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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, October 07, 2005

    The End of Paps? Will pap smears become obsolete? If this vaccine catches on, they might:

    An experimental vaccine against cervical cancer has cleared its final clinical hurdle, showing in a large trial of more than 12,000 women that it is 100 percent effective in blocking the major forms of the disease, its manufacturer said Thursday.

    Merck & Co. Inc. said it will seek Food and Drug Administration approval for the vaccine, called Gardasil, later this year and could begin marketing it in 2006. The vaccine immunizes against the human papilloma virus, or HPV, which is the primary cause of cervical cancer.

    If approved, the vaccine would most likely be administered to children 12 or younger -- before they become sexually active -- including boys, who can be carriers of the virus.

    The vaccine protects against a virus that has infected 20 million Americans and blocks a cancer that kills 3,900 American women each year. There is no treatment for HPV infection.

    Death rates are low in the United States because of widespread Pap screening, but worldwide, cervical cancer is the second-leading cause of cancer death in women, killing an estimated 250,000 each year.

    Will this become the next vaccine to be added to the childhood immunization schedule in the United States? Probably. Will anyone do a cost-effectiveness analysis before it's recommended for every female child? Probably not. We already give universal chickenpox vaccines to prevent about 200 deaths a year. We have an aversion to such stuff.

    UPDATE: Another side of the coin, from a reader:

    The medicine is great, but what about the moral issue? Do we tell kids that with this, and other shots, the risk of disease is lessened so grab a condom and go at it? Pregnant? Have an abortion and we can harvest the fetal cells.

    Teenage births are going down, but we still have a large number of single family homes and as a society we deal with the income, supervision, and other family issues that arise in these situations.

    We think everyone is putting forward a responsible message until your friends 20 year old daughter has to defend her choice not to have sex at a school mandated physical. The doctor suggested counseling since she should be sexually active and would benefit from the experience. The fact that her older sister had an out of wedlock child, and she has felt the repercussions, did not enter into the doctor's thinking.

    That old unintended consequences issue raises it's ugly head again.

    Well, that doctor could use some cultural competency training. (Oh, wait. Cultural competency only counts for different ethnic groups, not different cultural values.)

    All snarkiness aside, the threat of sexually transmitted disease - even fatal, incurable ones - does little to dissuade careless sex. Like smoking and lung disease, there's a disturbing tendency to think it won't happen to you. The power of denial should never be underestimated.

    Nor should the influence of culture on behavior. Giving the anti-HPV vaccine to children isn't going to encourage them to have sex at an early age. Giving them a pack of condoms and a Sex and the City DVD box set will, though.

    posted by Sydney on 10/07/2005 01:17:00 PM 0 comments


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