Category Archives: HPV & Cervical Cancer

The HPV Vaccine Controversy

Should HPV vaccination be mandatory for young girls? And, more pointedly, is it appropriate for the governor of Texas to bypass the legislature by using an executive order to mandate the vaccine in Texas?

Very interesting discussions on this issue over at DB’s Medical Rants. And in Dinosaur Musings. And on NPR. And in the letters section of the New York Times.

My thinking on this issue is colored by what I have come to know about Merck’s funding of the group called Women in Government (WIG), whose members have introduced most of the HPV legislation around the country. As you may recall, I wrote in December about the financial relationship between Digene, Merck and WIG. The Baltimore Sun broke the story in January, and then the AP picked it up, as did Fox News, Forbes and others.

In their reporting on the Texas mandate, the NY Times pretty much glossed over the flow of lobbying dollars from Merck into Texas. Merck declined to tell the Times how much they actually donated to Women in Government, which, by the way, carries a non-profit status.

Since then, Merck has been mysteriously removed from list of Business Council members at Women in Government. (Don’t worry – the old cached pages are still around).

“Members also play an integral role in planning for future growth, have the ability to attend our regional conferences, and support the financial stability of the organization.”

to this:

“Business Council members support the overall mission of Women In Government.

Fascinating.

Much of the opposition to mandatory HPV vaccination is coming from the usual anti-vaccine groups and the religious right. That’s unfortunate, because it is distracting the media from seeing the real story, which is the unprecendented influence of Big Pharma in legislating healthcare. And the use of Pharma-funded consumer “advocacy” groups to push Pharma’s agenda when the healthcare community does not respond fast enough for the shareholders. The push for mandatory HPV vaccination is not coming from any organized medical lobby that I have seen – it is coming from Merck.

Right now, because the HPV vaccine does more good than harm, the healthcare community and the media seem to be willing to let Merck slide on this one. But I believe it is a very slippery slope upon which we are allowing them to ride. They still need to get better at covering their tracks, but their recent absence from the WIG website proves they are fast learners in this regard. If they get any better, then a day will come when we will no longer know from where the influences are coming. And if the product being pushed is not the HPV vaccine but another Vioxx, I don’t want to imagine the outcome…

I will state again that I believe the HPV vaccine to be a good thing. And so far, I have trusted the CDC and the professional organizations who have recommended for use of this vaccine. I have even begun giving my patients the vaccine.

But in lobbying for making Gardasil mandatory less than one year since its FDA approval, I think Merck has gone too far in trying to assure the market for their vaccine. And when I see them covering up their relationship with the WIG and declining to say how much money they have given this group which is lobbying all over America for mandatory HPV vaccination, I find myself wondering what else they are hiding.

And that’s not a good way to feel about a company whose vaccine you are administering to your patients.
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Update: The American Academy of Family Physicians and the Texas Medical Association have both issued statments against mandatory HPV vaccination.

Got HPV? Have Some Carrots…

My patients who have HPV invariably ask “Is there anything I can do myself to help clear this infection?”

“Actually”, I tell them, “there is. Most importantly, don’t smoke. And eat your fruits and veggies.”

That’s right. Have a carrot. Or a tomato or some broccoli. Or better yet, a papaya. Because numerous studies suggest that women who eat more fruits and vegetables have lower rates of HPV infection, faster clearance of HPV once they get it, and lower rates of cervical cancer overall.

We don’t know which of the many vitamins and substances found in fruits and vegetables are responsible for this antiviral effect. It could be the combination of substances rather than separate vitamins themselves, since treatments using supplements rather than foods have not been effective. And it’s not at all clear if these foods are helpful once precancerous lesions are established. If veggies do work to prevent cervical cancer, it is most likely early in the natural course of HPV infection.

Large controlled trials are still needed, but, while we are waiting for that evidence, I see no down side to telling my patients with HPV to increase their dietary intake of fruits and vegetables if, like most Americas, they don’t get enough already.

How much fruit and vegetables? According to the American Cancer Society, everyone should have five or more servings of a variety of fruits and vegetables daily to help prevent cancer.

Here’s a great recipe for Carrots.

Glazed Carrots with Lemon (Adapted from the Silver Spoon Cookbook)
The original recipe used sesame seeds instead of pine nuts, and pearl onions instead of shallots. I’ve also made it substituting olive oil for the butter, and it tastes just a delicious.

1 ¾ lb carrots, fairly thickly sliced
3 tbsp butter
2 shallots, chopped
Strained juice and grated rind of ½ lemon
1 Tbsp pine nuts
1 tbsp chopped parsley
Olive oil for drizzling

Put carrots in a bowl. Add water to cover and a pinch of salt. Let soak for 15 minutes then drain. Melt butter in a pan and add shallots. Cook over low heat, stirring occasionally, for 5 minutes. Add lemon juice and rind and cook for a few minutes more. Add carrots, season with salt and pepper and cook for a further 10 minutes.

Meanwhile, lightly toast the pine nuts in a heavy skillet.

Transfer the carrots to a small serving dish, sprinkle with pine nuts and parsley. Drizzle with olive oil and serve.

Serves 4

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Here are a few references…

Int J Cancer 2005, 117 (4):629-637.

Cancer Epid Bio & Prev 2005. 14: 1149-1156.

JNCU Monograph. 2003;(31):29-34.