One of my guilty pleasures in this run-up to the next U.S. presidential election is watching proudly ignorant Republican wannabes like Rick Perry and Michele Bachmann lashing out at each other instead of Obama. The Minnesota representative recently attacked the Texas governor for proposing in 2007 that pre-pubescent girls in his state be vaccinated against the human papillomavirus, HPV, which has been linked to genital warts and cancer, especially in the cervix but also in the anus, vagina, penis and other body parts. So far, tens of millions of girls and young women in the U.S., Canada, Europe and elsewhere have received HPV vaccines, at a total cost of billions of dollars.
Some U.S. religious groups have moral objections to the vaccine, which they believe promotes sexual promiscuity. Bachmann, an evangelical Christian, also raised safety issues, claiming that the vaccine—marketed under the brand name Gardasil by Merck and Cervarix by GlaxoSmithKline—may cause retardation and "could potentially be a very dangerous drug," The New York Times reported.
Bachmann suggested, furthermore, that Perry's support for the HPV vaccine might be motivated by "crony capitalism." Merck had donated $30,000 to Perry's gubernatorial campaign, The New York Times stated, and one of Merck's lobbyists, Mike Toomey, had served as a chief of staff for Perry. A Perry spokesman dismissed Bachmann's charges as "ridiculous."
I almost hate to say it, but Bachmann's claims contain a kernel of truth. I'm not talking about her safety concerns, per se. As my Scientific American colleagues pointed out here and here, so far there is no evidence that Gardasil causes brain damage or any other medical problems. No, it's Bachmann's other accusation—that Merck might have unduly influenced Perry in 2007—that I have in mind. According to this outstanding 2008 investigation by Elisabeth Rosenthal of the Times, the rapid, widespread acceptance of HPV vaccines stemmed at least in part from the marketing muscle of their manufacturers rather than from the vaccines' medical merits.
Merck and GlaxoSmithKline, Rosenthal reported, provided "money for activities by patients' and women’s groups, doctors and medical experts, lobbyists and political organizations interested in the disease, sometimes in ways that skirt disclosure requirements or obscure the companies' involvement." Some health authorities worried that "because of the aggressive marketing, even parents of girls who are far from being sexually active may feel pressured into giving them a vaccine that is not yet needed and whose long-term impact is still unclear. Legislative efforts to require girls to have the vaccine only add to the pressure."
Critics fretted that the HPV vaccine, which can cost up to $1,000 per dose to administer when counting physicians' fees, may represent an inefficient deployment of scarce health-care resources. HPV is ubiquitous, infecting as many as 80 percent of all adult women, and yet cervical cancer is relatively rare; it kills about 3,600 women a year in the U.S., less than a tenth the number killed by either breast or lung cancer. Because Gardasil and Cervarix vaccines do not prevent all forms of cervical cancer, they do not eliminate the need for pap smears, which can detect cervical cancer in its early, most treatable stages. Nor is it clear how long HPV vaccines provide protection against the papillomavirus.
Rosenthal asserted that the HPV vaccines "are straining national and state health budgets as well as family pocketbooks. These were among the first vaccines approved for universal use in any age group that clearly cost the health system money rather than saved it, in contrast to less expensive shots, against measles and tetanus, for example, that pay for themselves by preventing costly diseases."
The HPV vaccine, which some authorities are recommending for boys, may yet prove its worth, especially in some low- and middle-income countries, where rates of cervical cancer are higher (because pap smears are less common) than in the U.S. As far as medical scandals go, the vaccine is not in the same league as, say, the surge in psychiatric medication of children, against which I railed in a recent post. But both cases reveal the unhealthy influence of profit-seeking pharmaceutical companies on our health-care system. Whoever our next president is, I hope he or she finds a way to fix this problem.
Photograph of Gardasil courtesy Wikimedia Commons