Valerie Schultz: Weapon against cancer? It's a shot in the dark
| Friday, Aug 14 2009 05:53 PM
Last Updated Friday, Aug 14 2009 05:55 PM
Childhood vaccinations are a complicated affair. There is pressure on parents, from both the medical and educational establishments, to accept every newly invented vaccination unquestioningly. Thus it is an unnerving moment for a parent to sign an official waiver for a "mandatory" vaccination for a child. The opinion pieces available online and in popular magazines and medical journals support contrary positions. The school nurse tends to disapprove of your action. You are left wondering if you will ever feel entirely certain of your decision.
Yet decide, we parents must.
Parenting requires difficult decision-making in densely gray areas. It also requires ongoing education and critical thought. Abdicating our responsibility to parent, just to avoid going against the grain of conventional wisdom, is no way to teach our children well.
The latest vaccine to vex and worry us is the first one that is made only for girls. Manufactured by the drug conglomerate Merck, Gardasil protects against two of the 40 strains of human papillomavirus, or HPV, that can cause genital warts and ultimately, cervical cancer. HPV is transmitted through genital contact. Three doses of the Gardasil vaccine are administered to preadolescent girls over a six-month period. While Gardasil is not currently mandatory for public school attendance, the state of Virginia is set to require it for girls entering middle school. Other states may soon follow.
My unease with the instant prevalence of Gardasil stems in part from the rush to market it. Merck launched a slick campaign in which various young women assert that "I could be one less," meaning one less woman to die of cervical cancer, thanks to the cure-all of this new HPV vaccine. Drug companies have a way of promoting their latest product that makes it seem as though they can see the future. When 11-year-olds are being immunized, it is not possible to report on their rates of cancer when they are adults, unless the scientists conducting the study can travel forward in time. The benefits of the HPV vaccine, at this point, are entirely projected.
And the risks inherent in Gardasil are still being assessed. The immediate physical side effects reportedly include headache, nausea, fever, dizziness, fainting, and pain and swelling at the site of the shot. More serious side effects have been reported, but Merck maintains that these conditions are not causally related to the vaccine. The National Vaccine Information Center maintains that the drug trials for Gardasil contain "too little long-term safety and efficacy data, especially in young girls, and too little labeling information on the contraindications." Further, the vaccine itself may not actually accomplish the good it promises: The types of HPV termed "high-risk" are generally removed by the immune system before they cause long-term problems, and rarely result in cervical cancer.
I am also uneasy with the possible false sense of security that Gardasil might give to the young women who are immunized. While the vaccine prevents transmission of two types of the HPV virus that are known to cause cancer, it does not protect against any other sexually transmitted diseases, of which there are many. I would hate for my daughter, or anyone's daughter, to believe that the shots she received in middle school have made her impervious to harm or infection at the hands of an insistent boy. I worry that the educational task of parenting will be deferred because we think this drug can take the place of solid guidance and pertinent information, especially in matters pertaining to sex. I would also hate to see young women ignoring the annual Pap screening that is still necessary, even with Gardasil, for the early detection of cervical cancer.
I vaccinated my infants against all the scary childhood diseases and while I was debating whether to have my youngest vaccinated against chicken pox when that shot became available in the 1990s, she caught the virus, making my decision moot.
Later, when the hepatitis B vaccine was required for middle-schoolers, I signed my first waiver.
The jury was still out on whether it was a good idea to vaccinate 12-year-olds against a disease that is primarily passed by dirty needles or high-risk sex. Now Gardasil looms, and my teenage daughters have not been vaccinated.
The widespread use of Gardasil is a huge experiment. After careful thought, I must decline to offer my daughters as human guinea pigs.
