Gardasil: The iPhone of Vaccines

Today while scrolling through my Facebook feed a post caught my eye because it was about Gardasil, the revolutionary vaccine that has changed the face of myriad HPV-induced cancers. The post, which I would not click on, purported to detail a case of someone receiving the vaccine and developing leukemia. Looking through the comments, one stuck out. It explicitly called into question ever trusting pharmaceutical companies. It struck me as conspiratorial, arbitrary, and so misplaced. 

I, for the life of me, do not understand why there is any animus towards Gardasil -- it really is on the level of the polio vaccine in its importance to me (I also highly regard Cervarix, the other HPV vaccine). This vaccine, constructed through really cool processes involving viral like particles (VLP), has the capacity -- if adopted at high enough levels to eradicate HPV-caused cervical, vaginal, vulvar, penile, anal, and head/neck cancers. Not many other vaccines can do that. The evidence is already beginning to amount as the vaccine, first protective against 4 chief strains of HPV and now 9, has had the time to begin to impact rates of precancerous lesions as those who received the vaccine are now entering eras in their life (post sexual debut) when these changes first appear and are diagnosed. In New Mexico, for example, this is evident even with poor uptake.

There is very close to zero safety concern with this vaccine (see here and here) which should be as routine for boys and girls as all childhood immunizations are. However, I think the strong connection with HPV acquisition and sexual activity has caused some parents to balk for whatever reason (even physicians sometimes demur when including the HPV vaccine in the list of schedule vaccines at a given visit). It's odd to me that this objection comes up when hepatitis B vaccine is targeted against another a virus that can also be sexually transmitted and it is given soon after birth.

When you ask someone to articulate their opposition to Gardasil it is often something they are unable to give logical arguments and instead, at most, rattle off a litany of anecdotes they've heard or come across on the internet that are almost always wrong. The same type of people who claim the government has a "cure for cancer" locked up somewhere are the same type who shun an actual preventive cure for HPV-induced cancers. Consistency is not something that is the strong suit of the conspiracy-haunted mind.

Worse than anecdotal evidence, to me, is when they just arbitrarily assert that pharmaceutical companies are out to poison and kill everyone -- as if that would increase their profit or shareholder value. Such insults and attack on integrity not only insult the pharmaceutical company personnel who brought this product to market but also the scientists who meticulously devoted their lives to solving this problem (one of whom received a Nobel Prize).

In my estimation, Gardasil is technologically as important as the iPhone and it, and the individual minds that made it possible, should be lauded.

A Rock Band that Battles HPV

This evening I attended a remarkable event sponsored by the Pittsburgh Jewish Healthcare Foundation and HPV Pittsburgh at Magee Women's Hospital of UPMC. The event included a screening of an interesting documentary film titled N.E.D. (No Evidence of Disease) which chronicles the rock band of the same name whose members are all gynecologic oncologists whose focus is on raising awareness of the cancers they expertly treat. 

Among those cancers several (cervical, vulvar, and vaginal) are the result of infection with the human papilloma virus (HPV). What is special about this cancer-causing virus is that highly efficacious vaccines have been developed to combat it.

Despite the availability of these life-saving vaccines since 2006, only about 57% of adolescent females and 35% of adolescent males have received one or more doses of these vaccines. As HPV is virtually the exclusive cause of cervical, vaginal, vulvar, anal, and penile cancer as well as significant proportion of head & neck cancers these vaccines--which now include a 9-valent version--have the potential to alter the cancer landscape by eradicating many cancers (and genital warts as well). 

As an infectious disease physician, I relish treating infectious diseases, however I don't bemoan the patients I never see because of vaccines. It is an unequivocally better state.

Cervical Cancer: Hopefully a Relic of the Past

Last night on an episode of Showtime's Masters of Sex, a drama focused on the research of Dr. William Masters and Virginia Johnson, the early work to encourage uptake of the now ubiquitous pap smear was portrayed. This test, developed by Dr. Georgios Papanikolaou, has proved to be essential in early detection of cervical cancer, whose cause is chiefly the human papilloma virus (HPV). 

In the episode a physician--played by Julianne Nicholson--is an early promoter of the procedure who is, herself, dying from cervical cancer. 

It is largely due to the early detection of cervical cancer via routine pap smears that such deaths are almost a relic of the past in the US. However, approximately 4000 deaths per year in the US are attributed to cervical cancer. 

Vaccines against HPV, as a supplement to routine pap screening, offer the promise of further decreasing the burden of cervical cancer. Currently, two vaccines are available: Merck's Gardasil and GSK's Cervarix. Both vaccines protect against the most common cancer causing strains of HPV while Gardasil offers additional protection against strains of HPV that cause genital warts. The vaccines likely offer protection against other HPV-caused cancers (vulva, vagina, anus, oropharyngeal) and are now part of routine childhood immunization schedules after much political wrangling (see Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine's Simple Solution).