Sunday, February 25, 2007

Changing of the Gardasil

I can't believe I'm standing with uber-conservative fundamentalist Christians on the topic of Merck's new wonder drug, even if our reasons may differ.

Since June when a federal advisory panel voted unanimously to recommend all girls and women ages 11 to 26 receive Merck's new vaccine for the virus that causes genital warts, Gardasil, which in clinical studies proved to prevent cervical cancers by preventing infection from four strains of the human papilloma virus, I have been waiting for government entities to mandate its use.

Merck, before abruptly halting it's lobbying efforts Tuesday, quietly poured money into pushing its revolutionary new drug -- which, for the record, costs $360 for the three-shot regimen needed for effectiveness -- on state legislatures across the country, hoping they will mandate the costly prevention for all girls beginning at age 11.

The drug company won't say how much it spent on this endeavor, but one might imagine such non-disclosure could mean the grand total is a boatload. Why just imagine, if even a small percentage of states pass measures to require parents vaccinate their girl children against HPV, the company stands to have a lucrative payday ... at least until its patent runs out or until the drug is approved for our boy children and the process starts all over again.

Now it seems New York is on the bandwagon, with legislators calling for laws to do just that: make it imperative that all girls get the series before they become sexually active.

Let me just get a few things off my chest:
I know that HPV is the most common sexually transmitted disease in the world, and particularly devastating to underdeveloped and impoverished nations.

I believe Merck's vaccine is safe and effective.

I fully expect Ittybit to get this vaccine when she turns 11, even if I have to pay out of pocket for it (currently most insurance WILL* cover this preventive measure).

I think the idea that HPV can be completely prevented by morally responsible living is akin to sticking one’s head in the sand.

I think that discovering that cancer can be caused by a virus is INCREDIBLY exciting for the future of medical research.

BUT ...
Do I want government telling me how to raise my child?

What if I were afraid of the repercussions of vaccines on cognitive development?

What if I was convinced of anecdotal accounts of parents who believed their kids were adversely affected by inoculations instead of peer-reviewed research showing no link between childhood vaccinations and autism?

What if *shudder* I believed in my heart of hearts that giving her the shot would be akin to giving her the keys to a lifetime of debauchery and moral decay?

In short, what if I were someone else?

I suppose there are still choices I could make. I could pull my kid from school and take her education on at home. Sure, I could fight the good fight and buck the laws of man. But should I have to, especially where medical decisions are concerned?

I think it's wonderful that this discovery has been made. I think it's a valuable health care tool that all people -- even boys when the drug is approved for use in the other 49 percent of our population -- should seriously consider. Like many have said, I believe there are more pros than cons in giving it to children.

However I wonder if Gardasil, in its current $360 form, will be made available to the developing world and those marginalized by inadequate medical coverage, where the need is arguably the greatest? Even in this country, doctors are reportedly not stocking the vaccine because they say insurers* aren’t reimbursing them appropriately.

I know this issue may one day go the way of seat belts, the infant car seat and, most recently, the ban of trans fats in NYC restaurants, but I can't help but want government to make its recommendations, decide such discoveries are worth funding for those least likely to afford it, and then step off and let folks make their own decisions.

And to tell you the truth, I'd just feel a lot better if a single drug company didn't stand to reap the benefit of a government mandate. I keep wondering why the rush? Where's the fire?

Seriously, if our government can require this for girls ages 11 and older why can't they require drug manufacturers make some concessions, too. Like lower the price? Oh, yeah, our government isn’t allowed to negotiate for lower drug costs; silly me.


Mrs. Harridan said...

Holy crap - $360?!

I think Glaxo SmithKline has a competing vaccine, but I don't believe that it has been as widely touted as Gardasil.

toyfoto said...

GlaxoSmithKline is developing its own vaccine, Cervarix, and could seek approval this year. It's not available yet, however.

Merck is also developing a vaccine for women over 26 as well as seeking approval of Gardasil for boys the next year or two.

stefanierj said...

I'm torn on this one. To some extent, the govt already tells me how to raise my child--they have standards for crib safety and require us to use car seats and lots of other things. The vaccines thing is tricky, though--I never had vaccines as a child, and we were always able to get philosophical or religious waivers for that so I attended public schools all my life (most people don't know those exceptions exist so they homeschool or assume vaccinations have to be done in order to attend public school). It seems to me that as long as the govt makes it available to those who want it, even if they cannot afford it, but creates a waiver for those who for whatever reason don't want it, it's cool.

toyfoto said...

I would argue that the government makes guidelines that manufacturers must adhere to for safety but you have the choice to buy from different manufacturers, or even take your chances with an heirloom. You might also take public transportation, which doesn't require the use of carseats. (When was the last time you saw an infant carseat on a city bus?)

But this drug is currently available through only one manufacturer and has been on the market for only eight months. I think politicians should worry about overall state of healthcare in this contry before they start gunning for one drug manufacturer who's got a very lucritive product.

lildb said...

yet another astoundingly articulate monologue on another important, litmus-y topic.

man. you're a genius. I swear, you gotta be.

gingajoy said...

This was exactly what I needed--I was talking with my husband about this last night (he's teaching an ethics course) and trying to explain why, although I am not with the fundamentalists, I kind of have a problem with it being required. Thanks for clarifying my thinking for me.

The Mad Momma said...

Wow.. been reading about it too and now you've managed to thoroughly confuse me on what my stand is!!! let me see... i agree with most of ur reasons for giving itty bit the vaccine... and i understand the outrage at the govt supporting one manufacturer... but i think most vaccines started out that way. eventually the 2yr or 3yr patent runs out and other manufacturers get a slice of the pie and things get cheaper.
i do agree though, that until that time the govt should subsidise it...