Thursday, July 24, 2014

Should Catholic Parents give their Children Gardasil?

Gardasil (and its sister vaccine, Cervarix) received lots of press seven or eight years ago, but I'm retouching the subject because I am getting Gardasil. (I'll explain why later.)

Basic Science (skip if you don't care or already know this)
Gardasil is approved by the Food & Drug Administration (FDA) for prevention of human papillomavirus (HPV) infection in people aged nine to twenty-six. (Gardasil for male and female patients, Cervarix currently for females only.) Like many vaccines for other viruses (e.g. the yearly "flu" vaccine), it innoculates the body with a recombinant protein pulled from the virus, so that the immune system learns to defend the body against that virus in the future. Gardasil is "quadrivalent" and protects against HPV types 16 and 18 (the types most associated with cervical cancer) and types 6 and 11 (the two most common types seen in genital warts). Cervarix is bivalent, offering immunization against types 16 and 18 only.

Morality (don't skip this)
HPV is a sexually-transmitted infection. Cervical cancer is a sexually-associated cancer. This makes Gardasil and Cervarix unlike every other vaccine that a Catholic parent may choose to give their children. Several moral questions arise:
  1. Is it moral to administer this kind of vaccine?
  2. Is it prudent?
  3. Is it imprudent not to receive this vaccine?
  4. Is there ever a case that a person should receive this vaccine?
(The derivation of culture cells from aborted children is beyond the scope of this post, as is herd theory and preference against vaccination. For the remainder, I assume that the parents reading accept the premise behind vaccination in general.)

Is it Moral to Administer HPV Vaccines?
The Catholic Medical Association (CMA) has a position paper on HPV vaccination which I find full of sound medical practice, reason, faith, duty to do what is right, and a spirit of obedience. They answer this question in this fashion:
The fact that HPV is spread primarily by sexual contact does not render vaccination against it unethical. Healing and preventing diseases, no matter what their source, are acts of mercy and a moral good. Prevention of HPV infection is distinct from, and should not be construed as encouraging, the behavior by which HPV is spread.
Per se, HPV vaccination is not an immoral act.

But is it Prudent?
Will we change promiscuity? time will have to tell. It remains true, as CMA points out, that best promote the health and happiness of adolescents, physicians, parents and social institutions should redouble their efforts to promote chastity. Consistent messages about and support for this virtue will not only help to reduce disease, but will help individuals, couples, and marriages to flourish. 
So is it Imprudent Not to Get these Vaccines?
Not really. CMA points out that the HPV vaccine is not the only way to prevent cervical cancer. In fact, cervical cancer is the poster-child cancer for prevention by cheap, easy screening (the Pap smear), which has not been connected with increased promiscuity

CMA also adds that the vaccine's long-term effectiveness isn't proven, and that there are eleven other subtypes of HPV that have been associated with cervical cancer. (These facts are part of the ordinary informed consent that physicians should provide to patients. By and large, I have not seen that OB/GYNs are great about giving all of this information before giving Gardasil and Cervarix. The good ones point out that the patient can still get other types of HPV.)

Is there Ever a Case that Should Receive this Vaccine?
I was spurred to write this post when I chose to "get Gardasil" (as an adult, at the tail end of the FDA's recommendation). Why? Because an attending told me that a colleague in the metroplex had respiratory papillomatosis from inhaling smoke from surgical cautery. In other words: after operating on infected cervixes day after day, an OB/GYN got the equivalent of genital warts in his windpipes! (Not fun.) Not the only case reported, either: a 2005 review cited "A case report [linking] the laryngeal papillomatosis in [a] ... surgeon to virus particles in the laser plume from one of his patients."

Some parents have told me they choose to vaccinate their children considering that you will never know who masturbates without washing their hands before touching your children (a stretch, but parents stretch all kinds of things for their children, and I can't argue--no one loves your children as much as you do). A young man or woman who finds that their intended has had previous sexual encounters may have reason to seek vaccination (I have seen a case of cervical cancer in a monogamous woman from her husband, who was faithful to her after marriage, but had had a previous partner).

In short
HPV vaccines aren't per se illicit. It may contribute to an increase in promiscuity; physicians don't always give water-tight informed consent about things they think are good, patients don't always understand informed consent, and advertising muddies the picture. Time will tell whether people mistakenly take the HPV vaccines to be a ticket to consequence-free sexual license. Ought parents to vaccinate? I can't make the case for all, but I respect each parent who chooses, in love, to vaccinate their children or to allow their children to choose vaccination. Are there cases when people really should? I thought so.

This is respiratory papillomatosis. The whitish globular growths are papillomas,
in the normally V-shaped valley of the larynx. Source: viveromd

In writing this post, I used the full prescribing information for Gardasil and Cervarix.

P.S. At the time the CMA position paper was written, there was much debate about whether HPV vaccines should be mandatory. That's a moot issue now, but I love CMA's answer. The paper points out brilliantly that since non-vaccinated students would not present an increased risk to vaccinated students while in school, as with droplet-communicable infectious diseases (e.g. measles). I have to quote it:
We presume that genital HPV infection is not transmitted while students are in school, and excluding non-vaccinated students from school would not prevent extramural transmission.
Come on, you have to smile. "We presume that schoolchildren are not having sex in the classroom." ROFL.

Wednesday, July 2, 2014

Fund a Battleship

I'm going to the Pope Paul VI Institute (PPVI) medical consultant program in November! This is a six-month thing with two on-site weeks in Nebraska at PPVI. It's going to cost about $5,000, so I'm fundraising. Tell EVERYONE you know! Even if you don't donate: go to the page, comment with Facebook, tell more people to do the same. Let's make it the most popular gofundme ever!!