The Gardasil Non-troversy has been rearing its ugly head in the Republican debates, and it is not helping the Republicans to have this discussion. As the Czar, and GorT put forth, it makes them look like fools, bickering amongst themselves over such silliness. They might as well be discussing the number of angels dancing on the head of a pin, for the good that it will do. Everytime some clizzown moderator brings up the issue, they should make the point that the Obama Administration is a genital wart on the economy and move on.
That being said, Dr. J. is not here to discuss any nitwittery regarding the Gardasil debate, but rather discuss public-health policy with you, Gentle Readers.
Gardasil is a quadrivalent vaccine against human papillomavirus (HPV) types 6, 11, 16, 18. These are associated with a majority of cases of cervical cancer (70%), penile cancer, head and neck cancer and genital warts. It is currently FDA-approved for use in males and females to reduce the risk of cervical cancer and genital warts.
All in all, this is a good vaccine that very effectively reduces the incidence of cervical, vulvar and vaginal cancers, and genital warts. Studies are underway to see if the vaccine reduces the incidence of other diseases associated with these types of HPV. The side-effects are largely benign. Pain at the injection site, flu-like symptoms, passing out after getting the shot, and, rarely, blood clots (1 in 500,000) or death (1 in 1,000,000).
So this raises the question, should your children get this shot?
Dr. J., who was last seen dusting Dr. Oz's cookies with arsenic, says YES. Both his daughter, the lil resident, and his son, the lil med student, will be getting this shot because even if insurance doesn't cover it, the shot is safe, and it works.
Dr. J. has had, during his storied career, the pleasure of biopsing cervical lesions and performing electrocautery resections of cervical tissue. He has even been witness to cone biopsies. It is painful to the young ladies undergoing the procedure, and the latter can affect cervical competence. Advanced cervical cancer is lethal. Genital warts are ugly to look at, fun to the provider to lase off of an anesthetized patient (it's like a videogame) but the lazed tissue hurts until it heals. Dr. J. has cared for a gentleman with penile cancer (no giggling, 'Puter). The penectomy was the least of his problems given the toxicity of chemo and radiation. And IF this vaccine reduces the incidence of head and neck cancers, it will be a blessing as those cancers are deforming and terribly lethal.
Is it cost effective? Robert VerBruggen at NRO did some basic math for us. Assuming a $360 a pop, and the incidence of cervical cancer (0.48% prior to the vaccine), $75K are spent to prevent one case. Reportedly Medicaid pays out $45K to treat the most extreme cases of the disease, which Dr. J. can assure you is underpayment for services rendered as Medicaid is a poor payor. This also does not take into account lost productivity (especially of non-medicaid) recipients and their families, and the pain and suffering caused by treatment of pre-cancerous and cancerous lesions. So one could argue (as 'Puter did at the Leaping Peacock, the other day) that the value of the vaccine goes beyond the dollars and cents.
Speaking of the impact of disease, Volgi's old drinking buddy, Ben Franklin penned this:
“In 1736, I lost one of my sons, a fine boy of four years old, by the smallpox...I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” - Benjamin Franklin
Now this gets to the question of public policy.
Should states mandate vaccination with this vaccine in school-aged children as an issue of public health?
Dr. J. will cop out and suggest that it is a matter of priorities and education of the public.
The reason your lil princes and princesses need to get vaccinated before enrolling in school is because we're sticking a bunch of kids together in an enclosed space where they are exposed to each others boogers and dirty paws (you can giggle now, 'Puter). The vaccines they receive prevent the spread of some nasty illnesses spread in this manner.
Because Dr. J. is on a roll, he will run the list.
Measles and mumps are booger-borne illnesses that are very contagous, usually benign, but both have lethal potential; measles can cause retardation, and mumps can cause sterility in young men. Rubella is not a big deal, unless you are pregnant, in which case it can seriously mess up your baby (deaf, blind, and mentally retarded), so knocking it out is a good idea.
Crutches, wheelchairs, and iron lungs. Your mom or grandmom can tell you how scary that one is. Nuff said.
Tetanus, kids step on rusty nails all...the...time...diphtheria and pertussus, spread by boogers (Whooping Cough) have lethal potential and the vaccines work.
HiB (Hemophilus influenza B) - Not the flu, but a bacteria that causes a flu-like illness and epiglottitis (which is nasty) and meningitis. Booger-borne and very rare in the post-vaccine era.
Pneumovax - Decreases incidence of pneumonia (though my kids both got a pneumonia) but the big thing, again, is that it prevents meningitis from this bug.
Chicken Pox - While it can kill, really, the state is doing you a favor. Taking 2 weeks off with your kid, if you work sucks. There goes your vacation time...
Hepatitis B - effective vaccine, big downside to catching the illness, but it's hard to catch without doing something stupid (sexual contact or shared needles) or getting a transfusion. Teenagers do stupid things. Soft call, but folks don't make a stink about it.
Those are the big vaccines required for school. They all make sense from a public-health standpoint. They are safe and confer long-term immunity (yeah yeah, boosters, but we have a schedule). Ones that you don't get (Hepatitis A, Meningococcus) are because they don't last very long and only really work during an epidemic or walking into an endemic area.
Dr. J. supposes that Gardasil falls into the category of HepB, so he has no objections to a state adding it to their required roster, and he feels that parents shouldn't as well, unless they were bitchin' about HepB as well.
Now as a matter of public health, Dr. J's health insurance covers it for his kiddos, so their actuaries buy into the hype. Given that, Dr. J. suspects that children on Medicaid are at higher risk than his kids, it probably falls into the purview of the state to cover the cost for the least among us.
Should it be mandated for kids (to show up for school), Dr. J. would say, not in the same way that the other vaccines (other than Hep B) are mandated, because the route of infection is less likely to occur at school and more likely to occur in the back of an '86 Oldsmobile...