Gardasil: New Hampshire shows how it’s done

The keys to creating overwhelming demand for Gardasil: free and voluntary. Live free or die baby:

The New Hampshire experience contrasts sharply with that in many other states, where opponents have cited factors like the drug manufacturer’s profit motive and the fear that inoculating young girls will encourage them to be sexually active.
New Hampshire has critics of the vaccine, too. But its health officials, wanting to encourage use of the vaccine, called Gardasil, say they have hit on an optimal method: making it voluntary and giving it free to girls ages 11 to 18 . . .
. . . In New Hampshire, where people wear their independent streaks with pride, “I suspect that we’re not seeing a significant controversy because there was a never a discussion about whether to make this mandatory,” said Greg Moore, a spokesman for the Health and Human Services Department.

Comments

KipEsquire
“making it voluntary and giving it free”
From “Live free or die…” to “Live for free and have somebody else pick up the tab…”?
So much for New Hampshire as a nest of radical libertarianism.
Tony
I understand the point, but it’s also hard to say it’s completely voluntary. If the parents take the child to get the vaccine, can the child refuse?
Anonymous
Free? Not for the guy who has to pay taxes? It the recipient of the benefits are only willing to get it if someone else pays the bill, then they don’t deserve the benefits–and the someone else certainly doesn’t deserve the bill.
The hell of it is, death by cervical cancer is nearly completely avoidable by regular exams and follow-up–which is still needed after this less than 100% effective vacine. In fact it is predictable that if vaccinated individuals do not obtain the care that they are supposed to get now, and which prevents fatal cervical cancer if obtained, then death rates of cervical cancer will increase, not decrease.
Anonymous
anon 9:19 where is this predicted at? Please supply your source for this hidious remark of yours. gardisil and PAP tests are not the same and they are not used as the same. Gardasil is PREVENTION it prevents of 70% of cancer causing HPV. PAP test is diagnositic…It detects dysplasia there once you already have been infected by HPV. Im hoping you are NOT a medical professional and still needed that pointed out to you.
Yes, cervical cancer is avoidable and been declininhg for a long time but that is not the case with HPV and cervical dysplasia. Show me a study that says HPV is on the decline! When there is a vaccine that will prevent 70% of all cancer and dysplasia causing cervical HPV then what can possibly be your gripe with it?
Anonymous
Anon 9:30:
You answer your own question if you will logically think about that key number of 70%. Do you need an “expert” or citation to do some basic logic? If so, I hope you are not a medical professional, as if so, you can never be anything more than a guideline technician monkey, not a physician.
Think about it. The vaccine can only be expected to be 70% effective in preventing dysplasia (and in the preliminary trials was much less effective than that–that is a theoretical maximum!). So if the other 30% aren’t getting the regular pap smears and dysplasia treatment as recommended now, then in that group cancer rates and mortality can be expected to increase considerabley.
That is ignoring the possibility that the several other cancer causing forms of HPV against which the vaccine does not protect might increase in incidence filling the ecological niche vacated by the strains prevented by the vaccine.
Anyone who thinks that some women will not slack off their exams with the rational that they have been vaccinated deal with a different specie of primate than I do, or just aren’t paying attention to human behavior. The question is how many? Until you know that the answer to that, you muct acknowledge that even universal vaccination could result in higher cancer death rates.
I am a medical professional–one who read studies and interpret’s their implications through a knowledge of the limits of study design and measurement, a knowledge of basic science, 25 years of clinical experience, and basic reason and common sense. I also have been around long enough to see the lastest “medical breakthroughs” disappoint in real practice several times.
One trend that I have noticed is that the excess hype of a new treatment is directly proportional to the profit to be made and inversly proportional to the number of hands in which that profit will be concentrated.
RJS
From “Live free or die…” to “Live for free and have somebody else pick up the tab…”?
So much for New Hampshire as a nest of radical libertarianism
You’re confusing New Hampshire with Massachusetts.
Until you’ve practiced any kind of medicine at any point in the supply chain in both states, you wouldn’t understand.
I love the New Hampshire way of doing this, and hate the Massachusetts one. There’s actual common sense in NH.
Oh, and incidentally, NH has no sales tax or income tax. So no, I’m not paying for someone else’s Gardasil shots. Not directly, anyway, and that’s good enough for me.
RJS
Please disregard the above comment. This is what should have been posted:
————————-
From “Live free or die…” to “Live for free and have somebody else pick up the tab…”?
You’re confusing NH and Massachusetts.
Not for the guy who has to pay taxes? It the recipient of the benefits are only willing to get it if someone else pays the bill, then they don’t deserve the benefits–and the someone else certainly doesn’t deserve the bill.
NH has no sales tax OR income tax.
What taxes, exactly, were you referring to?
Anonymous
Anon 9:02…You want 100%? Show me where there is 100% in medicine. 70% is certainly better than 0%. Your argument doesn’t hold water because the truth of the matter is you better be educationg your patients when they are given this vaccine and explain to them about prevention (gardasil) and diagnostic (pap).
Also, if you think all women are getting PAPs right now, you are SO wrong..I use to think that, until recently I read on a blog, where someone had written about grdasil and the first 3 commenters admitted they had NEVER had a pap test.
Please don’t use your education and your authority to rob the women in your practice, of something that prevents 70% of a bad thing!
mhatrw
To summarize this published medical journal article:
1. In the FUTURE I trial, GARDASIL demonstrated no clinical efficacy among the general subject population for overall reduction in the rates of grade 2 and grade 3 cervical intraepithelial neoplasia and adenocarcinoma — the only recognized precursors to cervical cancer.
2. In the larger FUTURE II trial, GARDASIL demonstrated no clinical efficacy among the general subject population for overall reduction in the rates of grade 3 cervical intraepithelial neoplasia and adenocarcinoma — the strongest (and many would argue only valid) precursors to cervical cancer.
3. Extrapolating from GARDASIL’s very limited clinical “success” (in the FUTURE II study only) against grade 2 cervical dysplasias (40% of which regress spontaneously), 129 women would be have to be vaccinated (at a cost of about $60,000) to prevent a single grade 2 cervical dysplasia.
4. GARDASIL’s protection against cancer associated HPV strains 16 and 18 appears to cause a disproportionate increase in of pre-cancerous dysplasias associated with other HPV strains associated with cervical cancer “raising the possibility that other oncogenic HPV types eventually filled the biologic niche left behind after the elimination of HPV types 16 and 18.”
5. Even if you segregate out the women who hadn’t been previously exposed to either HPV 16 or 18, we are talking about just a 17% decrease in all high grade dysplasias (266 out of 6080 vs. 219 out of 6087) — many of which would spontaneously regress without treatment. So we would have vaccinate 129 women (at about $500 for the three shot regimen) to avoid a single, eminently treatable dysplasia. That’s about $60,000 per dysplasia prevented.
This is all directly from the article linked above.
I myself would add that we currently have only 3 years of follow up to go on in terms of both GARDASIL’s safety and efficacy among the 16 to 26 year female population, no data concerning its efficacy among 9 to 12 year old girls and only 18 months of follow up on less than 600 total preteen girls in terms of safety data about GARDASIL within its targeted population.
Mike
Right on MHATRW! I’m sick of people writing with grandiose statements on this site about how doctors and gov’t are “raping” women by not giving access to every drug for free. PUH-LEESE!!! Public health measures should not be enacted just like that over limited clinical efficacy and evidence. If a disease is truly preventable with condom use, I think spending 60,000 per dysplasia prevented is not the smart choice anyway. But health policy makers and the CDC should be deciding these things. And they should take their time doing it. It’s not a crisis, like say AIDS or lung Cancer.
Anonymous
I am a physiciana and reviewed the literature and decided not to recommend the vaccine to my 18 year old daughter. Should I advise something to my patients that I wouldn’t advise for my own loved ones, based on an “official” recommendation from a panel composed of person’s whose personal integrity and conflicts of interest are unknown to me? I think not.
So where does RJS think the New Hampshire government gets it’s revenue? Voluntary contributions? A backyard money tree? Obviously some people are paying for these “free” vaccines with tax revenues and that means confiscation. RJS may be stupid enough to believe that if he doesn’t pay an income tax every quarter or a sales tax at the cash register he isn’t paying taxes. I am not.
RJS
“So where does RJS think the New Hampshire government gets it’s revenue? Voluntary contributions? A backyard money tree? Obviously some people are paying for these “free” vaccines with tax revenues and that means confiscation. RJS may be stupid enough to believe that if he doesn’t pay an income tax every quarter or a sales tax at the cash register he isn’t paying taxes. I am not.”
Of course they get money. However NH has limited social programs, and it is more expensive (for instance) for one to go to UNH as an in-state student than it is for the same student to attend UMass as an out-of-state student.
NH is not a nanny state by any means. The opposite really, which I applaud.
As someone born and raised in NH, I prefer it this way. I would choose this over the Massachusetts way of doing things (throw money at everything and tax the hell out of everyone) any day of the week. Sink or swim on your own, so to speak, when it comes to just about all aspects of life: education, medicine, etc.
NH gets a great deal of its revenue from things like the lottery and “sin” taxes. And state liquor stores. And since I don’t play the lottery, smoke, or drink particularly often, I am not paying. So in many respects, it’s voluntary.
In terms of getting money for local things, vehicle taxes and property taxes pick up some of the slack because the more traditional methods of getting tax revenue don’t exist in NH.
Anonymous
Incredible! NH has property taxes, utility taxes, communication taxes, meal taxes, . . . and the Dumb*** thinks he doesn’t pay taxes! Well, that will certainly speed up screening the blogs for something worth reading!
RJS
My point is merely that NH residents are taxed far less than, for instance, MA residents. And the residents of most other states, for that matter.
RJS
Oh, and Massachusetts has all those taxes, too. (As do most other states.) So I’m not entirely sure what you’re driving at.
Anonymous
Then I hope you are screening the boys your 18 yo daughter dates really well. Contrary to popular belief it does not take multiple sex partners, it only takes one. So, if down the line, your daughter gets cervical dysplasia and needs to have colposcopy, biopsies, and if she is lucky, cryotherapy, make sure that you take part of the blame for her going through that, DAD!
With over 50% of college girls having HPV, you’re a fool to be that naive.
Diora
Anon at 9:23, have you bothered to read the study referenced by mhatrw or at least his post? Can you disprove his data? You are using emotion to argue for spending on the vaccine that may not even be effective and you don’t provide any evidence that the paper that questions its long-term efficacy is wrong. Nobody prevents you from buying it for your daughter or yourself, by the way. You seem to completely ignore the data from a peer-reviewed paper in a medical journal based only on wishful thinking.
As a woman, I agree that a vaccine that is proven to significantly reduce the number of false positive pap smears as well as overtreatment (in the current legal climate..) would be a good thing, but the evidence that it will indeed be doing just that does not appear very convincing to say the least, at least based on the arguments mentioned here. Should there be a bit more evidence before this type of political decisions are made? And why does this vaccine need to be treated differently from any other new treatment or preventive measure? Does NH provide free statins for people with heart desease or free osteoporosis-prevention drugs for women at high risk? Where is the threat to public health that requires interference of the government?