I was given a copy of AIDS in Nigeria; A Nation on the Threshold (Harvard Center for Population and Development Studies, 2006) some time ago by a student friend who happened to have been employed with others in the editing and design of this large, expensively produced anthology of twenty-four commissioned HIV/AIDS/antiretroviral drug articles. The book was funded by the Gates Foundation and includes many beautifully reproduced color photographs of dying children.
Here is today’s NY Times follow-up by Elisabeth Rosenthal, health journalist. I’ll call her our Esther of the NYT (not the OT) for her work against two pharmaceutical corporate giants and their campaign for an unnecessary, possibly dangerous, expensive (for us), profitable (for them) national cervical cancer vaccination program.
"Articles Question Wide Use of 2 Vaccines" (August 21, 2008; A 15) by Elisabeth Rosenthal (and see Cervical Cancer Vaccines - Golden Opportunity)
Two vaccines against cervical cancer are being widely used without sufficient evidence about whether they are worth their high cost or even whether they will effectively stop women from getting the disease, two articles in this week’s New England Journal of Medicine conclude.
Both vaccines target the human papillomavirus, a common sexually transmitted virus that usually causes no symptoms and is cleared by the immune system, but which can in very rare cases become chronic and cause cervical cancer.
The two vaccines, Gardasil by Merck Sharp & Dohme and Cervarix by GlaxoSmithKline, target two strains of the virus that together cause an estimated 70 percent of cervical cancers. Gardasil also prevents infection with two other strains that cause some proportion of genital warts. Both vaccines have become quick best sellers since they were licensed two years ago in the United States and Europe, given to tens of millions of girls and women.
“Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer,” Dr. Charlotte J. Haug, editor of The Journal of the Norwegian Medical Association, wrote in an editorial in Thursday’s issue of The New England Journal. “With so many essential questions still unanswered, there is good reason to be cautious.”
In her article, Dr. Haug points out the vaccines have been studied for a relatively short period — both were licensed in 2006 and have been studied in clinical trails for at most six and a half years. Researchers have not yet demonstrated how long the immunity will last, or whether eliminating some strains of cancer-causing virus will decrease the body’s natural immunity to other strains.
More to the point, because cervical cancer develops only after years of chronic infection with HPV, Dr. Haug said there was not yet absolute proof that protection against these two strains of the virus would ultimately reduce rates of cervical cancer — although in theory it should do so.
Dr. Richard Haupt, medical director of Merck, called these concerns “very theoretical,” noting that continuing research and monitoring suggested that immunity would be longlasting and that the vaccine would not lead to problems with other strains.
He added that cervical cancer was “just the tip of the iceberg” and that HPV caused a huge amount of expensive and stressful testing in developed nations that could be avoided with vaccination.
The vaccines, which require three shots for a complete series, cost about $400 to about $1,000, depending on the country and the fees for doctors’ visits. Unlike older vaccines that save money by preventing costly disease, these vaccines cost health systems money.
The second paper published this week, a study by Jane J. Kim and Dr. Sue Goldie of Harvard, looks at the issue of costs and concludes that the vaccines will be cost effective only if used in certain ways. In particular, the researchers say the vaccines will be worth the cost only if they prove to protect girls for a lifetime, and if current methods for screening for cervical cancer using Pap smears can be safely adjusted to reduce costs there. Further research is required in both areas.
“I believe the vaccine is a great advance, but we have to implement it properly to get the benefits, and that hasn’t happened,” said Dr. Philip Davies of the European Cervical Cancer Association.
In developed countries, Pap smear screening and treatment have effectively reduced cervical cancer death rates to very low levels already. There are 3,600 deaths annually from cervical cancer in the United States, 1,000 in France and 400 in Britain.
Cervical cancer, like skin cancer, can generally be caught at precancerous or non-invasive stages and treated. Because the vaccine prevents infection with only some of the cancer-causing strains, Pap smear screening must continue even in those who are vaccinated.
The Harvard study concluded that giving the vaccine to 12-year-olds would cost $43,600 for every “quality adjusted year of life” it saved by preventing a cancer death; that price would often be considered acceptable by health officials in wealthy countries, experts say.
Dr. Haupt said the study proved that it was best to vaccinate early. “It underscores the value of vaccinating pre-adolescent girls,” since the vaccine works fully only in girls who have not been exposed to HPV.
But if the vaccine were given to all girls and women up to age 21, the cost per year of life saved would be far higher — $120,400, the Harvard study concluded. And if the vaccines prove to require a booster shot, as many critics believe, that cost rises to $140,000. In such cases it might make more economic sense to rely on Pap smear screening alone, the researchers said.
My additional point: Except for a few journalist like Dr. Rosenthal, we are in the outer reaches of health information, the Galapagos of health information. I read the Times, the Globe, and I check the WSJ, Financial Times, and others on the Internet. I’m able to read some major magazines (Harper’s, Nation, NY Review, etc). On health they provide a false sense of information.
Only sometimes do I see, reported by the like of the estimable Elisabeth Rosenthal, courageous clinicians, researchers, and MD’s, at risk to their careers, speaking truth in their scientific journals. They speak because truth is their thing. To be brief and vulgar, they may be surrounded by opportunist shits and sycophants in their profession, they may have to negotiate around referees and coward editors, colleagues may make jokes at their expense, they may half believe the Sisyphus Myth. (See Social Medicine - Matthew Dumont.) Nevertheless, as true warriors of social medicine, they go ahead and have their say. They are the only pot of gold we have at the end of our health rainbow. They are too few, standing against vast corporate armies and the eunuchs of public media, these Esthers, Miriams and Deborahs, but they find the openings in their professional media. We owe them.
Jim
Going for a Pulitzer, Elisabeth Rosenthal has an article in today’s New York Times on the drive by Merck and GlaxoSmithKline to establish a market for their new cervical cancer vaccines.* Rosenthal gives her article all the best features of Times-style investigative journalism: exposure of how the pharmaceutical industry has pushed their products into a reluctant market, misrepresented need, bought voices of approval, done PR and lobbying and massive amounts of dishonest advertising (young professionals urging girls to become “one less statistic,” young stars leaning forward to confide “my dreams don’t include cervical cancer’). Rosenthal quotes six or so physicians and professors of medicine—and some of them sound pissed off at being pushed around—and two industry apologist marketing people. However, Merck and GlaxoSmithKline have been able to sign up hundreds of physicians (providing $4,500 per 50 min. public talk), put them on “Advisory Boards,” provided them media exposure, and run cervical cancer awareness conferences and programs. I assume they have also printed millions of pieces of “informational” literature.
All Americans of any liberal inclination, all American minorities, and all of the world’s people felt that warming, that first blush, at the possibility of Barack Obama as President of the United States. That had something to do with renouncing our racist heritage. Perhaps it had something to do with reluctance about more of the Clinton duo and something to do with the quality of Obama’s presentations after eight years of George Bush. It had most to do with Obama’s opposition to the Iraq War and our perception that he, as an African-American, would provide a populist focus on America’s problems.
The blush is fading. (more…)
Matthew P. Dumont (b. 1937) is a physician and psychiatrist driven to Social Medicine by his concern for his patients and his long street engagement with mental illness. I mean "street" as in "street savvy" from Dumont’s sixteen years of community mental health work in Chelsea. MA (from fall 1975 through spring 1991 ).* (more…)
I am reading Ralph Nader’s Study Group Report on the Food and Drug Administration titled The Chemical Feast and using one of the health web sites of one of his organizations, Public Citizen, to look up information on dietary supplements found listed on cans of the "energy drinks" being marketed so actively to kids. This was for my article "To Protect Children from Beasts of Prey." Good time to add Ralph Nader to my Social Medicine notes (See my introduction for the rationale).*
Ralph Nader’s (b. 1934 in Winsted, CT) is the author of Unsafe at Any Speed (1965), and responsible for a number of other books (The Chemical Feast (1968), Vanishing Air (1970) and see below). He has made significant contributions to public health. (more…)
All of you will have noticed the emergence of the multi-billion dollar market in "energy drinks," those high-priced water/sugar/caffeine drinks with names like Red Bull (“It gives you wings”), Monster (“Unleash the Beast”), Vault (“The Taste, The Quench, The Kick”), Khaos, Cocaine Energy, SpikeShooter (with the caffeine of three Red Bulls) and, naming just a few, Super Mario Brothers Energy Drink. They are being marketed primarily to children with kid-oriented packaging, youth sports sponsorships, youth accessories (called "Swag"), youth celebrity endorsements, MySpace promotions, kiddy signage, "Reach Out-It’s Yours" displays, etc. The companies deny that they market to children and I’ve yet to read or hear a journalist call them on this obvious lie. Primarily their youth marketing takes the form of aggressive product placement in the aisles of greatest access for the young, all the key kid venues (7-Elevens, CVS, Walgreens, etc.).
Beginning in 1955 Tom McKeown (1912–1988) published a series of professional articles in the journal Population Studies.* He argued from his studies of mortality data that curative medicine was not the great savior of modern man it was said to be, that advances in medical technology, beginning only in the late 1890s, were not the primary cause of the sharp decline in early death from infectious disease that led to the great nineteenth century expansion of population. Nor was it the sanitary reforms that ended “The Great Stink of London.” The major positive factor, McKeown argued, was the improvement in the lot of ordinary humanity by industrial employment and rising wages. Furthermore, he consistently pointed out that these findings have implications for contemporary social well being, for health service legislation, and for international aid policy. Humanity is inherently healthy. The human environment—in the most broad sense of access to clean water, nutrition, and some measure of income equality making these possible—is the key to social health anywhere. (more…)
This Introduction begins my reading notes on the topic of Social Medicine. First I must explain why we should not leave this topic to the experts: the physicians, scientists, and the journalists who have given it their professional attention.
Social Medicine emerged with Florence Nightingale, her colleagues Edwin Chadwick, William Farr, and others in the mid-nineteenth century. They recognized that medical services must go beyond the care of patients who seek the assistance of a doctor. TB, cholera, and typhoid could not be treated effectively in individual patients. Private medicine, philanthropy, and profit-driven enterprises were entirely unwilling to deal with the causes of these plagues. In fact private enterprises were deeply implicated in people’s ill health and their poisoned environment just as they were implicated in the continuation of slavery in the colonies and child labor in the mines. (more…)
Not that it matters, Virginia, but I cannot yet see the line of attack the Republican party will choose against Barack Obama. We are in England for this month away from the US media. British media is not as coy as the American press 
about race. The Guardian sent a journalist to the Appalachian states which Obama lost (some counties as much as 60 points favoring Hillary Clinton). The articles quote local racists in a way that is not done in our press, calm offhand hate speech that is probably illegal in the U.S. Some of the rednecks say they are not “worried about Obama” because he will be assassinated before he ever becomes president. Complacently the journalist quotes this without comment; the Great Chain of British Being (Whites on top just below the lower angels) will be restored. Other quoted rednecks take it for granted that his program, should he win, will be to enslave Whites in retaliation for the 150 years of Black slavery, Jim Crow, and exclusion from the benefits of our sunny national economy. (more…)
Powered by WordPress