Talk:HPV vaccine

From Wikipedia, the free encyclopedia

Contents 1 Intellectual History 2 Controversy? 3 Strains 6 and 11 4 Contraction after marriage 5 NPOV 6 Not so much controversy anymore 7 More about the controversy 8 Number of sexually transmitted types of HPV 9 Only for young women--WHY? 10 HPV is a risk for Colon Cancer in Gay/Bisexual Men 11 Lifetime or booster?

[edit] Intellectual History

Someone from the University of Rochester has been posting the following text repeatedly:

"The key initial discovery leading to the development of preventive HPV vaccines was the demonstration that it was possible to block the infectivity of authentic virions of genital HPV type 11 (HPV11) with antibodies raised against the native HPV11 virions. This achievement was reported at the International Papillomavirus Workshop held in 1990 in Heidelberg, Germany, by a group of investigators from the University of Rochester (see external link below: "A Cancer Vaccine is Born"). The same group then developed a method for recreating the three-dimensional structure of the HPV11 viral outer shell, or capsid, in a non-infectious form, and demonstrated that HPV11 "virus-like particles" (VLPs) were capable of efficiently inducing HPV11 virus-neutralizing antibodies. Following this, the Rochester group generated VLPs of the two most prevalent cancer-causing HPVs, i.e., HPV types 16 and 18, and showed that they too were highly immunogenic and, importantly, were also antigenically distinct from one another, and from VLPs of HPV11. The new HPV vaccines thus consist of non-infectious VLPs, produced from multiple genital HPV strains, that replicate the immunologic properties of native virions, including the ability to induce conformationally dependent capsid-specific virus-neutralizing antibodies."

In truth, the development of the HPV vaccine was a incremental effort by laboratories based in the United States and Australia, with input from laboratories around the world. Pharmaceutical companies have also played a major role in developing methods to manufacture the HPV vaccine. IMO, the above posting is a biased viewpoint that doesn't reflect the more complicated origins of the HPV vaccine. The McNeil article listed on the main page gives an overview of the key published research underlying the vaccine's development. Chackerman

[edit] Controversy?

Is there a real scientific, medical controversy, or is it just hype? I would consider is controversial if a scientist had evidence that it didn't work or caused problems, but not if a PAC representative rants about it. Could someone shed light on this?

The only controversy is of a moral nature. I actually cannot imagine the mindset that finds even that controversial, but I'll spare you the rant. --Suttkus 00:53, 14 June 2006 (UTC)

My problem with the Bambenak article is that is just presents the viewpoint of a single (and IMO misinformed individual). I think a better reference that reflects the viewpoint of the "mainstream" christian conservative movement is the the Washington Post opinion piece that I've inserted. While I don't agree with the viewpoint, I think it presents a reasonable discussion of the viewpoints of this community. --Chackerman

I agree with Chackerman - the article should use the Washington Post ref. The clinical trial data clearly shows that vacinated women are 100% protected against the development of high-grade cervical dysplasias caused by the HPV types in the vaccine. Since high-grade dysplasia is a required step in the development of full-blown cervical cancer, it is logical to say that the vaccine offers at least some protection against cervical cancer. By mis-characterizing the views of "medical community elites," the Bambenak article is using a straw-man fallacy to manufacture controversy where none actually exists. Retroid 20:22, 13 August 2006 (UTC)

The article doesn't talk about what kinds of clinical trials there were and for how long. Can anyone add this information? —pfahlstrom 06:25, 20 January 2007 (UTC)

I attended a lecture by one of the doctors in charge of University of New Mexico Hospital's clinical trial. She said she was afraid that the vaccine would have the opposite effect through social factors. The vaccine works, she said, but only on women who never had sex before. She feared that marketing it to the public would have a series of disastrous side effects:

• Women who have already had sex and who are misinformed would have the vaccination ineffectively, either as a "cure" or because they think it'll still work.
• Women who had it would avoid pap smears and cervical screenings, thinking they were completely safe.
• Women who took it might have more sex, or unprotected sex, thinking it was safe.
• Parents might deny the vaccine to their daughters, thinking it promotes early, promiscuous, or extramarital sex.

She is also worried about the (currently stable) sexually transmitted HPV ecology; if these strains are wiped out or minimalized, other strains will take their place. She did advocate a government program to vaccinate all girls by age 10 (!), because that's the only way to be sure they're not sexually active yet. However, she had little hope of that happening.

After hearing her speak, I agree with all of her positions, because they seem to me to be well-reasoned. --BlueNight 17:28, 7 February 2007 (UTC)

BlueNight, what makes you say that the vaccine only works on women who hadn't had sex before? That statement doesn't seem very plausible, only in magic spells does the virginal quality of a woman have an absolute block on the nature of their immune system. Moreover, HPV is one of the lesser known sexually transmitted diseases among laypeople. Women might have more or unprotected sex if they had a vaccine for Syphilis, or Chlymidia, but most HPV infections don't even lead to a problem. 66.41.66.213 04:01, 23 February 2007 (UTC)

Concerned Women For America, has a video on their website about the use of this vaccine maybe we should have a link to it.

[edit] Strains 6 and 11

This is expected to help market the vaccine to men, who may otherwise have no interest in taking a drug that doesn't benefit them directly.

While this undoubtedly has some truth to it, isn't it a little crass to write this off as a mere "marketing feature"? Genital warts are a legitimate medical malady by any definition. It's not as though vaccinating against these strains is a purely cosmetic afterthought. --Peter Farago 16:52, 31 January 2006 (UTC)

Please change "that doesn't benefit them directly" to something more sensible. --JWSchmidt 16:55, 31 January 2006 (UTC)

I've replaced it with a relevant quote from a Merck spokesman. --Peter Farago 03:39, 16 February 2006 (UTC)

The significant feature to adding the non-cancer strains to the HPV vaccine (6 & 11) maybe going unnoticed here. Adding protection against these two commonly found strains of the virus will have the added benefit of reducing the incidence of mis-read or false positive Pap smears. This will reduce the need for costly retesting and will no doubt reduce the anxiety factor many wonen experience when recieving a 'positive' pap result.--BeohBe 16:42, 22 September 2006 (UTC)

[edit] Contraction after marriage

Some people oppose the vaccine because they think that it will encourage women to have sexual activity before marriage. However, a woman can contract the virus from her husband. They might counter this by saying that you should not marry someone who has sex before marriage, but it only takes a single exposure to get it and a person can usually conceal their sexual history, especially when it is limited. Also, some people get the disease from their mother, so they cannot be blamed for getting it (it is rare and a vaccine won't help them, but it would have prevented their mother from getting it). They can also pass it on to their husband or wife, with neither one of them having sex before marriage.

Also, I don't think that fear of cervical cancer is a major concern for women when deciding to engage in sexual relations. Pregnancy and AIDS are probably the most important concerns. Other diseases might cause concern, but they are not usually considered individually. People are usually only concerned with an individual disease when they have personal experience with it, such as getting it before (for bacterial diseases and crabs, which can be cured), knowing someone who had/has it or exposure to detailed information about it. Even if someone is concerned with an individual disease, it might not be HPV. Even if they are concerned about HPV, they are probably concerned about getting genital warts, not cervical cancer.

Should the article mention any of this? The first point is rather obvious, except the part about the ease of concealing past sexual activity, so I would not consider it original research. The second one is just speculation and should not be used, though it might be good to check if someone has made such an argument before. -- Kjkolb 21:34, 19 March 2006 (UTC)

[edit] NPOV

Extremists of the religios right? That isn't NPOV. I am going to change it. The entire contrversy section has the same problem.

[edit] Not so much controversy anymore

The lack of major public objections at the CDC's Advisory Committee on Immunization Practices hearings demonstrates that a broad consensus has been reached. Conservative religious groups appear to have realized that blanket opposition to a vaccine against cancer is bad PR, and public health officials appear to have conceded that mandatory vaccination is not likely to be feasible in the near future. Discussion of the RU486 debate in Australia seems somewhat off topic for an article about HPV vaccines. I streamlined the section, reflecting the fact that some initial controversy over the vaccine seems to have pretty much faded. Retroid 20:52, 4 August 2006 (UTC)

It doesn't matter if it's faded; we'd still report on what was present in the beginning, but I think you're basically right; there really wasn't that much opposition in the first place. — Omegatron 23:10, 4 August 2006 (UTC)

Most of the conservative religious folks now publicly say that they were mis-quoted back in the beginning. Which seems plausible given the media's tendency to accentuate conflict where little may really exist. So I'm especially uncomfortable with the hear-say quote about "going to sabotage our abstinence message." In this case it would be particularly important to use actual quotes from the original people. Retroid 14:29, 5 August 2006 (UTC)

[edit] More about the controversy

I don't want to play up the controversy, but it seems to me like there's precious little about it, considering how much of a big deal it was. I'm a very new Wiki editor and I don't want to go this alone, but I went to this article expecting to find more information than I did, as well as almost no citations. Can't we do better? Kagechikara 20:46, 6 October 2006 (UTC)

I don't think it was ever controversial among Christian conservatives. However, the price (and the inconvenience of having to get a series of three injections) have caused some complaints[1].

Also, there is some reason to believe that the vaccine's protective benefits are overstated. The Winer / U. Washington study[2] found that only 14 of 78 infections with high-risk types of HPV were types 16 and 18, the two high-risk types prevented by the vaccine. The other 64 high-risk infections were with 16 other high-risk types of HPV. NCdave 19:32, 24 November 2006 (UTC)

[edit] Number of sexually transmitted types of HPV

The article said that 30 strains are adapted for transmission by sexual contact. However, the Winer / U. Washington study (in the NEJM last June)[3] checked for 37 such strains, not just 30[4]. So I've changed the article to say 37.

The article also said that about a dozen types put women at risk of cancer; however, the Winer / U. Washington study listed 19 high-risk types (18 of which they encountered among the small group of U. Washington students who they studied). So I've changed "about a dozen" in the article to "about 19." That's a kind of funny phrase... does anyone think it should be "about 20," instead?

It is also worth noting that, unfortunately, the 126 new HPV infections detected in the Winer / U. Washington study included infections with 30 different types of HPV, not just 4. Only 21 of the 126 infections were of the 4 HPV types which can be prevented by the Gardasil vaccine. Only 14 of the 78 new infections with "high-risk" types of HPV were types 16 & 18, which can be prevented by the vaccine. 64 of the 78 high-risk infections were with any (or, in some cases several) of 16 other high-risk HPV types. NCdave 19:50, 24 November 2006 (UTC)

[edit] Only for young women--WHY?

As a young bisexual male I am at increased risk for HPV (increased prevalence among gay men).

I can also pass that virus along to women.

WHY is it that no doctor or clinic will administer the vaccine to me??

This makes NO SENSE in addition to being sexually discrimatory.

Why is a heterosexual woman's risk for cervical cancer more important than my risk for colon cancer??

As far as I can tell there is no shortage or harm in allowing young men to be vaccinated. —The preceding unsigned comment was added by Tmthymllgn (talk • contribs) 6:38, 30 November 2006 (UTC).

I'm really curious why this hasn't been proposed. Epidemiologically, it makes as much sense (or more) to vaccinate the potential carriers as to vaccinate those at most risk of being significantly harmed. Especially as one infected male can expose numerous females to the virus. Similar to a test they did a few years back in a small town on the winter flu shots where, instead of vaccinating the elderly (at greatest risk of harm), they vaccinated all the schoolkids, the primary transmission vector. Fan-1967 18:30, 3 January 2007 (UTC)

[edit] HPV is a risk for Colon Cancer in Gay/Bisexual Men

Why is this not mentioned anywhere on this page?

It is important that the vaccine be offered to young men as well (if not the entire population). —The preceding unsigned comment was added by Tmthymllgn (talk • contribs) 6:41, 29 November 2006 (UTC).

[edit] Lifetime or booster?

Is this a one time only vaccine, or should you get one every ten years or five years to get the full benefit? And while we're at it, will its' effectiveness be such that women who have had the vaccine can stop having pap smears? 66.41.66.213 04:06, 23 February 2007 (UTC)