Friday, February 16, 2007

Surprise! A debate unrelated to being knocked up!

I haven't given birth yet. Tomorrow I'll reach the 34-week mark, which is pretty good, in the world of twin pregnancies. I'm still itchy and resting and miserable, but feeling better about having gotten this far, and able to think a bit more clearly about something other than my own disheveled internal organs, in spite of the fact that pregnant women's brains supposedly shrink during the third trimester, which I find really scary! So, I am drinking a lot of water to combat this phenomenon. I assure you, this makes perfect sense to me.

The governor of Texas recently ordered that schoolgirls aged 11 or 12 within his state be vaccinated against HPV, the virus that causes cervical cancer. The vaccine, Gardasil, has received FDA approval and is relatively new to the market. The Texas order, naturally, has sparked tremendous debate. Some see it as essentially condoning sex among teenagers. Some see it as a huge life-saver and want all girls and women within the effective age range to be vaccinated.

In general, I'm pretty much in favor of vaccinations. I think they've enabled us to make tremendous strides towards eliminating childhood illnesses that used to be crippling and/or fatal, and eliminated a great deal of misery for children and parents. I'm also very much in favor of taking an active role in one's healthcare, though, and not blindly following advice that may not affect you, or that tramples all over your personal decisionmaking without a compelling justification. And I tend to exercise caution when deciding whether to use relatively new medications or vaccinations, regardless of whether they are rigorously tested and found to be safe and effective.

I have several problems with the Texas order. Not because I see it as condoning sex, but because I see it as a restriction on personal freedom in the absence of a compelling justification.

HPV is not like polio or whooping cough--one is not at risk of catching it through casual contact, which is the general justification for schools requiring vaccinations so as to prevent epidemics. HPV is a sexually transmitted infection. Even assuming that a significant number of young teenagers are sexually active, I highly doubt that a significant number of young teenagers are sexually active within the four walls of their schools--certainly not enough to reach epidemic proportions. Yes, I realize that schools often assume the role of looking out for the interests of their students in all aspects of their lives--in my opinion, at increasingly intrusive and uncomfortable levels--but I think that mandating a new vaccination that is not required to prevent an epidemic of illness at school is carrying this a bit too far. There are teenagers who aren't sexually active. There are also responsible parents who discuss such issues with their children, and help them to make informed decisions. Virtually all medications and vaccinations have benefits and risks. A non-sexually active teenage girl who takes an active role in her healthcare, assesses the benefits and risks, and has frank and open discussions with her parents may very reasonably decide not to partake of the HPV vaccination at this point. Do we really want to trample on the personal healthcare decisionmaking of such a person by virtue of the fact that she attends public school?

My other issue with this situation is that the vaccine is only approved--and would only be mandated--for girls. While only females can get cervical cancer, the HPV virus, in males, also causes penile and anal cancer--these cancers are less common than cervical cancer, but I imagine they also aren't fun. Plus, males can certainly carry and transmit HPV to women. Why make women bear the whole burden, yet again, of this sexual risk? And why deny males who wish to protect themselves through vaccination the opportunity to do so? The manufacturer of the vaccination is currently studying use of the vaccination in males to determine whether it would be safe and effective for them; it bothers me that this study did not take place at the same time as the studies on females.

Ok, my brain hurts. Back to the couch. Respectful comments on either side of the debate are welcome.


Blogger Ellie's Mommie said...

I so agree with you on this matter. The state of Kansas is currently debating it as well. Like you, I have no problem with vaccines, and I don't believe that it's about "promoting sex". I just feel that it takes away from our right to make informed decisions in our health care. I've read up on the studies and I am not fully satisfied with the amount of research that was performed. That, along with the fact that it is designed only for girls has me quite upset over the matter. Like you, I feel it takes away part of the responsibility from the boys. If I were to stretch my imagination a bit, I would say that it verges on opening a door that would force girls to be on birth control. I just think we should spend a little more time on the matter before we rush into making it a mandatory requirement of our young girls.

11:03 AM  
Blogger Mrs. Harridan said...

While I agree that it's pretty lame that they're just getting around to the studies for boys *now*, I also think it's a great idea for every girl to get this vaccination. Tough to enforce, but a great idea.

There are over 80 strains of HPV, though only a select few of them cause cervical cancer. However, it's important to note that there is no other way to prevent HPV. Unlike other potentially life-threatening STDs like HIV, a condom will not keep a woman from contracting HPV. The only way for a woman to take complete responsibility for her body is to abstain from sex.

It's interesting that no one has thought to include boys in the study until now. Is it to remove responsibility from the boys, or are the instances of penile/anal cancer from HPV very minor? Much like the talk of a "male pill" for birth control, I bet we'll hear a lot about a "boys' vaccine" that never materializes. It's a shame, because my gyno told me a story about a man he knew who infected two wives with cancerous HPV, and outlived them both.

This vaccine will prevent that from happening to a whole generation of women, which would be a wonderful thing even if it did promote promiscuity (which it obviously doesn't any more than any other birth control).

12:18 PM  
Anonymous TB said...

Happy 34 weeks. You're doing great!

I'm with you on this issue. As far as vaccinations go, I'm on board with them. I believe the benefits far, far outweigh any risks although I know there are many people who don't agree.

I do not believe a school should have the authority to mandate this HPV vaccination however. I would be interested to know what their stance is on requiring all school age children to receive standard vaccinations before attending kindergarten.

As you said, this disease cannot be spread through casual contact thus making it a requirement to attend school and only requiring girls to receive it seems completely arbitrary.

12:51 PM  
Blogger mamatulip said...

I pretty much agree with everything you said on the matter.


4:50 PM  
Anonymous Uncle Wiggily said...

This is my first romp through your blog;I don't have a well-formed opinion yet on the HPV high school vaccination thang, but I wanted to make the following general observation:

Clever writing, sense of humor, factually informed - I do not routinely associate these attributes with females in general, certainly not those who are attorneys, and absolutely positively not those who are in the late stages of a difficult pregnancy. I'm impressed. You can clutter up my CRT screen anytime.

Good luck with your delivery.

Uncle Wiggily

9:05 PM  
Blogger spellconjurer said...

I do not like Uncle Wiggily, Sam I am, I do not like him in a can, I do not like him in a dish, I do not like him cause something smells a bit like fish.

10:11 PM  
Anonymous V-Grrrl said...

I am wondering if the vaccine is being REQUIRED (rather than recommended) to ensure that insurers or the federal government subsidize the cost. Medical care deemed "optional" isn't normally covered by insurance or provided by free clinics and county health departments. By tying this vaccine to education, Texas may be trying to improve access to the vaccine for those who may for cultural and/or economic reasons be most at risk.

8:43 AM  
Anonymous Izzy said...

Giving girls the HPV vaccine condones sex? That's absurd.

Hope you and the twins are doing well and that you have an easy delivery :)

1:42 AM  
Anonymous wordgirl said...

I know! I KNOW! It's back to the puritanical/nonsensical thinking of the Religious Right who believe if a kid reads a book where one of the characters tastes a beer at the age of 16, then every kid who reads this book will go right out and get drunk. The only thing entertaining about the whole thing is that most of the people who are outraged are NeoCons fighting against the dimwitted candidate they voted for.

My objections involves the requirement factor and the fact that, once again, girls bear the burden for sexual relationships. Like you say, it's not measles. If they made it available, I imagine that most thinking people would go ahead and get it. But we're taking about cancer and I don't see people developing a vaccine against the day someone might take up a cigarette and start smoking it.

And yes...there are suspicions that Gov. Perry is a bedfellow with some pharmaceutical companies.

8:51 AM  
Blogger DebbieDoesLife said...

I live in Texas but am glad for once, that I do not have a girl. I do not agree with the government telling us we have to vaccinate. I believe we over vaccinate as it is and that is why asthma and allergies have gone crazy.

It made me angry when I was forced to vaccinate my youngest for chicken pox or he couldn't go to school. Even my pediatrician said, "we do not know how long this vaccine lasts. He may contract chicken pox when he is 25 which will be far worse than when he is young." But, I was forced to do it.

6:56 AM  
Blogger Mignon said...

spellconjurer, you make me laugh. Uncle Wiggily, while we all agree completely with your summation of our friend Arabella, you will not make any friends here by asserting that it is unusual to find intelligence and wit amongst females as opposed to males, which is what is implied in your comment. Care to revise?

Arabella, you are so right and brava for writing this post.

5:33 PM  
Blogger AmeDame said...

Last I heard, HPV can penetrate condoms. I don't know if it should be mandatory, but we don't know what, exactly, it would do to cervical cancer rates until it's used widely. I'd want my daughter (if I had one) to get it. Hell, I wish they'd made it mandatory in my school district 13 years ago. But I definitely see your point that boys should be responsible for their part of spreading it, too.

Even if the politicians are in bed with the pharmaceutical companies, widespread use could still save a lot of women (penile cancer's pretty rare, cervical caner's not) a lot of heartache.

5:58 PM  
Blogger AmeDame said...

dammit. obviously, that's cervical canCer

6:00 PM  
Blogger Tink said...

Everything OK? Drop us a line and let us know the kids haven't popped out yet. :)

5:10 PM  
Blogger Tortuga de Amor said...

I'm with Tink - this is a fascinating conversation, but I want to know where you, Arabella, are and if you and the babies are doing well! Sending positive thoughts your way whether you're still very uncomfortably pregnant or just insanely exhausted and happy with two new little ones and I hope all is well.

5:31 PM  

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