Nikki and the HPV vaccine

If you’ll recall, Nikki Haley got into trouble for sorta, kinda, trying to do the right thing: Save girls’ lives by getting them vaccinated against the papillomavirus that causes most cervical cancers. Until she realized it might not be a popular move with political extremists.

Here’s CNN’s recap:

Columbia, South Carolina (CNN) — As the debate over Texas Gov. Rick Perry mandating the HPV vaccine continues between Republican presidential candidates, a woman whose endorsement is coveted by all them, South Carolina Gov. Nikki Haley, has her own complicated history on the issue.

In 2007, shortly before Perry issued an executive order requiring that schoolgirls be vaccinated against the sexually transmitted human papillomavirus, or HPV, that causes most cervical cancers, Haley was throwing her support behind a similar bill in South Carolina. At the time she was in her second term as a state representative.

State Rep. Joan Brady introduced the Cervical Cancer Prevention Act in South Carolina, and the Republican corralled more than 60 legislators, including Haley, to sponsor the bill. Unlike the executive order for which Perry is taking heat, this legislative mandate did not include a provision for parents to opt out of inoculating their daughters.

Within months, fierce opposition mounted, and legislative records back up accounts from sources who recall sponsors “dropping like flies” before a unanimous vote killed the bill on April 18, 2007.

More than a dozen legislators formally requested to be removed as sponsors from the bill, but the future governor of South Carolina was not one of them…

[State Rep. Kris] Crawford, a Republican, said he is not so sure.

“There are exactly two groups of people who can claim they were against this giant overreaching of government — those who never sponsored the bill and those who were sponsors but subsequently removed their names from the bill when it was explained to be a boondoggle mandating vaccination of little 12-year-old girls against a sexually transmitted disease,” Crawford said. “Everyone else was either for the bill or riding the fence trying to claim victory regardless of outcome.”…

This is a pattern we’ve seen, of course — one in which our young governor blunders into a situation, can’t decide which is the safest political course for her, hunkers down and hopes to survive it, whatever happens to everybody else. By being on both sides, she hopes eventually to be on the winning side, and have some credit splash on her. It’s worked for her so far. As you’ll note, CNN is still calling her a “rising star.” Really.

But even some of the national media are starting to notice things.

34 thoughts on “Nikki and the HPV vaccine

  1. Doug Ross

    Let’s see some facts. What is the rate of incidence of HPV? What is the rate of HPV turning into cervical cancer?

    It is a SEXUALLY TRANSMITTED DISEASE. To make it mandatory for middle school age is wrong. The fact that they allow an opt-out means it is not a threat to the general public.

    Should we make treatment of AIDS mandatory and have the government keep track of anyone who is HIV positive? Let’s see the libreal community get behind that.

    Reply
  2. Ralph Hightower

    South Carolina despartely needs a SG vaccine to ward off Stupid Governors: Jim Hodges, David Beastely , Mark Sanford, and Nikki Haley, is our latest infection.

    24 years of do-nothing governots!

    Why? Why? Why?

    Reply
  3. Nick Nielsen

    Yes, HPV is primarily sexually transmitted, but the vaccine is apparently most effective when administered before girls become sexually active. Infection rates for sexually active adults (both mail and female) are estimated as high as 75%. Most of those infections are harmless and go away on their own, but some are persistent.

    The CDC says there was an average of 31,392 HPV-related cancers per year from 2003 through 2007, a rate of 10.6 per 100,000 population. These cancers develop as a result of long-term infection by the virus. Almost all cervical cancer is associated with HPV; there were 7.78 cases of cervical cancer per 100,000 women between 2003 and 2007.

    The National Cancer Institute estimates the worldwide incidence of HPV-related cancers at 5%. If we assume the United States is right up there with the rest of the world in infection rates (and it’s probably a safe assumption), here’s a chance to eliminate–not just reduce, but ELIMINATE–5% of cancers in the US, and people are against it? I just don’t understand this at all.

    Links:
    http://www.racoon.com/hpv/HPV-most_common_STD.htm
    http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
    http://www.cdc.gov/cancer/hpv/statistics/cases.htm

    Reply
  4. Scout

    Why does the fact that they have an opt-out mean it is not a threat to the general public? I think it means that personal choice is valued in this country.

    Parents can opt not to immunize their young children right now and that IS a threat to the general public. Still we allow it, and it is happening because we value personal choice. Serious diseases that have been unknown for the past 50 years are starting to come back because parents are choosing not to vaccinate.

    My understanding of why this vaccine is given to middle school age children is that physiologically that is when the immunity has the best chance of developing from the vaccine. It is not an insinuation that all middle schoolers are sexually active. It is an acknowledgement that if we take this action at this time, a larger percentage of the population will be protected as they mature. There simply is a window of increased efficacy in the middle school years.

    Kind of like saving for retirement – no one is suggesting that I am going to retire within the year, just because I am setting aside so much of my paycheck for retirement right now. But by doing it now, I am prepared when that time does come.

    Reply
  5. Kathryn Fenner

    As a member of the “liberal community,” I’m all for mandating HIV tracking and treatment.

    I’m also in favor of mandating all kinds of vaccines. I’m sick and tired of crazies relying on the “hred immunity” and denying things which are as close to facts as we can make them.

    and middle school girls are most definitely sexually active, whether their parents know it or not. Look at birth rates for that age group.

    and who cares what the rate of HPV turning into cervical cancer is? We have a pretty risk-free means of preventing it from doing so!

    Reply
  6. Doug Ross

    @Kathryn

    “Pretty risk free” is not the same as “risk free”.

    This is a case of a drug company using its lobbying power (i.e. money) to make a drug mandatory because they couldn’t make the case with data.

    $360 per female times tens of millions of females is a great boon to Merck. They have paid a lot of money to make that happen.

    It is not the same as mumps, measles, polio, etc. It is 100% preventable and only impacts a small minority of females.

    The cost far outweighs the benefits. Numbers I have seen suggest it costs $75,000 to prevent one incident of cancer versus $30,000 to treat it.

    Educate the public. Let parents decide.

    Reply
  7. Juan Caruso

    @ Nick
    “I just don’t understand this at all.”

    It currently a partisan issue libs hope will sideline Gov. Perry, the only conservative candidate with a very good shot of defeating the incompetent law school grad’, the incumbent.

    Won’t work, but sour grapes is evident even among South “non-partisan” South Carolinians who supported another lawyer, Vinnie you-know-who. Had Vinnie won, his position on the NLRB’s suit (note, not his position as a loser) would have been interesting.

    Equally interesting would have been his positions on state sovereignty matters such as Wisconsin’s recent limitations on unionized state employees. Frankly, all of those positions are too easy for conservatives to have guessed correctly. But, in fairness, Vinnie is a nice loser.

    Reply
  8. bud

    The cost far outweighs the benefits. Numbers I have seen suggest it costs $75,000 to prevent one incident of cancer versus $30,000 to treat it.
    -Doug

    Bogus, bogus, bogus. Not sure where the $360 figure came from but it seems highly inflated. The $30,000 figure likewise seems preposterous. Every young life lost to cancer costs at least $5,000,000 in various economic losses plus the excruciating, but unmeasurable, cost of suffering and grief. Not sure how this is 100% preventable unless you propose everyone abstain from sex for the rest of their lives. Preventing cancer by the application of a simple and safe vaccine seems like a no-brainer to me.

    Reply
  9. Doug Ross

    @bud

    Are you kidding me? The shots are $120 each. It requires three doses.

    Here’s an article from cnn.com that presents factual evidence and balanced analysis of the issue instead of the fantasies you concoct:

    http://money.cnn.com/2010/09/06/news/companies/merck_Gardasill_problems.fortune/index.htm

    “Three shots of Gardasil cost just under $400 dollars, about three to four times as much as MMR booster shots”

    Your $5 million number is the only bogus number. Totally fabricated.

    And, Bud, maybe you haven’t heard – if you and your partner do not have sex with multiple partners you can’t get the disease. That’s called being responsible.

    I’ve never said people shouldn’t get the shots only that it should not be mandatory.

    This is all about Merck’s bottom line and kickbacks to politicians.

    Reply
  10. bud

    The problem is with Merck, not the shots. There is absolutely no reason these shots should be so expensive.

    As for the $5million, check out the national safety council’s web site for a full explaination of economic costs.

    Reply
  11. bud

    Doug surely you are not serious when you suggest that everyone will go their entire life with only one sex partner? Otherwise the 100% preventable argument is absurd.

    Reply
  12. Kathryn Fenner

    and parents are often not the best judge–see how many decline to immunize their kids!

    Pretty much risk-free means, you might faint, vs. you might get a fatal disease, or one whose cure will leave you unable to carry a baby to term.

    Reply
  13. Doug Ross

    @Bud

    Why should the fact that people have multiple sex partners be a government issue to deal with? And the disease IS 100% preventable. Do you have HPV? I don’t. And I won’t.

    Do you think the government should track and treat anyone with HIV (AIDS virus)?

    My issue is solely with the mandatory aspect of the drug. The mandatory part is driven by Merck profit motives influencing government through lobbyists.

    Reply
  14. Doug Ross

    Here’s the liberal approach to solving a problem:

    People are promiscuous. The promiscuity leads to infectious diseases being passed among those who engage in the activity. The disease leads to cancer in a small number of women. The fix is to innoculate every female and presumably provide those shots for free to people who can’t afford them, sharing the cost of prevention of the sexually transmitted disease across all taxpaying adults.

    The conservative approach:

    Don’t sleep around. If you do and get the disease, deal with it.

    Reply
  15. Doug Ross

    @Kathryn

    “Pretty much risk-free means, you might faint”

    Seriously? From the American Medical Association:

    “Overall, 772 events (6.2% of the total number of adverse events, but only 0.003% of the total number of doses) were described as serious and included 32 deaths (1 per 1,000,000 doses).”

    I guess you just consider 32 deaths to be extended fainting spells.

    Reply
  16. KP

    I haven’t read anything that says anyone has concluded that the HPV vaccine actually caused the 32 deaths — only that 32 people died sometime after getting the vaccination.

    Still, I’m 100 percent opposed to making the vaccine mandatory. Plenty of drugs are approved on the basis of clinical trials, then pulled when they are found to be unsafe. I can’t imagine Haley supporting legislation with no opt-out for parents.

    Reply
  17. Mark Stewart

    Lies, damn lies, and statistics. Doug, is that really your rationale for opposing what’s sensible – just because you’ve got a hairball about Merck?

    When you said you don’t have HPV, you really meant you won’t get cervical cancer. But men transmit the virus to women; that’s how it works (and men get the virus from women, too). I don’t care about your particular sexual history; you get my point, the vast majority of people have had two or more sexual partners and therefore have a significant chance of passing on the virus. And then down the line somewhere, a woman will die of an otherwise preventable cancer. Or she’ll have a hysterectoctomy, etc, etc.

    Mandating immunizations gets my vote. It’s good for everyone; women, men, mothers, fathers, daughters and sons. If we’re going to make it optional, it ought to be the kids who decide whether they are going to be immunized or not – it’s their life. Oh wait, the same people who say immunizations can’t be mandated are also the one’s who say kids are too irresponsible to make informed decisions. That’s always struck me as sort of peculiar.

    Reply
  18. Doug Ross

    @Mark

    Read what I wrote. My issue is with the government mandating the shots. If you read the CNN article I posted above, you can see how this all played out. Merck developed a product and did a lousy job of marketing it. They had certain financial goals to meet to their shareholders based on the sales of Gardisil. When those goals appeared to be in jeopardy, they took another approach – spending money to lobby politicians to force the shots on the public.

    Why would it not be sufficient to allow pediatricians to tell parents during a regular visit about the shots and the relative benefits of taking those shots? If the data is indisputable, why would parents object when advised by a healthcare professional?

    And for those who can’t afford a $400 series of shots, who do you expect to cover the cost?

    Reply
  19. Doug Ross

    I’ll answer my own question:

    “why would parents object when advised by a healthcare professional? ”

    Because liberals believe people are mostly stupid and need smart people like the liberal community to manage every aspect of their lives. Can’t privatize Social Security because people are too stupid to figure out how to invest their money. Can’t offer competition to Medicare because old people are too stupid to manage their own healthcare choices.

    Reply
  20. Doug Ross

    And someone please defined “mandatory”. What should the consequences be for parents who refuse to give their kids the shot? Fines? Jail time? A stern letter from the Surgeon General?

    Reply
  21. Doug Ross

    And today’s news tells us that:

    “The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years — a lot faster than doctors believed — and that could help explain a recent series of outbreaks in the U.S. among children who were fully vaccinated, a study suggests.”

    Wonder what will happen when the HPV shows some unforeseen side effects when used over a period of years by millions of women. Let’s not keep our heads in the sand and pretend that clinical trials aren’t “tweaked” for the benefit of drug companies.

    Reply
  22. Doug Ross

    I know people hate it when you bring facts and expert opinion into a debate but here’s a blog entry from Scientific American about Gardisil:

    If you can’t be bothered to read this then you are admitting you are close minded on the topic.

    http://blogs.scientificamerican.com/cross-check/2011/09/19/michele-bachmann-wasnt-totally-wrong-about-hpv-vaccines/

    “Critics fretted that the HPV vaccine, which can cost up to $1,000 per dose to administer when counting physicians’ fees, may represent an inefficient deployment of scarce health-care resources. HPV is ubiquitous, infecting as many as 80 percent of all adult women, and yet cervical cancer is relatively rare; it kills about 3,600 women a year in the U.S., less than a tenth the number killed by either breast or lung cancer. Because Gardasil and Cervarix vaccines do not prevent all forms of cervical cancer, they do not eliminate the need for pap smears, which can detect cervical cancer in its early, most treatable stages. Nor is it clear how long HPV vaccines provide protection against the papillomavirus.

    The HPV vaccine, which some authorities are recommending for boys, may yet prove its worth, especially in some low- and middle-income countries, where rates of cervical cancer are higher (because pap smears are less common) than in the U.S. As far as medical scandals go, the vaccine is not in the same league as, say, the surge in psychiatric medication of children, against which I railed in a recent post. But both cases reveal the unhealthy influence of profit-seeking pharmaceutical companies on our health-care system. Whoever our next president is, I hope he or she finds a way to fix this problem.”

    Reply
  23. David

    Because liberals believe people are mostly stupid and need smart people like the liberal community to manage every aspect of their lives.

    Libertarian solution: Let poor people with no hope for a better future die and reduce the surplus population.

    Insightful. That’s really furthering the conversation here.

    Reply
  24. Doug Ross

    @bud

    Let me know when we can try the libertarian solution. We haven’t had the chance yet. Seems like the poor are dying just fine using the liberal programs right now.

    Reply
  25. bud

    There is a new report out now suggesting HPV is probably a leading cause of other types of cancer in addition to cervical. The math doesn’t start and end with the “small” 3600 cervical cancer deaths but is likely far greater given higher instances of throat cancers. Plus, the economic costs are not limited to deaths. The many 10s of thousands of “cured” cancer victims should also be counted among the costs. A woman denied the opportunity to have a child suffers enormous personal trauma in addition to the significant medical costs, often to a young woman who is likely uininsured.

    Having said that let’s do some math:

    @ $3,600 per cancer death times $5million we end up with $18billion from that alone.

    @ 2,000 cases of throat and larynx cancer deaths we can add another $10 billion/year.

    Now for those cured we can probably conservatively calculate about $100,000 per case in all costs. We’re now talking 10,000 “cured” cancers per year add in another $billion or so.

    We won’t add any costs to those who suffer with HPV but never get cancer but those costs are probably considerable.

    We can easily end up with $29 billion in economic losses alone that are easily preventable each year through a simple vaccine.

    Not sure what Dougs talking about with the $1000 so we’ll just use the actual patient cost of $460 for full treatment, a cost that will certainly decline over time. (In the real world the actual cost to society is far less with most of that going to excess profit.)

    Each year we could easily vaccinate 20,000,000 young girls and maybe some boys too. @ $460 x 20 million = $9.2 billion we could eliminate HPV and the cancers that go with it. And the side effect costs would be extremely minimal, probably just a hanful, if any deaths. Using Dougs suspect 32/year we could add about another $160 million on the cost side. Other side effect costs would bring that to say $500 million. We’re now up to about $9-10 billion. This gives us a pretty good 2-1 cost/benefit ratio. That’s a very good bargain for the government and a great benefit for society.

    Reply
  26. Doug Ross

    @bud

    Do you pay to go to the doctor when you get shots? Or is it a free service?

    Your numbers are completely false. Why do you waste time doing calculations based on a made up number of $5 million dollars. That number is meaningless to the point of absurdity. I mean it is borderline idiotic. I have a very good job and I haven’t earned anywhere close to 1/3 of $5 million dollars in my lifetime.

    And guess what, Bud? the people who die from cervical cancer don’t do so at an age before they start working. Or does the $5 million figure count no matter how old you are?

    Seriously, you need think about numbers like $5 million for a life before you try to present them as factual. Total fabrication.

    Reply
  27. Doug Ross

    @bud

    And here’s the point you keep missing: I don’t care if people get the shot. Get the shot. Pay for the shots.

    You want other people to pay for the shots… not you… other people.

    Reply
  28. Brad

    So… you’re saying it’s OK to make the shots mandatory, as long as the person getting the shot is also forced to pay for it, instead of someone else paying for it…

    I’m confused.

    Anyway, something I probably didn’t make clear earlier is that I can see arguments for and against this program. But it’s based not in philosophy; it’s based in whether this particular vaccine is the right one to require people to get. The idea, the PRINCIPLE, that you shouldn’t require people to get certain shots for the sake of public health — like the smallpox vaccination I had to get before I could start kindergarten right here in South Carolina — is ridiculous.

    Reply
  29. bud

    Doug,

    Here’s an excerpt from the National Safety Council providing a short explaination of the comprehensive costs of injuries. I’ve seen higher figures from the Federal Highway Administration but this can easily be justified. Premature death really is expensive. Preventing it with a simple vaccine is cheap and should become even cheaper in time. Not sure why the pushback on something so simple.

    Comprehensive costs of motor-vehicle crashes. In addition to the economic cost components listed above, the following comprehensive costs also include a measure of the value of lost quality of life which was obtained through empirical studies of what people actually pay to reduce their safety and health risks. The average comprehensive costs on a per injured person basis were:

    Average Comprehensive Cost by Injury Severity, 2009
    Death $4,300,000
    Incapacitating injury $216,800
    Nonincapacitating evident injury $55,300
    Possible injury $26,300
    No injury $2,400

    Since the lost quality of life figures, which are included in the above comprehensive costs calculations, do not represent real income not received nor expenses incurred, they should not be used to determine the pure economic impact of past crashes.

    Reply
  30. Doug Ross

    @bud

    “Since the lost quality of life figures, which are included in the above comprehensive costs calculations, do not represent real income not received nor expenses incurred, they should not be used to determine the pure economic impact of past crashes.”

    Do you understand the last sentence, Bud? If the $4.3 million shouldn’t be used to determine economic impact why would you use it for cervical cancer deaths? It’s a bogus number for your analysis. Case closed.

    Reply
  31. Doug Ross

    @Brad

    What’s confusing?

    The HPV vaccine should not be mandatory. The risk is very low compared to other mandatory vaccines.

    It was made mandatory not because of public health concerns but because of Merck’s profit motive.

    Bud wants it mandatory and paid for by someone else (the rich people he despises so much).

    Reply

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