Is this a responsible decision by our public health decision makers, or just the result of good campaigning and the efforts of public relations experts hired by Merck to sell as much as possible of this product in the interest of shareholder dividends?
The injection probably won't cause any harm - and intuitively makes sense - but it must be kept in mind that immunization to Human Papilloma Virus numbers 6, 11, 16 and 18 has never been shown yet to decrease the incidence of cervical cancer.
The fact is that we don't know as much about various infections as we think we know. For example, bacteria cause a great deal of intestinal infections...but we now know that killing all the bacteria in the intestine is a very bad idea that can lead to horrific diarrhea and a potentially deadly condition called "toxic megacolon". Another observation has been made in Germany, showing that our lack of intestinal parasites may be a cause of horrific diseases like crohn's disease. We got rid of almost all known intestinal parasites in the modern world....but - as sufferers of Crohn's disease will tell you - this may have been a bad idea!
So, will immunizing our grade 5 girls now make them actually at risk for the development of even worse gynecological conditions in the future? We just don't know! So until this is proven, why the heck are we paying millions to immunize our young girls? If you are a Merck stock shareholder - the most profitable answer is a resounding "WHO CARES? JUST SELL IT!!!!!!"
I suppose that on the other hand - it can be weakly argued that doing nothing can result in millions of girls developing cervical cancer that could have been prevented by Gardasil.
This probably isn't true. Millions of cases of Cervical Cancer simply don't happen. In fact; because of screening programs like the annual PAP smear, Cervical Cancer is surprisingly rare in Alberta. Although my practice population consists of the relatively socioeconomically advantaged, I have not seen a single case of Cervical Cancer in 10 years of practice! I have seen a lot of cases of "pre-cancer" - but these were all 100% successfully treated with colposcopy.
In my opinion best prevention of cervical cancer is (in addition to PAP testing)......you guessed it: GOOD PARENTING!!!!! Having said that - while I had good parenting...I was a bit of a handful! Perhaps I am to experience a bit or irony in my never-ending attempts at parenting!
The risk factors of cervical cancer that have been shown to be effective if managed are the following:
Sex at an early age
Multiple Sexual Partners
High risk Sexual Partners
Kids whose moms took DES (diethylstilbestrol) during pregnancy in the 1970's to prevent miscarriage.
Long term use of Oral contraceptives
Infections with chlamydia or genital herpes
Poor socioeconomic status
Exposure to cigarette smoke.
But people (especially policy makers) are often sheep-like in their decision making...and we are now going to immunize young Alberta girls with Gardasil.....I personally would like to see more data on how well Gardasil prevents Cervical Cancer....which I am sure will be eventually forthcoming.....won't it?
Will there be any incentive for Merck to do so after the immunization become generic and all invested dollars are considered to be remunerated at the targeted profit margin? I wouldn't blame them for "moving on", as it were, to....say....immunization of teenaged boys against stupid risk-taking behavior....
Any parent that will eventually have a child that gets cervical cancer would certainly be in favor of spending millions to prevent even one case...and I'd be right there behind them.
While their decisions for/against immunization campaigns are necessitated by our limited public health funding, I don't envy the task of public health policy makers! Obviously - given the recent news in Alberta of the top end Public Health Physicians resigning from Alberta Health - the people that actually know about this stuff should be cultivated as valuable public resources by government - not let go of by some near-sighted administrative dinosaur.....
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