Monday, February 05, 2007

Leaning in a new direction

In case it wasn't obvious in the last posts I've written about it, my first reaction to the news that the HPV vaccine is going on a roster of required vaccinations for school in Texas was, "Heck yes!" Cervical cancer kills, genital warts are a drag, and yearly pap smears are no party either. I'm not a doctor or a public health expert, but the information about Gardasil's efficacy and safety make it look like a pretty good bet for eradicating most cases of cervical cancer.

Still, I've come to the conclusion that I don't think it's wise to require vaccination against HPV in schoolchildren at this point. Loquacious commenter stickdog - who has an axe to grind, but I was wrong to call a troll - has given every possible reason to oppose widespread HPV vaccination, and while I'm not buying all of it, my change in position has definitely been guided by the info stickdog has brought.

I really, really want Gardasil to work, and nothing that I've learned about its approval process has set off alarm bells in my head. But the fact remains that there isn't a huge body of evidence supporting Gardasil's long-term efficacy and safety, and the health problems associated with HPV don't seem pressing enough that we ought to embrace Gardasil so enthusiastically. The current system of keeping a close watch on American cervices has failed many, but in my view, not so many that we couldn't take our time in evaluating Gardasil. Think of it this way: if we're going to be instituting a large and expensive public health program aimed at preventing cervical cancer, we might as well devote the money to access to the medical care that already works pretty well (say, refunding this program) as we wait to get a better picture of what Gardasil has the capacity to do.

I predict that Gardasil will be a valuable tool in eradicating cervical cancer in America. On the other hand, responsibly prioritizing public health spending means that if we're going to make an investment in a new tactic, we ought to be as sure that it will work as we can afford to be. If Gardasil is used on a country-wide scale and it flops, we'll be stuck with not only a huge bill and an unimproved HPV rate, but we'll have also spent money that could have been used to address other public health concerns. Considering the relatively low urgency of the problem that HPV presents for Americans overall, I think it would be smarter to wait for more information to roll in as people voluntarily vaccinate.
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