18 August 2009

(Kind of) True

From AP via Yahoo:

Studies: Merck vaccine safe, promotion unbalanced

"Two studies by federal and academic researchers have found low rates of side effects with the blockbuster cervical cancer vaccine Gardasil, but a total of 32 deaths — and questionable promotion tactics by maker Merck & Co......Merck's marketing strategy, [Sheila M. Rothman and David J. Rothman, authors of the second study] wrote, sought to 'avoid limiting the vaccine to high-risk populations' and instead promote it for all women, and 'secure government reimbursement and mandates,' such as state requirements that schoolgirls have the vaccine."

As it happens, I am a proponent of vaccination in general. My family has avoided a number of potentially deadly or disfiguring diseases because we've been vaccinated against them, and vaccination initiatives have protected the lives of many others throughout the world. I heard terrible stories from my parents and grandparents about polio and measles and diphtheria, and those who died or were left permanently crippled by them. My children have never had chickenpox or mumps, the misery of which they heard about from me.

I have to admit that I was astonished--and more than a little disturbed--by the vast array of new vaccines that pediatricians presented to me when my children were born. It seemed that there was a vaccine for everything except stupidity. The chickenpox vaccine was approved for use in the U.S. about a week before the son had his 15-month well child visit, and our then pediatrician couldn't wait to stick the kid with that needle.

Which precipitated a tremendous argument between the pediatrician and yours truly.

I see chickenpox as a inconvenience, not as a disease that requires vaccination. And although both my children have since been inoculated against it, I still see it as an inconvenience, and believe me, I know exactly how much of an inconvenience because I was in high school before I finally contracted it. Yes, it's true that those with compromised immune systems are at greater risk from varicella, and it's also true that people can develop complications, but in all my life and of all the many, many people I've encountered therein, I've never met anyone who had trouble with chickenpox. By the same token, a family member was made sterile by mumps; I know two women who became deaf because they had measles; and I've met several who suffered complications from polio.

Of course, part of the reality of today is that parents send their sick children to daycare and to school regardless of illness because daycare and school are their childcare arrangement, and the parents either can't or won't take off from work to care for the children. My son and a number of his classmates became very ill in preschool after a parent dumped her extremely sick child at the school and then made herself unfindable for the duration of the day.

(It's been years, and this still rankles with me, in part because the school administration was completely up in arms about the situation but wouldn't dismiss the family because they didn't want to lose the tuition. We ended up walking because of it, though, so they still lost tuition.)

So, with this situation, for the population at large, varicella becomes not an inconvenience, but a reason to vaccinate.

While I don't believe the whole vaccination-gives-your-kid-autism argument (and I won't engage that topic here. You are free to believe what you will), I do believe in due diligence with regards to any health care choice. And that led to my next enormous argument with our then pediatrician: OPV vs. IPV. He was incensed that I wouldn't follow his guidance and allow him to give my daughter live polio vaccine, that I insisted he inoculate her with killed vaccine, and he seemed further annoyed by the fact that I was completely willing to pay for the more expensive IPV. But I'd done my research on the matter, and my mind was made up: the daughter would get IPV.

Funny that the American Academy of Pediatrics came to the same conclusion only a few months later.

Which leads me to Gardasil.

I have a daughter who is nearly 12-1/2 years old. When she went in for her well child visit near her twelfth birthday, our current pediatrician (who is the most brilliant and fabulous doctor ever), talked about what vaccinations and boosters she should receive, what he recommended. I go into the doctor's office armed to the teeth with information, not to be argumentative--in fact, the disagreements with our previous pediatrician caught me completely off guard, because I see it as a responsibility to be a well-informed parent and consumer--but to be able to understand the situation from the doctor's point of view and to be able to ask rational questions if I need to.

As I was already well aware, he told me that Gardasil was being recommended for all girls 12 and up. As I'm sure he knew I would, I started asking questions. And we agreed.

My daughter is not in a high risk population for HPV at this point, so he understood my reticence about vaccinating her at this age. He also recognizes that I'm not a fool, that I know the statistics about active teenagers as well as any parent.

It's not just the daughter's age nor her station in life nor her response every time we talk about intimacy (an unrestrained "GROSS!") that is stopping me from getting her vaccinated. To my mind, there are still significant questions regarding Gardasil's efficacy and safety (you can read some of the news reports here and here. The latter is particularly eye opening with regards to reporting--or lack thereof--of adverse effects. You can also read the CDC's VAERS report here).

This is not a head-in-the-sand issue either. As the varicella vaccine became a necessity with the social changes in parenting and work, so HPV is a real health issue. I am well aware that at some point, both my children will decide they want to explore intimacy, whether I approve or not. But I'm also well aware that I have to assess the risk of illness versus the benefit of a vaccine. Today? Today, the risk is low that my daughter will contract HPV, so I see little benefit to inoculating her, and her doctor concurs. But my assessment is predicated on the knowledge that the daughter and I have discussed the issue at length, and that she is aware that she has to be a partner in protecting her health. As unsavory as the whole idea seems to her today, I for one know that frequent reassessment is required.

For today, I'm unsurprised but annoyed that Merck has tried to take Machiavellian steps to force me to vaccinate my daughter, and perhaps that is what enrages me most. This vaccine might well be a boon to girls in high risk populations, and I'm not just talking about those who choose to be active, but the young girls no one talks about: the ones upon whom activity is forced. So why so much effort directed at targeting my daughter, other than the obvious: she can afford it.

So today, we are holding off on this one. But don't doubt I'll be watching the vaccine information closely. It's my responsibility to the daughter to do so.

Go listen to some good music: "(Kind of) True" from the album Visions of Excess by Golden Palominos.

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