Cervical cancer vaccine

secrecy_ie

Hi All

I set up a petition regarding the cervical cancer vaccine that was abolished by Minister Mary Harney last week.

Please take a moment to sign this petition if you think its important that young girls between the ages of 10-12 receive this vaccine that will prevent them from getting cervical cancer when they're older:


http://www.PetitionOnline.com/ccs2008/

Amnesiac_ie

Harney's decision to scrap the HPV vaccination programme utterly disgusts me. In this bloated and inefficient health service she so proudly rules over there are several, several areas where improving efficiency could lead to cost savings. Yet once again the so called progressive democrat panders to the layers and layers of incompetent public sector management and tries to cut costs at the front line. First of all she tried to wrestle universal access to primary care from over 70s. Now she has scuppered a real chance to rid the country of cervical cancer; a disease which claims the lives of 120 young women and mothers in this country each year.

My anger with this woman and this government grows each and every day. And the alternative is d'Enda.

I really feel I should emigrate.

norrie rugger

shur everyone knows that treatment is better than prevention!

Do cork and kerry kids get the tb vaccine yet?

RobFowl

I hate to say this but this issue is not as straightforward as it is being made out. There is no proof yet that this vaccine will have any effect on the rate of cervical cancer. It probably will but there is a very small risk it will actually increase the risk. Put simply we will not know how well or what if any effect it will have on cervical cancer for at least 10-20 years.
If you want to get some scientific opinion have a look at this editorial from the New England journal of medicine ( a very prestigious and highly regarded medical journal)
http://content.nejm.org/cgi/content/full/359/8/861
Some times waiting and seeing and not rushing ahead and committing to start a new vaccine is the better option

tallaght01

It's an interesting editorial, robfowl. I had just read it, and logged on to post that same link to stimulate some discussion!!!

norrie rugger

The New England Journal of Medicine: Human Papillomavirus Vaccination &#8212 wrote: »

If HPV-16 and HPV-18 are effectively suppressed, will there be selective pressure on the remaining strains of HPV? Other strains may emerge as significant oncogenic serotypes.

Resolving the first essential questions will require decades of observation of large numbers of women. The last question may be answered sooner. Published reports of trials show an increasing trend of precancerous cervical lesions caused by HPV serotypes other than HPV-16 and HPV-18.2,4,6 The results were not statistically significant, however, possibly because there were too few clinically relevant end points in the observation periods reported.

I am really uncomfortable with this statement
Please correct me if I am wrong but it seems to equate to "what's the point in using this vaccine as something as bad could develop, in the vaccum it leaves"

Agin she relies on (admittedly statistically insignificant) test results

"Resolving the first essential questions will require decades of observation of large numbers of women. The last question may be answered sooner. Published reports of trials show an increasing trend of precancerous cervical lesions caused by HPV serotypes other than HPV-16 and HPV-18.2,4,6 The results were not statistically significant, however, possibly because there were too few clinically relevant end points in the observation periods reported. If randomized, controlled trials involving vaccinated and unvaccinated women continue for a few more years, we will most likely be able to tell whether this is a true trend. If so, there is reason for serious concern. "

While I admit that this is something that does need to be followed up on, she can not use it as a point against vaccination at present IMO

The author also seems to take a lot of "possibilities" into consideration. Nothing wrong with that but I feel that she gives too much weight to these possibilities in her argument.

"the sexual behavior of the girls and women and their partners, and finally, women's cervical-cancer screening practices."

These are unquantifiable and can not be relied in an argument.


She also mentions "natural immunity"

"Since most HPV infections are easily cleared by the immune system, how will vaccination affect natural immunity against HPV, and with what implications?"

"the effect of the vaccine on the natural immunity against HPV infections,"

There is evidence emerging that not everyone can clear the virus with ease. There are reoccurances of the virus years of the initial outbreak in certain individuals, long after an expected immune response should supress.

Also I am loath to take cost-effectiveness into an argument like this, how much is 1 person worth? An unanswerable question IMHO

norrie rugger

If the trials being performed, on males, show that it is effective, should the vaccine be administered to the male population also?


Also, what are the HPV types that are now being linked to penile and oral cancers?

RobFowl

norrie rugger wrote: »

If the trials being performed, on males, show that it is effective, should the vaccine be administered to the male population also?


Also, what are the HPV types that are now being linked to penile and oral cancers?

There are no ongoing trial in boys/men that I could find. The licensed use is for girl/women only.
HPV types 16 & 18 are the ones linked to oral and penile cancer

RobFowl

I take the point that alot of the concerns expressed in the NEJM editorial are speculative.
The problem I'm having at the moment is the almost hysterical outcry for the vaccine program to be implemented.
The facts as I see them are that the vaccines offer protection against either type 16 & 18 or 6,11,16 & 18 depending on the manfacturer.
The only research published so far is limited to a 3 years follow up. No proven decrease in cancer has yet been shown although an 18% decrease in high grade (roughly equivilent to CIN III) in vaccinated vs non vaccinated subjects.
There can be a 10 years or longer gap following HPV exposure and development of cancer. So we will not know if it works until 10 years at least.
In an Irish context it will probably cost 10 million a year.
So if we start now we will probably have the first definitive data on its effectiveness in 7-10 years.
I take Norrie Ruggers point that cost effectiveness is a nasty concept but we could be committing to spend 100 million on something which mat not have any long term effect.
I'm on the fence as far as whether it should go ahead but I'm getting very frustrated with the DOH being accused of killing 12 year old girls by delaying the start date of this vaccination campaign.

RobFowl

norrie rugger wrote: »

Do cork and kerry kids get the tb vaccine yet?

They will later on this year (only a 36 year delay shur what are ye complaining about)!!!!!

http://www.irishtimes.com/newspaper/ireland/2008/1103/1225523317186.html

406C

continuing the NEJM theme

"A cautious approach may be warranted in light of important unanswered questions about overall vaccine effectiveness, duration of protection, and adverse effects that may emerge over time,... HPV vaccination has the potential for profound public health benefit if the most optimistic scenario of effectiveness is realized."

http://content.nejm.org/cgi/content/full/356/19/1991


And this in the same edition highlights three of Gardasil's limitations: The two strains of HPV it protects against do not cause all cervical cancer; vaccination must take place before young women are infected with either of those two strains; and "whether this approach will extend the paradigm of vaccination to the prevention of death and disability from cervical cancer is an unanswered question."

And then: "We must also carefully monitor for unintended adverse consequences of vaccination."

http://content.nejm.org/cgi/content/full/356/19/1990

I then read around and find out it has no proven immunity past a three year period and the adverse effects highlighted in NEJM include paralysis, bell's palsy, Guillain-Barre Syndrome, seizures, and in a number of cases, death. Yes death.

Now it appears less of a wonder drug and more or pharma hype and political opportunism on behalf of the government opposition.

the withdrawal of the supposed cervical cancer vaccine also begs the question are other drug therapies or vaccinations out there not only costly but ineffective- are the DOHC doing a cost/benefit analysis on all introductions of such?

What next for the chop?

Traumadoc

There has been a lot of emotional stuff thrown about " killing 12 year old girls" etc.
Will women who have had the vaccination feel that they do not need screening?
Will more women die as a result of the introduction of vaccination?


A lot of this would be very dangerous to point out as the mob has taken over.

Don't even dare to question the efficacy of screening mammography.

http://www.cochrane.org/reviews/en/ab001877.html

norrie rugger

RobFowl wrote: »

There are no ongoing trial in boys/men that I could find. The licensed use is for girl/women only.
HPV types 16 & 18 are the ones linked to oral and penile cancer

I'm fairly sure there is. I'll investigate more tomorrow

Traumadoc

http://pub.ucsf.edu/today/cache/feature/200802291.html

JoeTheDumber

I can assure you, if I had a twelve year old girl, she would never recieve this vaccine.

The government are adopting an old ploy. Say something is good, deny it to the people, have the outcry and then everyone will clamour for the vaccine.

Just like the flu shot, "we have not got enough for you all", and the masses flood in far greater numbers than if the false shortage was not promoted.

I challenge anyone to name a person who wanted to get the flu shot without later recieveing it.

And another thing, your Dr has no idea what is in the vaccine. He is trusting the word of big Pharma, and as we all know those boys have vastly conflicting agendas.

NO TO THE CERVICAL CANCER VACCINE

norrie rugger

JoeTheDumber wrote: »

I can assure you, if I had a twelve year old girl, she would never recieve this vaccine.

The government are adopting an old ploy. Say something is good, deny it to the people, have the outcry and then everyone will clamour for the vaccine.

Just like the flu shot, "we have not got enough for you all", and the masses flood in far greater numbers than if the false shortage was not promoted.

I challenge anyone to name a person who wanted to get the flu shot without later recieveing it.

And another thing, your Dr has no idea what is in the vaccine. He is trusting the word of big Pharma, and as we all know those boys have vastly conflicting agendas.

NO TO THE CERVICAL CANCER VACCINE

Are you like this with all vaccines or just new ones?

JoeTheDumber

norrie rugger wrote: »

Are you like this with all vaccines or just new ones?

All.

Do you know that autism has gone from 1 in 4000 thirty years ago to 1 in 185 now?? The medical journals have been updated to include these "new normals".

I don't trust people just because they wear a white coat and act arrogant. The older generation have been decimated with the flu vaccine, I know a local nurse who has worked in this area, absolute horror show according to her.

norrie rugger

JoeTheDumber wrote: »

All.

Do you know that autism has gone from 1 in 4000 thirty years ago to 1 in 185 now?? The medical journals have been updated to include these "new normals".

I don't trust people just because they wear a white coat and act arrogant. The older generation have been decimated with the flu vaccine, I know a local nurse who has worked in this area, absolute horror show according to her.

right,
Nice name.

Next please, iggy for the troll

JoeTheDumber

norrie rugger wrote: »

right,
Nice name.

Next please, iggy for the troll

I'm no troll. It is amazing the lenghts people will go to, anything to avoid looking at issues which would cause them to question major issues.

Continue on, my friend. We are "all in this togeather".

ZYX

JoeTheDumber wrote: »

And another thing, your Dr has no idea what is in the vaccine. He is trusting the word of big Pharma, and as we all know those boys have vastly conflicting agendas.

NO TO THE CERVICAL CANCER VACCINE

Perhaps you should educate us. What is in the vaccines that makes them so dangerous?

norrie rugger

ZYX wrote: »

Perhaps you should educate us. What is in the vaccines that makes them so dangerous?

Quiet you

Since when do the scaremongers need actual evidence.
They have "Stories" from "people" to back up their claims of Big Pharma conspiricies.

Everyone, demand that all smallpox vaccine be destroyed and the disease released into the atmosphere!!
Same for Polio.

OK now back on topic, so there is indeed trials occuring in men.
Given the small occurance of penile cancer and small (but rising) occurances of anal/throat. Should men also be vaccinated to confer a herd immunity.

Disclaimer... I am basing all this on the likelyhood that this vaccine is indeed effective

RobFowl

norrie rugger wrote: »

OK now back on topic, so there is indeed trials occuring in men.
Given the small occurance of penile cancer and small (but rising) occurances of anal/throat. Should men also be vaccinated to confer a herd immunity.

I would think to get herd immunity men would need to be vaccinated. As I understand it you need 81% polulation coverage with a vaccine that has 95% efficacy to have effective herd immunity.
There is a precident with the Rubella vaccination (booster) though thats only given to girls around 14.
Any public health bods out there

RobFowl

JoeTheDumber wrote: »

All.

Do you know that autism has gone from 1 in 4000 thirty years ago to 1 in 185 now?? The medical journals have been updated to include these "new normals".

I don't trust people just because they wear a white coat and act arrogant. The older generation have been decimated with the flu vaccine, I know a local nurse who has worked in this area, absolute horror show according to her.

Though you might be interested in this Joe !
http://www.amazon.co.uk/X-Files-Complete-Collectors/dp/B000X41AY8/ref=sr_1_11?ie=UTF8&s=dvd&qid=1226603225&sr=1-11

Though remember not too long ago certain big pharmaceutical companies were accused of withholding data on the risk of MI's and COXII anti inflammatories, so ?????????

JoeTheDumber

Though you might be interested in this Rob !

http://www.worldnetdaily.com/index.php?fa=PAGE.view&pageId=68454

No need for your childish remarks either.

JoeTheDumber

RobFowl wrote: »

Any public health bods out there

:eek:

Another of the EU mentality, shut up all disenting voices. If you are so sure of your position, why worry about the opinion of others.

Thoie

I don't want to get in the middle of any fascinating arguments, but I have a slightly different question.

The original suggestion was to give the vaccine to girls before they became sexually active.

Would the vaccine be any use for women who are already sexually active - eg a 30 year old woman with no history of STDs? Is there an upper age limit at which point it's useless? Is there a lower age limit - eg, could you pay to have your 5 year old vaccinated?

ZYX

JoeTheDumber wrote: »

Though you might be interested in this Rob !

http://www.worldnetdaily.com/index.php?fa=PAGE.view&pageId=68454

No need for your childish remarks either.

A little more reliable
http://cdc.gov/vaccinesafety/vaers/gardasil.htm


Deaths
As of August 31, 2008, there have been 27 U.S. reports of death among females who have received the vaccine. There was no common pattern to the deaths that would suggest that they were caused by the vaccine. Of the 27 U.S. reports:

• 3 reports were related to diabetes or heart failure
• 3 reports were related to viral illnesses or meningitis (an infection in the brain)
• 2 reports were related to drug use
• 2 reports were related to blood clots
• 5 reports are being evaluated (attempting to follow up/identify case)
• 1 report is still under review or VAERS is still waiting for additional medical records, such as an autopsy report or death certificate
• 1 report of seizure disorder (history of seizures)
• 3 reports had an unknown cause of death
• 7 reports that could not be evaluated because they did not have enough information to identify the person, or to verify that a person had died

JoeTheDumber

ZYX wrote: »

A little more reliable
http://cdc.gov/vaccinesafety/vaers/gardasil.htm

I assume that .gov stands for GOVERNMENT. A bit like the Irish government paying for an "independent" report into Lisbon. Who pays the piper calls the tune.

RobFowl

Thoie wrote: »

I don't want to get in the middle of any fascinating arguments, but I have a slightly different question.

The original suggestion was to give the vaccine to girls before they became sexually active.

Would the vaccine be any use for women who are already sexually active - eg a 30 year old woman with no history of STDs? Is there an upper age limit at which point it's useless? Is there a lower age limit - eg, could you pay to have your 5 year old vaccinated?

The upper age it's been tested in is 26. The theory is that by that age you will have probably been exposed already so vaccination would be pointless. Also it is not known how long the vacine protects you for , it may only be 10-15 years so if it were given to a five year old it may have worn off before they become sexually active.
Hope that answers the question

RobFowl

JoeTheDumber wrote: »

. If you are so sure of your position, why worry about the opinion of others.

Joe as far as I can see the you are only person posting who has a definite opinion which you're not going to change !
The position I have is that the benefit of the vaccine has yet to be proven.
In terms of safety it is being monitored and so far has been deemed safe. This is under review bay the FDA in the States the Irish medicines board here and similar agencies in most countries. These have has no qualms about withdrawing drugs and vaccinations in the past (e.g. Accomplia ,Vioxx and Aulin).

Triangle

Didn't M.Harney say she plans to bring it in next year to secondary schools and the original plan was to bring it into Primary schools.

So, lets say the plan was to administer it to 6th class (primary) girls and instead she admins it to 1st year (secondary school) girls. Then this would mean that the same people are covered.

Or am i mistaken?

To me it seems like it's been blown out of proportion - I can't say I have a full understanding of the whole thing, but i thought she said the above on Darcy's show (on which his attitude annoyed me)

DrIndy

Less slagging please and more clean scientific debate. This thread started out very well so lets get back on track before closure.

The difficulty with the cervical vaccine is that is protects from the commonest causes of cervical cancer and the false sense of security can lead to less cervical screening and theoretically an increase in cancer as less women are screened.

In my experience - women who present with cervical cancer to hospitals when asked if they ever had a smear, the answer is almost always "never"

Screening is fundamentally important and the vaccine does not replace that, it justs adds an extra level of protection from a horrible and potentially preventable disease.

I have read the convincing evidence for this vaccine - but cost and long term efficacy is yet to be fully ascertained.

406C

DrIndy wrote: »

I have read the convincing evidence for this vaccine - but cost and long term efficacy is yet to be fully ascertained.

agreed but would add neither has its safety

rebel girl 15

from my understanding of it, the screening programme would be less effective from than the vaccine programme. Yet the government want to bring in the screening programme, and scrap the vaccine programme? Idiotic decision!

Correct me if I'm wrong.......

RobFowl

rebel girl 15 wrote: »

from my understanding of it, the screening programme would be less effective from than the vaccine programme. Yet the government want to bring in the screening programme, and scrap the vaccine programme? Idiotic decision!

Correct me if I'm wrong.......

As I read it the screening system (smears) detects pre cancerous lesions and allows them to be treated to prevent them developing into cancer. It has been around for 30 years and has been proven to be effective in reducing cancer deaths by up to 90%.
The vaccine program prevents infection by the viriuses which probably cause 70% of cervical cancers. It looks at this stage (3 years data) as if it will probably reduce the developmeant of cancer in a proportion (as yet unknown) of 70% of cervical cancers.
There is in my mind very little doubt that screening is effective and should be introduced. (to be honest it's embarrassing that it wasn't introduced years ago).
HPV vaccination (not exactly cancer vaccinnation) looks as if it will be effective but only on top of screening. (Its not really a question of one or the other). Questions have been raised here as to it's safety which the evidence does not seem to justify.
It does come down to a cost/benifit analysis which I feel has not been proven. The Irish professional body has however recommended that there is enough evidence to go ahead and start a vaccination program.
On financial ground this is not now going ahead in 2009 as was planned.
The descision making process is very far from clear cut and I am very happy that I do not have to choose one area of healthcare over another. Mary Harney has chosen not to go ahead as it would involve cutting the budget from another area. Whether or not it was the right choice will probably not be known for 10 or more years.
By all means express an opinion but be aware that there are limited funds so choices will always have to be made. Should breat cancer sreening be cut to facilitate this vaccination. Should funding for heroin addiction be cut, maybe heart disease treatment be denied to smokers??
I am not suggesting any of these but just want to emphasise that money needs to go where it will do most good.

406C

RobFowl wrote: »

Questions have been raised here as to it's safety which the evidence does not seem to justify.

so are you saying it hasn't been confirmed as yet safe?

RobFowl wrote: »

It does come down to a cost/benifit analysis which I feel has not been proven.

nor effective?

RobFowl wrote: »

The Irish professional body has however recommended that there is enough evidence to go ahead and start a vaccination program.

why would they do so given what you have said?

RobFowl wrote: »

By all means express an opinion but be aware that there are limited funds so choices will always have to be made.

so whilst not safe nor proven - why shouldn't it be cut?


and if so how come it was being advocated by our profession and undermining the confidence of the public in us?

RobFowl wrote: »

Should breat cancer sreening be cut to facilitate this vaccination. Should funding for heroin addiction be cut, maybe heart disease treatment be denied to smokers??

good questions added to which I would add the best aspect of medical care - emergency medicine and A&E

RobFowl wrote: »

I am not suggesting any of these but just want to emphasise that money needs to go where it will do most good.

exactly and as possibly put better should the nation be experimented upon rather than puttin our resources to already proven areas of cost versus benefit


and not only this but should other areas of proven cost vs benefit be introduced and what are they - this perhaps is the question right now - don't you all think?


then there is the other dreaded question awaiting us all - have all the other vaccines undergone analysis in regard to aspects of safety and cost vs benefit?

Is this really the bogey question for medicine and so our relationship with our profession's present financial backer - the pharmaceutical industry?


Has the economic crisis and governmental cost vs benefit analysis forced an awakening of reality not only for the Irish medical professions and the public but for medicine and its provision world wide?


this perhaps is the bigger question for all of us here debating this.














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RobFowl

406C wrote: »

so are you saying it hasn't been confirmed as yet safe?
.

No I am saying that the concerns expressed about the safety of the vaccine are not justified. It is licenced and under close monitoring and as such is safe.



Re. The Irish professional body has however recommended that there is enough evidence to go ahead and start a vaccination program.
why would they do so given what you have said?

This is their report. The reasons I don't agree with it is that they assume it's 100% effective and provides lifelong immunity. It's members are quite a prestigious bunch though.
http://www.hiqa.ie/media/pdfs/HIQA_HTA_HPV_Full_report.pdf

RobFowl

406C wrote: »

Has the economic crisis and governmental cost vs benefit analysis forced an awakening of reality not only for the Irish medical professions and the public but for medicine and its provision world wide?
.

Excellent point which I fully agree with

406C

RobFowl wrote: »

Questions have been raised here as to it's safety which the evidence does not seem to justify.

406C wrote: »

so are you saying it hasn't been confirmed as yet safe?.

RobFowl wrote: »

No I am saying that the concerns expressed about the safety of the vaccine are not justified. It is licenced and under close monitoring and as such is safe.

sorry I have just read of adverse events reported in regard to the vaccine that included death, disability and neurological syndromes so necessitating the close monitoring alluded to. In addition there are no long term studies investigating any possible adverse events taking longer to arise.

For me so far based on this thread and what I have read both in the NEJM and afar, the vaccine has failed a cost versus benefit analysis, has no proven immunity past three years, has issues in regard to safety and has been pushed hard by its for profit pharmaceutical company.

Personally my children won't be getting it - the girls and the boys (yes) nor will I be advising anyone asking me about it to go for it either.

Cancer is not caused by a vaccine deficiency.





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RobFowl

Hi 406c

406C wrote: »

sorry I have just read of adverse events reported in regard to the vaccine that included death


.

To put this in perspective you are 7.5 times more likely to die from eating peanuts then getting this vaccine

RobFowl

406C wrote: »

Cancer is not caused by a vaccine deficiency.
.

in this case it might be !
Also if you find the cause of cancer then a nobel prize is yours my friend

406C

RobFowl wrote: »

To put this in perspective you are 7.5 times more likely to die from eating peanuts then getting this vaccine

Hi Rob the issue then is should we advise parents of young children to give them the peanuts or not and if we do, just see how many die or not?

Why would you play a numbers game and expose children to such risks of deaths (and disability) when the vaccine is not proven past three years and also has no proven long term safety?

Not me and given the oath I took not for my patients either. Parents ask us our best opinion - not to repeat third party assertions. They expect us to investigate them.

406C wrote: »

Cancer is not caused by a vaccine deficiency..

RobFowl wrote: »

in this case it might be !

don't be so silly - lets not lower the thread to this Rob. Cancer is not the result of vaccine deficiency no more than a headache is a lack of paracetomol.

406C wrote: »

Also if you find the cause of cancer then a nobel prize is yours my friend

The reality is that we are seeing a rise in ill health never seen before; asthma, allergies, neurological disorders, and cancer. And now even heart disease in our children and young adults.

Health and wellbeing are more often than not, the product of looking after ourselves and establishing healthy common sense habits associated with a healthy lifestyle.

Presently there is no incentive for people to do because when they get sick they expect us to fix them up no matter what the cost, and for the taxpayer to unreservedly fund their choice not to look after themselves.

This is the problem right now.



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