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ugazine Volume 39, Issue 2 Spring 2008 One Less?

Giving more thought to HPV By Lindsay Oberst As you relax with friends, watching the latest drama-packed episode of “Grey’s Anatomy,” the commercial break begins, and you hear the words, “You could be one less.” Among the fast-paced car ads and sensory food pleas, this commercial, with skipping children and apparently troubled women, does not cause you much concern. Even the mention of the life-threatening infection human papillomavirus fails to distract your attention. But should it? The most common sexually transmitted disease in the United States may now be one less concern for both women and men. HPV’s new enemy goes by the name of Gardasil and is the first vaccine to be developed for the prevention of cervical cancer. However, several questions concerning this medical advancement persist. Does the vaccine work as it claims? Does the government have the power to mandate it? And, are they other options? According to the American Cancer Society, cervical cancer kills almost 4,000 American women each year, which is about the average number of freshmen accepted to the University of Georgia. After a 2006 study, the Food and Drug Administration licensed the Gardasil vaccine for use in women age nine to 26 years old as a method of prevention for cervical cancer caused by certain types of HPV. Merck & Co., an international developer, manufacturer and distributor of pharmaceuticals, created the HPV vaccine and the

“One Less” campaign. According to Merck, Gardasil protects against four types of HPV, which together cause 70 percent of cervical cancer and 90 percent of genital warts. A study sponsored by Merck and reported by Medical News Today in September 2007 suggests that the vaccine protects against 10 more types of HPV than originally thought. Tests on male usage of the vaccine are still underway, although the CDC believes males should receive the vaccine in order to protect themselves from passing the infection to females. But Gardasil may not be as effective as Merck claims. A 2007 study in The Journal of the American Medical Association found that among women ages 14 to 24, the prevalence of all 37 types of sexually transmitted HPV combined is 33.8 percent – much lower than the 50 percent figure cited on Merck’s website. The study also found the frequency of two types to be lower than predicted. And many express concerns that overconfidence in the vaccine could undo years of progress in promoting cervical cancer screening using Pap smears. According to the American Cancer Society, when the disease is detected early through Pap testing, the survival rate is more than 90 percent. According to the Alliance for Human Research Protection, some scientists suggest that the money likely to be spent on the vaccine in coming years might be better used to expand Pap screening. Even with the vaccine, women need to receive regular Pap smears, according to the University Health Center website. Still, lawmakers in most states have considered adding Gardasil to the list of mandatory school shots. In 2007, Texas Gov. Rick Perry made an attempt to mandate the vaccine, proposing a plan that would require girls entering the sixth grade to receive the Gardasil vaccine beginning in September 2008 unless parents filed an affidavit objecting to the vaccine. Merck lobbying efforts were unsuccessful, and the Texas legislature passed a bill blocking

Perry’s order. Georgia lawmakers rejected a similar bill prepared by State Sen. Don Balfour in 2007, but this issue could reappear in the future. As a result of opposition to the Gardasil vaccine mandate, many states have agreed to fund public education materials for the vaccine. One UGA student who received the Gardasil vaccine does not support government mandate of Merck’s product. She believes the shots are a good idea, even for adolescents; however, she admits that the vaccinations are more painful than other regular vaccinations. “I think people should be educated about the vaccine enough to make an informed decision on whether or not they want to get it,” she says. Merck says the benefits of the cervical cancer vaccine are necessary. Because the vaccine is so new, however, it remains largely untested. The cost is high – at about $360 for the full series, it could be a burden on many families. This issue also brings up ethical concerns of whether or not mandating a sexual vaccine contradicts the message of abstinence. The CDC recommends that for the vaccine to be most effective, girls between 11 and 12 years old who have yet to reach sexual maturity should receive the shots. Opponents of the vaccine, such as the Georgia Christian Alliance, believe that vaccinating preteen girls could promote promiscuity. Cervical cancer kills 10 women a day in the United States, the CDC reports. Yet, overall, does a devastating need for this vaccine exist? Seventy-five percent of infections in adults and 90 percent of those in adolescents disappear on their own, according to the American Cancer Society. Also according to the American Cancer Society, between 1955 and 1992, the number of cervical cancer deaths in the United States dropped by 74 percent. Gardasil is the first cervical cancer vaccine, but it is not the only

option – other companies are working on their own vaccines and treatments as well. HPV is a concern for woman and men alike and though Gardasil is an option worth considering, at least for now, the decision to be one less is up to you.