Now you have a vaccine for the disease. What do you do with it?
You may think the right answer is to get the vaccine into the bodies of the people who are dying of the disease, and at first glance, it would seem that Merck, the maker of the cervical cancer vaccine Gardasil, would agree with you. This is what Merck says about themselves on their website:
Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them.
Those of you with business degrees though, and who work for Big Pharma in particular, understand full well "people who need them" means "people with money"
Whether they need them or not.
Don't get me wrong. Cervical cancer is real and pretty scary. If you're in a place like Africa where your chances of ever seeing a doctor are pretty damn slim that is. If you're here in the land of the free™ (certain restrictions apply) routine Pap smears will stop cervical cancer long before it gets to the scary stage. So what is Merck doing to get Gardasil to the people that need it?
A hell of a lot of lobbying to force girls in this country to get injected, that's what.
The result?
“There was incredible pressure from industry and politics,” said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention that recommended the vaccine for all girls once they reached 11 or 12.
“Merck lobbied every opinion leader, women’s group, medical society, politicians, and went directly to the people — it created a sense of panic that says you have to have this vaccine now,” said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School.
The result?
In the United States, 41 states have passed or begun considering legislation on cervical cancer, according to the National Conference of State Legislatures, and 24 have considered proposals to mandate the vaccine for girls, generally in middle school.
BUSH ADMINISTRATION FORCING HPV VACCCINE ON IMMIGRANTS: In July, U.S. Citizenship and Immigration Services quietly amended its list of required vaccinations for immigrants applying to become citizens. One of the newest requirements was Gardasil
Sooooo.......one more time.....95% of cervical cancer deaths happen OUTSIDE the western world. Meaning it would make more sense to require people LEAVING the US to get vaccinated, not people who are moving to a place where access to preventative care is routine.
"What else is new Drugmonkey?" some of you might be saying. "The Bush administration has quite a track record of getting things exactly backwards, and science really isn't their strong point." I'll have to give you that. Many of the 41 states that have a sudden interest in cervical cancer though, are probably run by competent executives, which makes me think the $162 per dose of Gardasil, most of which goes straight into Merck's pocket, just might have something to do with this sudden awareness of what should be a medium to low priority disease.
Meanwhile a girl in Africa just felt a weird pain. Merck seems to have no interest in her.
32 comments:
But most importantly here, Guardisil is not just to prevent cervical cancer - that's just a nice little side benefit... It's to prevent GENITAL WARTS. Keep your friggen legs closed and you won't have a PROBLEM!
What angers me most about these commercials is that they have parents going, "Oh, isn't that fantastic! I should get my 10 year old non-sexually active child that injection so she won't die a horrible death! :0D" Yeah, yeah, I know it's for the future, when said child will most likely turn into slut-mode if current American trends continue, and when's the last time America's learned from its own mistakes? But I really think they're glossing over the truth and that's more irritating than anything.
~Megan, future pharmacist (8 more months!!) and hopeful future spreader of pharmacy angst to the unknowing...
Drugmonkey, you've done it again. How do you do it?
About 12 women a day in the US die from cervical cancer. And about 13,000 are diagnosed each year. Because those women must be treated, we're talking significant healthcare dollars that could be potentially saved - if those 12 women a day aren't enough inducement.
Great post! My sister had been considering vaccinating her 11 yo and wanted my opinion. I told her I would wait til it was on the market a little longer. We all know any problems that are occurring are being buried by Merck "caring" team of money hungry twits.
As for Bush--why am I always hearing that Republicans are for small govt but they are always sticking their noses where they don't belong??
Spoken like a virgin...
Sorry, sorry, kidding. Knee-jerk reaction to the good ol' "keep your friggin legs closed"!
Now, most college females (granted, I'm in pharmacy school, and we're a different breed [also, this is just my own observations]) are not, in fact, running around with their legs wiiiiide open.
Quite a few of them, in fact, come to college still virgins, and eventually figure out the other sex, perhaps through their first boyfriend here in college. Perhaps their second. Perhaps both!
And let's say, since they're in pharmacy school, and smart, they're probably on the pill. And they probably take it religiously, and 90% of the time will also use condoms (though, if they forget, no big deal - they're on the pill. And they trust their boyfriend, right?).
Ah yes. Trust of the boyfriend! Now, this cuddly little hypothetical girl of ours may be reasonably sexually inhibited (i.e. not sleeping with a different guy every night). But what if her boyfriend had had sex with another girl or two before this one? And what if one of those girls or two hadn't been as careful as our protagonist?
Pretty normal scenario, I'm afraid, Megan, which I'm sure you've seen play out time and again.
You don't have to be a slut to get genital warts. And if Gardasil is covered by your insurance (like it was mine), then I can't see a reason not to get it. Merely noting that people who feel they should get it are sluts, well...come now, they teach us deductive reasoning and patterns in DSM and Therapeutics.
In today's day and age, as many have noted, simply wagging a finger and saying 'Do not have sex.' in a stern voice (re:abstinence-only teaching) is extremely ineffective. (Reference: http://www.washingtonpost.com/wp-dyn/content/article/2007/04/13/AR2007041301003.html)
Along the same line of thinking (Megan) is the idea that all young women are predictably sexually active.
I don't know the facts/figures about prevalence of STD in 1st world countries with high rates of multi-sexual partnership, but there are a few other factors to consider.
It's beyond my understanding of how 'society' i.e. moneyed folks, promote the slutful behaviour of youth, then spend beaucoup bucks to 'clean up' society. It comes down to EDUCATION.
Yea sure, a majority of what is is going on is normal hormonal, but a lot of it is based on the ostrich approach (not that I've ever seen the bird with its head in the sand or dirt, or just plain buried), but I'm absolutely, positively sure that if people were able to objectively look at the impact of multi-sex partnerships on STD (without the 'just say no' crowd blindness) some or a lot of people might be able to make the most socially acceptable decisions, and not encourage decision-maker paranoia.
By encouraging parents of young women to have their daughters get these injections, it seems to me, that 'society' is saying 'we expect all young girls to have polygamous sex, whether it's their choice or it's forced on them', and that's just not right in a civilized society.
I'm only 50 years old, but I'm not so far out of touch with reality that it's as if I live on a different planet.
arkiern,
If you read the like to the NY Times article I put in you'll see the current Gardasil scheme will be a net *cost* to society in dollar terms.
And there is the Pap smear.....we seem to be forgetting about the Pap smear that will prevent almost anyone from dying from Cervical Cancer here if used....
Damn right, Megan! Sexual enjoyment is exclusively for men and whores! And nobody ever gets raped, right?
How the hell can you be eight months from being a pharmacist and not even know that the vaccine doesn't even prevent warts, it prevents the dangerous strains of warts linked to cancer? And they don't give the shots to that age group because they're trying to crank out little sluts, it's the age at which it creates optimal immunological response! I mean come on, I'm a complete layperson and manage to know this. Feel however you want about the politics of the vaccine, but at least get your facts straight and knock off the blame-the-woman crap.
Please don't become another of those tiresome freakshows that wants to jackboot your 16th-century sky-fairy crap down our throats. If you want to do that, get a job at fucking Denny's where you're not screwing with people's survival.
Also, it's spelled 'Gardasil.' Where are you going to be working, anyway? Because I'd like the opportunity to steer very, very clear.
*Rolls eyes* So just because I spell something wrong as I'm typing quickly means I'm incompetant? Love it!
Anyways, all I'm trying to point out is that safe sex is a fantastic way to go and that the commericals irritate me. They gloss over the "other HPV diseases" and seem to glorify the prevention of cervical cancer to get sales from worried parents. Don't get me wrong, those that would benefit from it should definitely get it.
I just also really think that direct-to-consumer advertising should be outlawed.
How do you put a cost on the close to 5,000 women a year net gain who won't die. Many women are not up-to-date on their pap smears. Yes, cervical cancer would be caught early if they were and thus eliminate the deaths. But they would still have to have treatment that could possibly interfere with their fertility. And what of a woman whose cancer is discovered when she is pregnant? What of penile cancer? This vaccine could prevent all that. We have a vaccine that can prevent a cancer that affects 13,000 women a year!
thanks for the "exactly backwards" phrase
A friend's otherwise healthy child received the vaccine and 2 weeks later came down with fever, seizures and delusional behavior. They have diagnosed her with an autoimmune disorder, possibly lupus, that is likely attributed to the Gardasil vaccine. She's currently receiving chemotherapy. Her college education is on hold, and this ordeal has taken a toll on her family as well.
Some articles sent my way:
http://tinyurl.com/5ggwhc
http://tinyurl.com/6hx326
http://tinyurl.com/64cpng
I'm not recommending it to anyone I know; I'll take the wait and see approach.
Anonymous, so angry!
First of all, I am a pharmacist. I am female. I believe in the right to do whatever the hell I want to my body whether that involves birth control, abortion, vaccinations, or cutting off my left pinky finger. It's MY issue. I also got this vaccine. Come on, giving someone a vaccine for a disease that can be caused by a strain of STD does NOT make them a slut. (and FYI, strains do cause warts... strain = viral infection = possible warts). If that was the case, why then, do we vaccinate for Hepatitis B? This is also a sexually-transmitted disease. Ohmysorepublicrighttolifefriends, have you ever SEEN a case of cervical cancer? I invite you to the oncology ward some day. This vaccine might not save millions, but if it is YOUR friend, YOUR mother, YOUR aunt, that is having her entire abdominal cavity more or less ripped out, who has to endure horrific chemotherapy and radiation and slings and temporarily implantable reservoirs to deliver these wonderfully toxic medications, I bet you would say, hey, what the hell why not give these girls the opportunity to NOT ever endure these things? If we are really worried about healthcare dollars, I can give you cost analysis after cost analysis of ways to do it. I can site the healthcare mantra of the Medicare Medicaid policies that work to "decrease spending" and also work very efficiently to cut care and cut hospital reimbursement leading to, as multiple hospitals in our metropolitan area are enduring, layoffs of healthcare providers, which then leads to closing of units, which leads to decrease patient care. Overall, there are so many things wrong with our system, I hardly think that again, just like the many arguments about hiding these educational programs about safe sex and disease prevention to these "young, innocent" girls at age 12 by pretending the world hasn't been this way for the past 100 years and that abstinence only policies truly work, you are living in a dream world. If a $125 dollar vaccination saves me from having to endure chemotherapy, implantable drug delivery devices, and a loss of my uterus, vaginal cavity, lower intestines, liver, pancreus, and a variety of other seemingly useful organs, I'll take it anyday and recommend it to any female I encounter.
~the slut pharmacist... or vaccinated pharmacist. You apparently choose.
Though it would be hard to disagree with your comment about Big Pharma's indifference toward the Third World, I think analyzing whether people in developed countries actually "need" Gardasil is a bit misguided. Your point about Pap tests is well taken, but after all, thousands of women still get cervical cancer, despite the fact that Pap tests are regularly available. And the disease is indeed horrible - we have a 36 year old woman on our palliative ward with end stage cervical cancer who is in excruciating pain despite hundreds of milligrams of hydromorphone being pumped into her. Sure, Merck is creating a sense of hysteria around a product they want to sell. That's what Big Pharma does best. In Canada, we have commercials running all winter long exhorting people to get Dukoral vaccine for travellers' diarrhea before going on any vacation, never mind that it doesn't work too well and it's for an ultimately self-limiting condition. Gardasil, however, is a case where I think people will ultimately benefit, despite the windfall that Merck will no doubt reap.
As an aside, I find it interesting that many "parents' rights" and conservative groups are also accusing Merck of underhanded lobbying, as these people would seem to be the Bush administration's bread and butter.
Though admittedly, their opposition is for far different reasons than that of the Drugmonkey...
Obviously it's disgusting that they aren't pushing this for individuals outside the US. I also hope that the immigration laws allow for testing so if the woman already has one of the strains of HPV, she doesn't get the vaccine (I heard that scenario can cause an increase in cancer).
But at the same time, I got the vaccine and I support adding it to the ranks of normal vaccines. Most women don't get regular pap smears. Some poor women don't get them EVER. It's hard to predict sexual activity or likelihood that a person will have the time or money to get regular pap smears, and I see nothing wrong with suggesting it for children, though I don't think it should be required until more testing is done.
The Bush administration is being stupid about the immigration stuff, and it could be harmful, but for girls and young women in ANY country this is a good idea. I got it as soon as I was planning on becoming sexually active, and would have done so earlier but it was only available at that time.
Okay, okay, don't get your panties in a bunch.
All I'm saying is, there is NO reason why I should've had as a 14 year old female needed to HAVE to have an injection to protect me from contracting the etiologic virus associated with cervical cancer. At 14 years old, while I didn't have all the mental nor biological information, I certainly knew that if I did not want to contract syphilis, then I would not ever choose to have casual sex--as a 50 year old, that is what I was concerned about at age 14. And, the reason I knew that? I worked as a hospital volunteer and the nurse that was training me warned em about changing the bedlinens of a patient with syphilis.
Cervical cancer is bad, a death sentence, and yes, I worked as a nursing assistant during pharmacy school, cleaning and changing the bloody drainage from a woman dying an agonizing death from that kind of cancer.
But, my point--if Merck is going to promote Gardasil in the 1st world, who's going to provide the vaccine for genital herpes, chlamydia, multiple miscarriages or abortions, gonorrhea, etc. Where do we draw the line at providing 'quick fixes' free of charge, and as a matter of policy demanding that ALL young women get vaccinated?
And, if young women HAVE to have it, why not young men? I would beg to differ with any respondent that proposes that all young women are promiscuous or stupid enough to not see what a + b = if given adequate and proper education, and for that matter, society's input as well.
When do you see on a popular TV show an educational segment on effects of multiple sex partnerships?
So, yes, this an emotional issue--and for the record...I'm not a Republican! (Just someone --a pharmacist-- who intensely believes in FREEDOM of choices, especially for the informed public.)
Cathy Lane RPh
Interestingly enough, Diane Harper did a lot of the studies on Cervarix....GSK's version of the vaccine. (That comment popped up in my memory because I did a big presentation on Cervarix!) Interesting because I wonder how much GSK would market its drug. :)
http://www.ncbi.nlm.nih.gov/pubmed/15863374?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
http://www.dartmouth.edu/~wstudies/faculty/harper.html
I must admit... my girls got the shot.
But you've made me think some more. This is a good thing.
This is why I've gone and nominated you for a blogger award -- well, actually, awarded you with the Blue Ribbon Blog Award.
(here's the post in which I did it, and the rules of the game should you choose to play) http://shadowdancer.typepad.com/blog/2008/09/blue-ribbon-blo.html
All right, Cathy, I'm sure you, as an RPh, remember your A&P and the varying structures of the penis and the vagina. As such, I certainly hope you realize what a terrible and un-scholarly question "Why not young men?" is. If you do not see/understand this basic concept about vaccine competence and varying administration, I recommend going back to your pharmacy schoolbooks ASAP (Goodman & Gilman should have the info you need, I'd offer you the page number but I'm not sure we have the same edition).
This has been one of your better blog entries. I totally agree with you. It's like cervical cancer is now the disease of the moment. But pharmaceutical companies trying to make money off an ignorant public is nothing new.
Exceeeeept that men can be carriers of HPV just the same. Don't get what your point is, Erin.
Young men may not be able to get cervical cancer but they certainly can get genital warts which is what half of the HPV strains in the vaccine are meant to prevent. Further unvaccinated young women can be prevented from getting HPV if the young men they are sexually active with had the HPV vaccine before they were sexually active. It is a very fair question to ask. Why not young men?
I personally know 3 women who've had cervical cancer (and another 4 who are daughters of former coworkers), two of which have had surgery, rendering them unable to have children, and another is going to go in soon for the same type of surgery. All before age 30. I checked to see if the vaccine was covered under my insurance (it was) and if the vaccine was one containing any trace live virus (it does not). I have a friend from high school who is rabidly Catholic and Republican and has no desire to have sex before marriage. She got the vaccine. Because, like someone else already posted, you don't 100% know what your boyfriend/husband did before you and why worry about cancer if you don't have to. I'm iffy on requiring every girl to get it, but they want to give it young when they're sure you haven't had sex yet. It's a shame they don't push this in the developing world, but with how widespread a problem this is it would probably be more cost effective to work on promoting PAP smears. Who knows. All I know is I have no intention of getting cervical cancer, and I'm doing all I can (the vaccine, not being a slut, safe sex with the boyfriend) and I see nothing wrong with that.
erin---I think Cathy is saying to help prevent the spread of HPV not to prevent cervical cancer....
Kinda like how no one tries to come up with birth control for men...God forbid someone put the onus on a man. There has to be some drug that will stop sperm production or kill the little buggers but NOOOO all these years and still nothing for men. Not that I would believe a man who said he was on a contraceptive, we all know they'll say anything in the heat of the moment
Heh. Guys. I'm not saying young men shouldn't be protected. I'm commenting on /why/ it isn't available to young men. Think about it - which genital structure has mucus membranes? Which doesn't? How do vaccines work? How does this particular vaccine work?
/That/ is why young men do not currently have the option of using it. Physiology mixed with a little good ol' pharmacokinetics!
Female pharmacy student. 28. Missed the "26 year age limit" when the vaccine hit the market by a few months. Don't care.
I'll tell you why I'm not going to fight getting the vaccine as an off-label from my doctor. I want to wait for all the dark secrets to come out.
A friend of my boyfriend was diagnosed with renal failure. Her doctor thinks it is related to the Gardasil vaccine she just received.
Mothers of preteens and young teenage girls claim their daughters have had everything from fainting spells to seizures after receiving this vaccine.
It just doesn't sit well with me. It hit the market too hard too fast.
5th Year Pharmacy Student
Unrelated to thread...but...DrugMonkey, it's been seven whole days since an update to the blog garden. I'm suffering from Drugmonkey withdrawls...500mg stat!
How about we scrap the vaccine and just get routine pap smears available to women and girls everywhere? The vaccine's side effects are serious and being buried by Merck and those who are profiting from the vaccine. I'm not getting either of my daughters injected with this drug no matter what.
anonymous #12,
I'm actually on vacation this week...regular posting will resume soon.
Thanks for noticing....:)
Off topic; http://failblog.org/2008/09/25/meat-snack-fail/
Your fame is growing, DrugMonkey.
"Mothers of preteens and young teenage girls claim their daughters have had everything from fainting spells to seizures after receiving this vaccine."
oh please, that happens with a lot/most vaccines. The incidence of these was looked at and is at no higher level than many other vaccines. As a Pharmacy student i'd hope you would have known that.
Christ, I've even fainted after having a vaccine, it wasn't Gardasil, AND I'm a guy! Fainting doesn't mean crap.
I just have to comment: Erin must feel pretty stupid in light of the new post on marketing the vaccine to guys.
DM, I have a question for you. I've heard a lot of horror stories about effects of the vaccine, including 10 deaths in a year and such. I know they claim there's no link, and I actively work to convince parents that there's no link between vaccines and autism, but I am concerned about the safety of this drug. I haven't gotten it yet, but am wondering if you think it's safe.
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