to prevent people from infecting others. The first is the rubella vaccine, which (in the form of a combination vaccine which also includes measles and mumps) is given to all children, although the main harm of rubella is to pregnant women. The second one I can think of is that the flu vaccine is recommended (at least in those years where we don't have a vaccine shortage) not only to the elderly and those with chronic conditions that put them at particular risk, but also to people who will be in close contact with such people.

Finally, I'll note that the hepatitis B vaccine, which is routinely given to newborns, raised similar issues to the HPV vaccine, when it was introduce to the schedule, because hepatitis B is often sexually transmitted. Of course, there's an obvious difference in that hepatitis B, unlike HPV, poses a fairly equal risk to men and women.

And, for what it's worth, I know all these things because I keep a FAQ on childhood vaccinations (which I had better get around to updating, since there have been a few changes since I last worked on it).

Hugo

Thank you, Lynn. If parents are willing to immunize for Hep B, one would expect them to be equally willing to go with Gardasil. I'm struck, however, that Gardasil is to be given to preteens (if I understand the articles) while most of the other vaccinations are given much earlier.

Ahistoricality

Flu vaccination focus is shifting from "vulnerable" to "transmitter": Japan, which vaccinates very few of its elderly, has almost no elderly flu deaths each year because it vaccinates health care workers, teachers and schoolchildren first. This interrupts the spread of the virus very effectively. I think NPR did a report on this idea a few days back, too, if you want to go looking for more detail.

The "Free Rider" issue is an ongoing one with children's vaccinations: people who don't believe in vaccination (or who don't have access for some reason) get a 'free ride' because the vast majority of the population has vaccinated. The problem is that a high enough percentage of free riders can create a situation in which an epidemic can still perpetuate itself. Plus the free riders are vulnerable, which creates social costs....

NancyP

I don't have the stats offhand, but the incidence of penile invasive squamous cancer is probably about 0.1-0.2% that of invasive cervical cancer in the US. However, both are STDs involving HPV. The difference is that penile mucosa is less vulnerable, probably due to developmental considerations. Penile squamous mucosa does not derive from pre-existing glandular mucosa, whereas cervical squamous mucosa does derive from glandular mucosa. Furthermore, there seems to be sex/ sex-hormone-related differences in susceptibility of squamous mucosa that always was squamous mucosa, ie, anal verge in both sexes, labia in women. Pre-cancer (high-grade dysplasia)is commoner in women than in non-immunosuppressed gay men (both groups get pre-cancer fairly commonly).

nik

I think you're skirting around some serious moral issues.

If an adult wants to be vaccinated to protect someone else then that's very noble and he should be congratulated. But (some people) are talking about vaccinating boys who are too young to give informed consent. The vaccine has not been demonstrated to protect men against any disease.

You're exposing boys to the risks of side effects and adverse reactions in order to protect other people from infection, and you're consenting to this on their behalf. If they're damaged - for no possible benefit to themselves - then I think they've got a legitimate complaint. There are ethical reasons for being wary about providing interventions which are not beneficial to the recipient, but may harm them, without their consent.

This isn't comparable to a male birth control pill which people take after consenting to, and benefits the recipient by letting them control their fertility.

zuzu

You're exposing boys to the risks of side effects and adverse reactions in order to protect other people from infection, and you're consenting to this on their behalf.

How is this any different from giving babies MMR vaccines?

NYMOM

"Obviously, boys don't get cervical cancer, and other cancers in men are not linked to the HPV virus. Thus the only reason to give the vaccine to boys would, I presume, be to prevent them from infecting a future female sexual partner. (Those who understand the medical dimensions of this issue better than I, please correct me if I'm wrong!) We don't generally prescribe a drug for one class of people to prevent something from happening to another class; I can't think of any similar vaccine."

NYMOM said: But a similar situation can exist: like forcing isolation an an infected individual who can make others sick; even if they are just carriers and no harm to themselves.

Like Typhoid Mary, for instance. A woman who was a carrier of typhoid even though she herself didn't suffer any symptoms of it. She worked as a cook and infected hundreds of people with typhoid before they traced it to her...

This vaccine is the same sort of situation.


"You're exposing boys to the risks of side effects and adverse reactions in order to protect other people from infection, and you're consenting to this on their behalf."

NYMOM said: Well we can do it the other way. Test boys for this and inform them when they are ready to have sex they are responsible to get the vaccine OR they'll be charged with a crime if they get somebody sick.

The way we do now for people who are informed they have AIDS and go around having unprotected sex...

evil_fizz

One point that has only been touched on here is that HPV doesn't just affect women. It also has significant health implications for gays. HPV is staggeringly common among gay men (one study examining gay men in San Franciso found that 95% of study participants had it). I think that making sure than boys and men are well informed about HPV is essential regardless of the gender of their future potential partners. It's not just a feminist issue, but a public health issue.

mythago

one study examining gay men in San Franciso found that 95% of study participants had it

I would be extremely interested in seeing such a study.

Another part of the reason that we immunize babies against Hepatitis B is that it is largely a sexually-transmitted disease. Which means that people will not get the vaccine for themselves or their older children later, because people tend to be in denial about STDs--and so it's just plain better for public health to immunize children along with all the other childhood vaccines.

Amanda Marcotte

Hells yeah I knew an MRA would try to argue that this vaccine is invading on every man's right to decide for himself if he wants to give his woman cancer. Sweeeeeeeet.

jaketk

i don't see how this teaches any real responsibility to boys at all. what it does is force boys to take the blame for something that they haven't even done, potentially damage their health (the drug has been tested on women, but the article made no reference to the affects of the drug on the male reproductive system, not that violating a boy's in that way is wrong, to say to them, at 12 years old, that they are responsible for women's health, i.e. women's health is more important than their own, and most importantly, neither women nor girls bear any of the same responsibilites to boys' health. that's a very horrible message to send, and i would certainly not want anyone telling that to my 13 year old cousin.

jaketk

Hells yeah I knew an MRA would try to argue that this vaccine is invading on every man's right to decide for himself if he wants to give his woman cancer. Sweeeeeeeet.

just as you would argue that vaccinating women to prevent testicular cancer would be invading on every woman's right to decide for herself if she wants to give her man cancer.

djw

jaketk: Reading peoples minds=less than first rate debating technique.

jaketk

i have read several of amanda's less than positive remarks on men, some of them particularly hateful. so i am merely making a logical leap based on her previous comments. of course, it is rather interesting that you consider the act less than first rate when i do it, but amanda's use of it is perfectly fine.

evil_fizz

one study examining gay men in San Franciso found that 95% of study participants had it

I would be extremely interested in seeing such a study.

The article I was referring to can be found here but a mea culpa is in order. I made a mistake when referring to the original article. The study participants were HIV-positive gay men. (Thanks for getting me to double check!)

Also, I don't think that giving the vaccine to men in any way force them to "take the blame". Men can transmit the virus to women, to whom it presents a much more serious threat. By eliminating the virus or drastically reducing its incidence through vaccination, we're addressing a public health concern. There's no blame in it, just an effort to make sure that everyone (men and women) stay as healthy as possible.

I find it unlikely that the vaccine will have adverse affects on the male reproductive system. I would also be a bit more sympathetic to this argument if the reverse weren't constantly true. The overwhelming majority of clinical trials are conducted without any investigation into effects on women's reproductive health. It's something that the pharmaceutical industry does constantly.

jaketk

what drugs are administered to women to prevent or reduce the occurence of a disease that affects mostly men that has not been tested to see what the affects are on women?

hugo states quite clearly that boys, but not girls, should be concerned about their future partners' health, and that "at, say, twelve, they could get an invaluable lesson about accountability and responsibility." perhaps i have an antiquated understanding of these words, but this implies it is boys' fault.

i do not think we should give children drugs that a) have not been tested on their age group, b) have not been tested on the opposite gender, to whom it will be administered, and c) have not been tested to see what effects the drug will have on a growing child's reproductive system.

David Thompson

"And of course, there's the obvious question: how many women would trust their husbands or boyfriends to remember to take the pill?"

To hazard a guess, about the same as the number of men who would trust their wives or girlfriends to remember to take the pill.

nik

Zuzu asked: "How is [giving boys HPV vaccine] any different from giving babies MMR vaccines?"

I think there are two main reasons:

(1) The MMR vaccine prevents three diseases. In the case of rubella the protection is against a mild disease, but still a disease. HPV vaccine hasn't been demonstrated to protect boys against any disease - so, unlike with the MMR vaccine, they gain no benefit from the intervention.

(2) Measles, mumps, and rubella are all very infectious and immediate threats - if we waited until a baby was old enough to give consent before we gave the vaccine, they'd have already caught the disease. HPV infection isn't an immediate threat in the same sense, we can delay vaccination until later so the person can make their own decision.

NYMOM commented: "But a similar situation can exist: like forcing isolation an an infected individual who can make others sick; even if they are just carriers and no harm to themselves... This vaccine is the same sort of situation [to detaining typhoid carriers]."

There are important differences.

(1) The boys given the vaccine aren't carrying anything.

(2) People can catch diseases like typhoid and TB from very indirect contact, which they have no say in bringing about. HPV is much, much more difficult to contract.

Hells yeah I knew an MRA would try to argue that this vaccine is invading on every man's right to decide for himself if he wants to give his woman cancer. Sweeeeeeeet.

A woman's perfectly entitled to decide to get vaccinated and to decide who she wants to have sex with. I've no problem with men deciding to get vaccinated; but giving it to children who can't consent to the procedure and don't benefit from it is problematic. I'm not an MRA, this is just basic medical ethics.

bmmg39

"jaketk: Reading peoples minds=less than first rate debating technique."

...except that's not what he did. Amanda misrepresented someone else's post, and Jake switched the genders to show how ridiculous that was.

bg

NYMOM

"jaketk: Reading peoples minds=less than first rate debating technique."

...except that's not what he did. Amanda misrepresented someone else's post, and Jake switched the genders to show how ridiculous that was.

bg"

But I believe djw was doing the same thing jaketk claims he does. Which is infer from past posts what someone is likely to say in the future and then beat them to the punch BEFORE they get the chance to say it...

See below...

Jaketk said: "i have read several of amanda's less than positive remarks on men, some of them particularly hateful. so i am merely making a logical leap based on her previous comments."

Jaketk does that to me very frequently as well that's why I know his "logical leap technique"...

Thus btw's comment to him was very fair.


Richard

Amanda Marcotte says:


although the main harm of rubella is to pregnant women

AFAIK, the main harm of rubella is to the fetus a pregnant woman is carrying.

While it does not matter as far as the argument for giving the MMR vaccine, I think that accuracy is important. I am happy to be disabused of the above notion if it proves not to be correct.

Amanda Marcotte

If women gave men a disease that gave them cancer and there was a vaccination, I would support that vaccination. Duh.

But forget it, you guys are going to begrudge women any small break we get in life. Why not argue that it hurts men to give girls this vaccination while you're at it? After all, women not getting cancer has to hurt men somehow, doesn't it? Think harder, guys--there has to be a reason that women need to be getting HPV.

Anyway, you should support boys getting vaccinated because you never know, not getting the shot might make those who don't sexual pariahs because they are considered diseased.

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