If you're living in the US: please consider getting the vaccine, ragardless of your age. It was covered by my (rather shitty) health insurance. It consists of just 2 (EDIT: 3 for adults!) doses. It is recommended for both Males and Females.
It is actually not straightforward to do. Safeway Pharmacy refused to actually give me the vaccine when I showed up saying I'm not in a group that's eligible. One Medical told me that it would be a $400/shot 3-shot regimen. I'll probably just travel to India some time to visit family and get Cervavac there instead of Gardasil here. It's about $20/shot.
as far as I can tell, pharmacists cannot give vaccines off-label (this is an issue for the new covid guidelines and some states fell back to an Rx if no longer eligible for the covid booster).
Your PCP may give a vaccine off-label though, which is how I got my Shingrix, though I had to pay out of pocket.
This is mostly guesswork but I think you need to get the vaccine before you catch it and lots of people have it as they get older.
If you have a limited supply the greater bang per buck would be to start with the young people who almost certainly haven't caught it yet and then work your way up.
It's less that and more "we just haven't tested it in older populations yet".
Sure you are more likely to have it the older you are but even then you are unlikely to have all the strains. The vaccine covers like 9 or 10 different strains so it can protect you from the other strains even if you already have one of them.
It's generally only when you get into the 60s and up that the justification for not recommending the vaccine changes. Once you get into those later years the immune response changes a bit and you get new concerns.
An example being herpes zoster (chickenpox) where after a certain age you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get).
> Why is there an age limit on an all encompassing vax
Vaccines are subject to stringent safety standards since they’re administered to healthy people. The age limit may suggest that at the time of the recommendation, in the relevant jurisdiction, the manufacturer had not studied its safety and efficacy in >40 year olds.
(I also don’t think it’s an age limit as much as the upper end of a recommendation.)
E.g., the Shingles vaccine simply hasn't been tested in <50 populations. But if you're under 50 and you've had the chicken pox, you should ask your PCP to prescribe the shingles vaccine off-label and go get it, because shingles sucks and the vaccine definitely works.
I don't follow your logic here. The GP comment is saying that the vaccine isn't available for populations it hasn't been tested for. Why are you recommending people ignore the fact that safety and efficacy testing isn't available for their population?
And how can you say the vaccine definitely works for populations it hasn't been tested on?
It's an age limit to the approval caused by a lack of studies. To study it in over 45s you need suitable over 45s--but there aren't a lot of over 45s with risk but not prior exposure.
The rationale is that most sexually active people have already been infected with HPV anyway, so the largest benefit of administering the vaccine is at a young age.
In the US, recommendations come from the United States Preventive Services Task Force. They explicitly do not consider cost in their decisions. They look at harm vs benefit, usually with a focus on mortality reduction. Most insurance companies will base their coverage on the USPSTF.
Decisions as to whether or not to pursue regulatory approval for, example, expanded coverage of the HPV vaccine to men, or older age groups, is very commonly informed by cost-benefit calculations. I've worked on those projects, seen presentations by my colleagues, etc. There was a good two years of my life where this was what I worked on (mostly strain replacement post-vaccination).
It's a level of evidence that's generated (usually) prior to ACIP, and it is presented to them, while there is not necessarily a bright line threshold.
if you suspect that the cdc has been captured by big pharma, "and we don't care about cost of these recommended drugs" should pretty much seal the deal for you :)
There used to be fears of "death panels" controlling access to medical care when Clinton tried to propose universal health care.
The CDC and FDA are about safety, not cost management. And they get significant complaints about how much they regulate pharma and are impediments to pharma for that!
Now the conspiracy theorists of the other side seem to be having their day in the public mind.
This isn't a conspiracy theory - I worked on projects around that during graduate school, and talked to my colleagues who worked on them. Cost-effectiveness thresholds are a consideration that goes into how widely a vaccine will be rolled out, etc.
That was, for example, why boys were originally not part of the recommendation for the HPV vaccine. It would double to cost, while doing very little to prevent cervical cancer via indirect protection. Once the evidence accumulated that it was associated with other cancers, that stopped being true.
Cost considerations would be more from the CDC's Advisory Committee on Immunization Practices, not the mentioned above United States Preventive Services Task Force. (Oh, and I see that another comment parallel to mine up there now mentions ACIP too...)
In any case, somebody thinking that evaluating safety and efficacy aside from cost considerations means that there's collusion with pharmaceutical companies would be a conspiracy theory.
the cdc decides to make recommendations no matter how expensive, and big pharma collects the expensive, and the expert community works for the cdc and big pharma? do you even understand what regulatory capture is? do you understand how framing something as saving lives no matter the cost draws attention away from funneling money to big pharma no matter the deficit?
A lot of replies that are mostly true, or somewhat true, or simply missing the real reasons.
There are two factors here:
1) Vaccine-derived immunity is a function of the individual's immune response, which in general, weakens significantly with age. It is not unrealistic for a vaccine to simply fail to elicit any response in someone old enough.
2) It is very, very difficult to recruit folks without HPV that are over 40 for a clinical trial. Most people of that age, who were never immunized, most likely have had it. This significantly convolutes the signal.
3) This is all especially confounded once something becomes "standard of care". Every year there are fewer and fewer people age 40+ with HPV.
For these reasons, the vaccine is currently officially ??? in people over 40. Most doctors will prescribe it anyways if you ask. It may or may not infer immunity. It almost certainly will not harm you.
HPV tests are of low value (as an adult, if ever sexually active, you likely have it but can do nothing about it); a new biomarker test that can detect the cancers is being developed [1]. Ongoing cancer surveillance is all you can do once exposed without having been vaccinated (and if cancer occurs, immunotherapy).
As pm90 wrote, I strongly recommend getting vaccinated [2] unless a doctor tells you otherwise, even if you already have HPV or have had previous potential exposure.
Isn't that basically everyone who's had sex with someone who had sex before the vaccine was common? I was denied when I asked my last doctor, on that logic. I'll ask my current doctor.
Right. And a few years ago my doctor's office had orders for both the the quadvalent vaccine and the nonavalent vaccine in the system and almost ordered only the quad for me.
Definitely ensure you're requesting the 9 strain version.
Information from the CDC [1], indicates Adverse Reactions are similar to administration of a placebo, which is not zero. Any vaccine administration has potential for negative adverse reactions, it's reasonable not to get a vaccine if you judge the upside is not worth the downside, even if the downside is small.
The CDC says:
> Like all medical interventions, vaccines can have some side effects.
> A temperature of 100°F during the 15 days after vaccination was reported in 10% to 13% of HPV vaccine recipients. A similar proportion of placebo recipients reported an elevated temperature.
If you take some research subjects, do nothing to them, and then ask how they did 15 days after, I would be surprised if 10-13% reported a 100F fever during that time. But, that's a reasonable result from a saline or hpv injection.
It's not approved for those over 45. (AFIAK, simply because so few people in that age group would have risk without having had prior exposure. Basically only those who had divorced or lost their long time partner.)
This is not true any more. The vaccine has been shown to lower cancer risk for those who already carry the virus, so it is recommended even for people who are HPV positive
That feels like a wild assumption to me - we really think people 45+ aren't having casual sex? less casual sex maybe, but I would imagine still a decent amount, statistically.
There are over 30 strains of HPV with just 2 causing the majority of cancers. So sure, most people may have had some strain of it, but that's not really relevant unless immunity is broad across strains.
I met with a new PCP a few weeks ago and it was recommended to me (at age 43). I got the first shot with the 2nd and 3rd scheduled for the coming months.
I'm sorry, but you sound like the people who try to get me take ivermectine for Covid. "just get it off label" or "tell the doctor you just got back from pauea new guinea and saw worms in your stool."
I know you are very well intentioned, but American's actually have very good doctors.
It's a standard vaccine for preteen/teen boys now too. If your doctor has been telling you not to get it for the past 15 years, they've been doing you a disservice.
I got 3 doses of gardasil at 37 in Norway. I do not want to expose women to a potentially deadly virus (plus I’d also like to avoid having penile cancer and mouth/throat cancer myself). If your doctor is seriously advising you against taking the vaccine, you should consult another doctor for a second opinion.
“The route of HPV transmission is primarily through skin-to-skin or skin-to-mucosa contact. Sexual transmission is the most documented, but there have been studies suggesting non-sexual courses.
The horizontal transfer of HPV includes fomites, fingers, and mouth, skin contact (other than sexual). Self-inoculation is described in studies as a potential HPV transmission route, as it was certified in female virgins, and in children with genital warts (low-risk HPV) without a personal history of sexual abuse. Vertical transmission from mother to child is another HPV transfer course” [1].
Right, but do the vaccines help against the strains of HPV that are transmitted via non-sexual contact? The vaccine being 9-valent implies (to me, a layman) that strains need to be targeted fairly specifically in order for vaccination to be effective.
Yes. While direct genital contact is the highest probability way to spread it, any skin-skin, skin-mucosa, skin-object-skin contact can potentially spread it. Consider how much you trust others to wash their hands after using the restroom. Low probability, but possible.
You’ve got a low probability of getting polio, but there’s no reason not to be vaccinated if you can.
Even if you already have a strain, there are multiple types. In fact, people who got a vaccine early on, should consider an updated shot for more complete protection.
The protection from the vaccines lasts (probably) a lifetime, and HPV is quite widespread because it is: very easily communicable, and infections linger for potentially long periods of time without any obvious symptoms
Something like 80% of people are sexually active at all will be infected with HPV at some point. You may not have been sexually active, but your future partners may have been. I personally have a friend who went through stage 4 cancer contracted from her (now ex) husband.
So, of course not literally everyone needs to take it, assess your own risks, but it's quite an easy, highly effective vaccine: don't overthink it.
Rape, you might become sexually active in the future, and although sexual transmission is the most common way, there are some other ways to get infected.
Unless you're never sexually active (meaning, you eventually do have sex), it's worthwhile getting since there is a risk to yourself if you get infected.
I'm male and read about this exposure vector back in 2012 when it was only rolled out to 12 year old girls, with a further guideline that nobody over 26 should take it.
this was pre- antivaxxer anxiety, and just run of the mill 'is the government condoning sex' anxiety, and it was controversial for that reason alone
the issue was that if you've been exposed already then the vaccine doesn't work. they had a test for women that can prove they've been exposed or not, and most adults have. they don't have a test for men that can prove they've been exposed or not, and most adults have. At the time, they had also only considered males to be carriers, with no cancers themselves.
so for the US government to recommend a limited stock and get insurers on board, it was all based on probabilities of exposure and utility.
I was younger at the time, naturally, I paid $600 out of pocket to get it across 3 doses because I figured it was worse than that, or I could get some 'male ally' brownie points from women. I wasn't wealthy then but figured this experience couldn't be taken from me even if I went bankrupt.
Since then, they've further linked it to throat cancers in males, because of our mouth's contact with genitals, and insurers are told to cover it across all genders and up to mid 40s. that's not really much of a difference now though, since the checkpoint is basically the same group of people, 13 years later.
They're still assuming older people are not worth bothering with, due to likely exposure.
There is an amusing side of this if you are male and not vaccinated yet, since nobody can tell if you've been exposed still: keep your sexual relationships with younger women. lol. in case you needed an excuse - higher probability they're vaccinated.
"this was pre- antivaxxer anxiety" - It was really, really not.
Another thing to keep in mind was that the initial trials were only using cervical cancer endpoints - the association between HOV infection and cervical cancer is really strong. At that time, vaccinating boys provided only indirect protection (you couldn't infect a female partner), rather than direct protection (you won't be infected) in the context of cervical cancer.
Women prior to sexual debut were the biggest "bang for the buck" and the obvious first recommendation target.
Researchers both at universities and in private industry then started working on other populations based on alternative endpoints.
The current recommended cutoff is 45 (well, pre the current US administration). So I think it was a question of we tested this at the time in these high risk age groups and we were still waiting on the results for other cohorts that were less important.
I went to my local megacorp pharmacy out here in California, and asked about the COVID vaccine that’s no longer recommended by our anti-vaxxer overlords.
Apparently, it’s about as easy to get as an old-school medical marijuana card.
Results vary by state though. No need to travel to Canada or Mexico (yet).
If we had as trivial of vaccinations for smallpox, anthrax, and rabies as we have for HPV, I'd collect them all. One fewer risk in my life, and a finite reduction in the risk of everyone around me's life, with no downside at all.
1 pin prick * 340,000,000 people > 340,000,000 people * 6.1 cases of cervical cancer * 0.9 efficacy / 100,000 people
Your world view assigns equally negative utility to at most 18,214 shots as 1 case of cervical cancer.
Put another way: If you were told you had to either take a shot every day, or you are guaranteed to get cancer, would you really choose the cancer?
Good stuff. Australia has a target for eliminating cervical cancer by 2035 and ofcourse HPV is responsible for a large proportion of penile, mouth, throat and anal cancers as well. All my kids got free vaccinations at school.
It is shocking that there are still places in the world where this is controversial. You can tell a lot about the qualities of a society by the way they care for their own.
You should think about how you would react to “you can tell a lot about the qualities of a society by the way they [detain people on Nauru | reject asyl seekers | don’t care for indigenous populations]”.
I feel your comment is a generalisation and could be construed as provocation/trolling. Probably not your intention, but just so you are aware how this is coming over.
Better maybe: “societies that have good health care thrive” or something like this. Sounds less judgmental and it doesn’t put all US Americans in one basket.
I fully agree on the content though, only criticising the form here.
RFK Jr may be a bit biased, his opposition has been profitable
> Kennedy for years has earned referral fees from Wisner Baum, a Los Angeles personal injury law firm that is currently suing Merck, alleging the pharmaceutical giant failed to properly warn the public about risks from its vaccine against human papillomavirus (HPV), Gardasil, according to financial disclosure documents filed by Kennedy with the Office of Government Ethics.
The goal wasn't to eliminate the HPV strains, it was to decrease cervical cancer. Has Denmark encountered a drop in cervical cancer? If so, that's a great outcome!
The lead time from infection to cancer is very long, we would not expect to see too much of a drop *yet*. But testing for those strains seems to be as useful for screening as a pap smear.
It has only been targeted against the strains known to cause cancer. I haven't looked but I would guess getting all strains would have been a greater challenge, and would not have greatly increased uptake of the vaccine. The false perception that it's a vaccine that will encourages unprotected sex has already greatly hindered adoption in the US.
That's really interesting, and from that I would assume that the risk of cervical (or other cancers) from HPV is associated with how often someone is reinfected? ie, someone who got HPV once in college doesn't have HPV their whole life? And potentially has a lower cancer risk than someone who is repeatedly re-infected?
It's incredibly prevalent, but most people clear it within a couple years, and won't even know that they had it. The time to clear it is just variable and depends on your body's immune response, the longer you go without clearing it the higher the cancer risk.
In a sense no, hence the choice to vaccinate younger children who will mostly not be sexually active yet.
But because the modern versions of these vaccines cover many strains (initial vaccines were two, Denmark chose a 4 way vaccine, now a nine way) it's very possible that you get a meaningful benefit by being protected from say six strains your body has never seen, even though the three it has already seen wouldn't be prevented.
I've heard of it being administered post exposure as a way to help the body fight the existing infection. Seemed a little odd when I first heard it as HPV should clear on it's own.
Wasn’t this also the same conclusion for Australia? Cervical cancer plummeted to record rates. Men should still get it so they don’t effect their partners and HPV causes all sort of cancer too.
Yes, Michael Douglas had a throat cancer he said was from "oral sex" meaning HPV infection, and I remember social media berating him for saying that as if it were impossible, but it really is.
Random anecdote: with whole genome sequencing, which is fairly common among the rich with cancer, you can sometimes find the exact cancer driving genes that the HPV has amplified. I remember looking at one case where the HER2 gene was amplified with many copies, and you could see it attached to chunks of HPV genome. Fortunately there's now many drugs that specifically target amplified HER2, originally developed only for breast cancer, where there are diagnostic test to find the subset of breast cancers with the amplification.
Australia rolled out the HPV vaccine for girls in 2007. Boys were included in the program in 2013. Modelling says that "elimination" depends on both the vaccine and a screening program [3].
That's great to hear! Here where I am, Ontario, Canada, I just barely missed out on getting the HPV vaccine for free in high school. At the time, they were only vaccinating girls, but added boys a year or two after me.
> "Details of the Gardasil litigation show how Kennedy took action beyond sowing doubt about the safety and efficacy of vaccines in the court of public opinion and helped build a case against the pharmaceutical industry before judges and juries."
> "Kennedy, a longtime plaintiffs' lawyer, became involved in the Gardasil litigation in 2018 in collaboration with Robert Krakow, an attorney specializing in vaccine injury cases, Krakow said"
I remember this being a big controversy in Texas in the 2000s. Our Republican governor, forcing girls to get the vaccine! What does he think Texan girls are, lusty?
Not like disease prevention is a universally good thing and some people tend to have sex.
At the end of the day, religious radicals like STDs because it enforces their worldview that having multiple sexual partners in a lifetime is a sin.
Depends on your health insurance. My previous insurance company paid back the full cost when I was 30 years old. I can recommend checking https://www.entschiedengegenkrebs.de/vorbeugen/kostenerstatt... (and then also confirming that with the insurance company over text, just to be safe)
In Denmark you can. I was in my mid thirties when I went to my doctor to ask them to prescribe it. Before each shot I would go to the pharmacy and buy one dose and go to the doctor to have them administer it for me (if I wanted to). At that time I think it was free for teenage girls, now it's free for teenage boys as well.
The evolution of who gets HPV vaccines is really interesting. At first it was young women, as vaccinating young men had a very marginal decrease in cervical cancer rates via indirect protection (which itself is a function of how many young women are vaccinated). Then as HPV infection was linked to more cancers, vaccinating young men crossed the cost-effectiveness thresholds many governments use.
Vaccinating older populations is similarly just a less clear-cut case, but it's a cost-effectiveness argument, not one purely driven by if the vaccine offers protection.
it's not just the cost of the vaccine roll-out though, you need test on your target demo and since these are healthy people the bar is very high. If the demographic (like males over 45) shows very little involvement in the infection vectors then testing might fail the cost-effectiveness, not the delivery of the vaccine.
Generally yes. I asked my primary care physician and would have been able to get the vaccine dose from the pharmacy (paying for it myself) and she would have administered it.
It’s insane to think that someday humanity will finally find a cure for cancer, and then after all this money and research and struggle people will just… choose not to use it.
A cure is a treatment, a vaccine is a prophylactic. The most dangerous, by far, cancer that this would help mitigate is cervical cancer which makes up about 0.7% of cancer deaths in the US, exclusively amongst women. The overwhelming majority of cervical cancers occur in Africa due to the fact that HIV/AIDS dramatically increases your susceptibility to developing it.
I think this is untrue. All work by uncontrolled replication of cells. This is why nanotechnology had the promise of being able to eliminate cancer - imagine a nano scale robot regularly cycling through your body on occasion, looking for and eliminating cancerous growths.
Drugs, though, probably have very limited potential.
It turns out a human body has a lot of surfaces facing the "outside" in some sense and we forget about the parts we can't see. Most of this surface is not covered in what we'd conventionally consider skin. It's bit like if you were looking at surfaces in a house and forgot the walls and ceiling.
And even before the antivax nutters here went from fringe to a significant social force, HPV vaccines were already being decried for "promoting casual sex." Our culture is so broken in so many ways.
Also, forget "She might die of cancer" just exactly how bad is it if your daughter is a whore ? What else are we ruling out, independent business owner, politician ?
What happened to "I just want my children to be happy" ?
Of course, I for sure held off on having casual unprotected sex with multiple partners as a teenager because I was worried about contracting HPV, but thanks to Gardasil my slut era was legendary and enduring.
Maybe we’re seeing selection pressure against those prone to addictive cycles of social-media influenced misinformation?
Like, anti-vaxers died at higher rates in Covid [1]. This will continue across disease outbreaks, particularly ones for which we have near-comprehensive vaccines like measles. And given antivax sensibility is heritable (through parenting, not genes), one would expect this to stabilize the population over several generations to one that doesn’t have this defect.
The article you are referencing is based on CDC data which is not matched by a more complete data maintained by UKHSA. I think Norman Fenton commented on that at some point. I'd be careful when taking its conclusions at a face value. I actually went through that paper and looked at the UKHSA data back in 2023.
And the government was spreading a lot of BS, too.
I'll let the "CDC can do no wrong" crowd pile up.
very few people are against vaccines per se, they are just against *unsafe* vaccines. "anti-vax" is a term used to dismiss dissident without having to deal with their arguments i.e an ad hominem. As an analogy, if I object to high levels of mercury in fish, am I anti-fish? or anti-poisonous-fish ?
The people that are against "unsafe" vaccines do not do the proper research to determine whether a vaccine is actually safe. These people claim that safe vaccines, like the COVID shots, are actually unsafe because they googled up some claims that were not rigorously researched or reviewed.
I had seen attempts to engage with these arguments in good faith. It was wasted effort.
I think you missed the point. Granted the disease is dangerous, but what if the cure is worse ? If we don't know this is true, we ought to assume the risk outweighs the benefits until PROVEN otherwise- that is the precautionary principle. As an analogy take Vioxx, a headache remedy that caused thousands of heart attacks. Merck the manufacturer started an advertising campaign for the drug AFTER the learned it was killing people - they were ultimately fined 4.5 billion.
The docket shows us that pharmaceutical companies are serial felons who have paid some of the largest fines in history for lying about their products. It is prudent to be skeptical until proven otherwise.
I agree.
Pfizer settled more than a few cases.
When talking about a low probability but catastrophic event, the burden lies on the side of the vaccine manufacturer and a mandating agency (and not on the side of the consumer) to prove beyond any doubt that the treatment is safe. I doubt Pfizer has met that bar.
Edit: To all the pro-Pfizer downvoters, feel free to take some Zantac. You have learned nothing.
This is now a global problem. The guy who started it, Andrew Wakefield, is British, and we have long had antivaxxers in Europe too.
Prior to Covid, the antivaxx scene was vaguely left-and-green oriented, biomoms, vegans and other "very natural" people; you would expect them to vote for Greens or even more alternative parties. This changed abruptly and now the antivaxx scene is mostly rightwing, but the common base is still the same distrust.
I wonder if this is the price we pay for radical informational transparency. Nowadays, democratic countries with reasonable freedom of press cannot really prevent their own fuckups from surfacing in the worst possible way. Some people react by complete rejection of anything that comes from "official" channels and become ripe for manipulation from other actors.
i dont think its nearly so transparent. its easy to be recommended and read some viewpoints, but very technical and hard to be recommended others.
with radical information transparency, id expect both views to be equally easy to parse and to be recommended both, in which case the choice would be obvious to everyone, or at least they could very well describe their risk tolerance to different risks, or laziness, for why they made a certain choice.
i expect im not up to date on all the vaccines i should be, but its on laziness rather than gwtting bad information. ...also a lack of information on which ones i should have.
> I wonder if this is the price we pay for radical informational transparency. Nowadays, democratic countries with reasonable freedom of press cannot really prevent their own fuckups from surfacing in the worst possible way. Some people react by complete rejection of anything that comes from "official" channels and become ripe for manipulation from other actors.
Such people have always existed, unfortunately. I don't think it's a result of anything particularly new.
The people existed, but a portable always-running conveyor belt of bad news that is addictive enough to make them glued to the screen did not.
In the 1990s, you had maybe 15 minutes a day on average to consume news, either from a paper newspaper, or from an evening TV relation. Now, quite a lot of people spend 20 times as much time doomscrolling. Of course the impact will be much more massive.
Sure, but this implies the only source of "manipulation from other actors" is the news, media, or government. Churches, cults, and just other ignorant people existed to cause distrust in authority.
I'm not denying that there's a difference - obviously technology has enabled the scale of things to grow quite a bit, both good and bad - but it's beside my point, which is that, given that it's not a new phenomenon, blaming it on technology seems doomed to failure. Without solving for the underlying issues, people will continue to mistrust authority, whether they're being told to by news or their neighbor.
Mistrusting authority might be good. What I see happening is in fact trusting too much into "authority" without penalizing it for inconsistencies - I would call it more like blind faith. I feel this happens because it makes it easier than questioning everything you hear and deciding for yourself, and accepting you might be wrong, or that the information is unknown. People want a savior and a simple solution!
> blaming it on technology seems doomed to failure
Recognizing that technology is now so convenient, psychology manipulative, and operates in a furiously fast feedback evolutionary regime, and that it has radically increased the spread of cultural irrationality isn't about "blame" in a judgy moral way.
It is about characterizing major factors behind the problem.
The enormous amount of near instant coordinated (by intention or dynamic), interactive misinformation, made so conveniently available that large percentages of the population routinely and enthusiastically expose themselves to it, participate in reinforcing it, throughout their typical day, is very new.
> "Not everything that is faced can be changed, but nothing can be changed until it is faced." -- James Baldwin
That's a little like saying nuclear bombs aren't a technology, but a human problem. And you bet, they sure are, but it's a lot harder to wipe out everyone, if the nutjobs in your community just have a pointed stick.
And 'nutjobs' may be pejorative, but I'll hold on to it as apt. At the same time I assign no blame, for it is an issue of cognition. The best way I can describe it is, intelligence is not a single factor. And it's not even a few factors. It's a massive bar graph, with 1000s upon 1000s of bars, each delineating a different aspect of intelligence.
A lucky few may score high on all those bars, yet even the most intelligent of us tend to score high on only some of those bars. And my point is, I've seen people immensely intelligent on some of those bars, yet astonishingly deficient on others.
We love to make fun of politicians, so I'll use one as an example here. Politicians tend to be incredibly personable, and very difficult to dislike in person. They exude congeniality, they read you like a book, and can often orate your wallet completely out of your pocket, and you'll thank them for it too. It's how they managed to go so far politically, yet some of these same politicians have severe and massive deficiencies in cognition.
Back to the pointed sticks, and the nutjobs who would wield them pre-tech, these people are simply as they are. Yet in the past, you'd see one nutjob in a community, and they'd be surrounded by normalcy, it would temper them, mitigate their effect, sand off their edges so to speak.
Yet as our communities grew in size and scope, these individuals could finally meet more of their ilk. A large city might have dozens of them, larger still cities hundreds, and they'd meet up. And as technology grew, and access to the printing press become possible for all, and for less and less cost, these same people could then send their madness in newsletter form to even those small communities where maybe only one nutjob existed.
But those people needed to still connect in some way. Maybe through an ad in the back of a magazine, or something akin yet far less gated by 'normals'.
Yet today? Now? Algorithms match you up with all those nutjobs. Where before you might live in isolation, and the friends you had might scoff at that weird idea you have, now you've found a community of hundreds, or thousands just like you! And they all affirm your madness, they pat you on the back, they congratulate you for seeing the light! They whisper all those sweet nothings into your ear, all those secret things you knew were true, and they listen to all you say on the subject.
For the first time in your life you have a home, a community, and before TikTok, or some weird forum, it would have never all been possible. You'd have been isolated, even in the age of magazines, and print, for you'd have never found one another.
And worse, now profit enters the system. Those who would steal, or thieve, or build bridges with sub-standard concrete for profit, or anything for money regardless of cost to us all, appear on this scene. They see those nutjobs, and they seek to profit from them. They own youtube, or tiktok channels, and often do not believe in anything but profit. They'll tell you anything you want to hear, espouse any crazy idea, and like that bridge built with substandard concrete, they'll take the money and run as society collapses around them.
This profit motive was always there, see cults. Yet the reach and scope was just not what it is today, there is so much more range given to a single person now.
People have had a mistrust in authority as far back as when nomadic tribes were the norm but somebody had to decide where to hunt or gather that day or to move on. Good luck changing human nature.
Chatty Kathy could only share her moonbat ideas with a couple people at a time. Now she has a TikTok and the ability to go viral. Even folks sharing her video to mock it are spreading her message.
Although you are (as I understand) right, the question itself is valid, lots of diseases spread to species other than the one that is in the name… Chickenpox, monkeypox, swine flu, or even the Spanish flu.
This site is full of people perfectly capable of reading most studies. I would much rather see these links go to studies than endless clickbait articles about studies.
The conclusion of the study show that about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection. This does appear to be a reduction from an earlier 2013 study but the earlier study was by different authors with different methodology so gauging the scale of the reduction is not straightforward. My opinion is that a safe conclusion of the study is that HPV prevalence has not increased.
> Infection with HPV types covered by the vaccine (HPV16/18) has been almost eliminated. Before vaccination, the prevalence of HPV16/18 was between 15–17%, which has decreased in vaccinated women to < 1% by 2021. However, about one-third of women still had HPV infection with non-vaccine high-risk HPV types, and new infections with these types were more frequent in vaccinated than in unvaccinated women.
The conclusion seems to be that the vaccine is extremely effective at preventing infection by the strains included in the vaccine. One might reach a stretch conclusion and infer that the 9-valent vaccine would be even better as it would (probably) dramatically reduce the risk of several of the remaining “high-risk” variants.
The study is linked early in the article and is fairly dense, the article summarized it well and is a lot more readable.
16/18 are the most carcinogenic strains, they have been close to eradicated in Denmark. "Denmark close to wiping out leading cancer-causing HPV strains after vaccine roll-out" is the full headline and 100% accurate.
Those were the only two high risk strains covered by the vaccine used in the time frame studied. The study covers the first cohort of girls given the 2008 version of the vaccine when they recently reached age to start screening. It is expected to not see other strains affected in this study, even though current vaccines are broader. The total number of high risk HPV cases in the study went down post-vaccination.
The notion of numbered strains of HPV is about diverging lineages going back hundreds of thousands of years in a highly conserved, slowly mutating virus. They are not comparable to things like seasonal COVID or flu strains.
> about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection.
That number was referring to different strains not covered by the vaccine. The study says the rate of infection dropped to less than 1% among those strains the vaccine protects against.
Denmark is in a chronic baby shortage [1] and people in Western democracies are having less sex generally [2]. So, yay, less HPV. Go get vaccinated [3]. Unfortunately, there are some pretty significant (and sad, yes, sad) confounders.
Do you mean there is a causality between less sex and HPV vaccination, when you write “confounder”? I can’t find any study supporting this, hence double checking.
Cervical cancer really doesn't need to be a thing anymore, the vast majority of cases are oncoviral, and we know how to prevent HPV.
If you're living in the US: please consider getting the vaccine, ragardless of your age. It was covered by my (rather shitty) health insurance. It consists of just 2 (EDIT: 3 for adults!) doses. It is recommended for both Males and Females.
It is actually not straightforward to do. Safeway Pharmacy refused to actually give me the vaccine when I showed up saying I'm not in a group that's eligible. One Medical told me that it would be a $400/shot 3-shot regimen. I'll probably just travel to India some time to visit family and get Cervavac there instead of Gardasil here. It's about $20/shot.
Depending on the state you’re in, you likely have to get a prescription from a doctor, not a pharmacist, due to the wording of the law.
Simplest route would be to call your primary doctor and ask if they can give it to you at your next annual checkup.
as far as I can tell, pharmacists cannot give vaccines off-label (this is an issue for the new covid guidelines and some states fell back to an Rx if no longer eligible for the covid booster).
Your PCP may give a vaccine off-label though, which is how I got my Shingrix, though I had to pay out of pocket.
What’s the procedure of getting Cervavac in india?
You can pretty much walk into any decent clinic and just ask for one.
And note i believe they just increased the recommended age of administration up to ~40yo? Throat cancer sucks. Get the vax.
Why is there an age limit on an all encompassing vax, wasn't the famous posterchild for this disease Michael Douglas?
This is mostly guesswork but I think you need to get the vaccine before you catch it and lots of people have it as they get older.
If you have a limited supply the greater bang per buck would be to start with the young people who almost certainly haven't caught it yet and then work your way up.
It's less that and more "we just haven't tested it in older populations yet".
Sure you are more likely to have it the older you are but even then you are unlikely to have all the strains. The vaccine covers like 9 or 10 different strains so it can protect you from the other strains even if you already have one of them.
It's generally only when you get into the 60s and up that the justification for not recommending the vaccine changes. Once you get into those later years the immune response changes a bit and you get new concerns.
An example being herpes zoster (chickenpox) where after a certain age you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get).
> Why is there an age limit on an all encompassing vax
Vaccines are subject to stringent safety standards since they’re administered to healthy people. The age limit may suggest that at the time of the recommendation, in the relevant jurisdiction, the manufacturer had not studied its safety and efficacy in >40 year olds.
(I also don’t think it’s an age limit as much as the upper end of a recommendation.)
E.g., the Shingles vaccine simply hasn't been tested in <50 populations. But if you're under 50 and you've had the chicken pox, you should ask your PCP to prescribe the shingles vaccine off-label and go get it, because shingles sucks and the vaccine definitely works.
I don't follow your logic here. The GP comment is saying that the vaccine isn't available for populations it hasn't been tested for. Why are you recommending people ignore the fact that safety and efficacy testing isn't available for their population?
And how can you say the vaccine definitely works for populations it hasn't been tested on?
It's an age limit to the approval caused by a lack of studies. To study it in over 45s you need suitable over 45s--but there aren't a lot of over 45s with risk but not prior exposure.
The rationale is that most sexually active people have already been infected with HPV anyway, so the largest benefit of administering the vaccine is at a young age.
It's likely that they haven't tested it as thoroughly in older folks and that most older folks have already been exposed to HPV.
Already exposed without having any issues from it.
That last part doesn't matter. You can develop cancer later.
To be blunt: Cost-effectiveness.
In the US, recommendations come from the United States Preventive Services Task Force. They explicitly do not consider cost in their decisions. They look at harm vs benefit, usually with a focus on mortality reduction. Most insurance companies will base their coverage on the USPSTF.
https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
Decisions as to whether or not to pursue regulatory approval for, example, expanded coverage of the HPV vaccine to men, or older age groups, is very commonly informed by cost-benefit calculations. I've worked on those projects, seen presentations by my colleagues, etc. There was a good two years of my life where this was what I worked on (mostly strain replacement post-vaccination).
It's a level of evidence that's generated (usually) prior to ACIP, and it is presented to them, while there is not necessarily a bright line threshold.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7652907/
if you suspect that the cdc has been captured by big pharma, "and we don't care about cost of these recommended drugs" should pretty much seal the deal for you :)
Oh wow how the conspiracy theories change.
There used to be fears of "death panels" controlling access to medical care when Clinton tried to propose universal health care.
The CDC and FDA are about safety, not cost management. And they get significant complaints about how much they regulate pharma and are impediments to pharma for that!
Now the conspiracy theorists of the other side seem to be having their day in the public mind.
This isn't a conspiracy theory - I worked on projects around that during graduate school, and talked to my colleagues who worked on them. Cost-effectiveness thresholds are a consideration that goes into how widely a vaccine will be rolled out, etc.
That was, for example, why boys were originally not part of the recommendation for the HPV vaccine. It would double to cost, while doing very little to prevent cervical cancer via indirect protection. Once the evidence accumulated that it was associated with other cancers, that stopped being true.
Similar logic applied to older women and men.
Cost considerations would be more from the CDC's Advisory Committee on Immunization Practices, not the mentioned above United States Preventive Services Task Force. (Oh, and I see that another comment parallel to mine up there now mentions ACIP too...)
In any case, somebody thinking that evaluating safety and efficacy aside from cost considerations means that there's collusion with pharmaceutical companies would be a conspiracy theory.
clear financial incentives are never conspiracy theories: always follow the money.
thinking that they are conspiracy theories? that's a conspiracy theorist.
There's no clear financial incentive on the decisions here. If there were, it would be collusion, and not in the open, and therefore not clear.
the cdc decides to make recommendations no matter how expensive, and big pharma collects the expensive, and the expert community works for the cdc and big pharma? do you even understand what regulatory capture is? do you understand how framing something as saving lives no matter the cost draws attention away from funneling money to big pharma no matter the deficit?
let me guess, you work in this area too.
A lot of replies that are mostly true, or somewhat true, or simply missing the real reasons.
There are two factors here:
1) Vaccine-derived immunity is a function of the individual's immune response, which in general, weakens significantly with age. It is not unrealistic for a vaccine to simply fail to elicit any response in someone old enough.
2) It is very, very difficult to recruit folks without HPV that are over 40 for a clinical trial. Most people of that age, who were never immunized, most likely have had it. This significantly convolutes the signal.
3) This is all especially confounded once something becomes "standard of care". Every year there are fewer and fewer people age 40+ with HPV.
For these reasons, the vaccine is currently officially ??? in people over 40. Most doctors will prescribe it anyways if you ask. It may or may not infer immunity. It almost certainly will not harm you.
Conspiracy theory: they want old people to die.
Finally, affordable housing!
Any way to test for previous exposure? I'd be pretty surprised if I didn't already have antibodies. I suppose it doesn't matter though.
HPV tests are of low value (as an adult, if ever sexually active, you likely have it but can do nothing about it); a new biomarker test that can detect the cancers is being developed [1]. Ongoing cancer surveillance is all you can do once exposed without having been vaccinated (and if cancer occurs, immunotherapy).
As pm90 wrote, I strongly recommend getting vaccinated [2] unless a doctor tells you otherwise, even if you already have HPV or have had previous potential exposure.
[1] Circulating tumor human papillomavirus DNA whole genome sequencing enables human papillomavirus-associated oropharynx cancer early detection - https://academic.oup.com/jnci/advance-article-abstract/doi/1... | https://doi.org/10.1093/jnci/djaf249
[2] https://en.wikipedia.org/wiki/HPV_vaccine
(had three doses in my 30s via Planned Parenthood)
> previous potential exposure.
Isn't that basically everyone who's had sex with someone who had sex before the vaccine was common? I was denied when I asked my last doctor, on that logic. I'll ask my current doctor.
Yes.
Doctor recommended it to me when I was almost 30. So yeah, I'd say still go for it.
Note that the modern vaccine covers 9 different strains.
Right. And a few years ago my doctor's office had orders for both the the quadvalent vaccine and the nonavalent vaccine in the system and almost ordered only the quad for me.
Definitely ensure you're requesting the 9 strain version.
Not sure but theres zero downside to getting it
Information from the CDC [1], indicates Adverse Reactions are similar to administration of a placebo, which is not zero. Any vaccine administration has potential for negative adverse reactions, it's reasonable not to get a vaccine if you judge the upside is not worth the downside, even if the downside is small.
The CDC says:
> Like all medical interventions, vaccines can have some side effects.
[1] https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
If it's similar to placebo, doesn't that imply that it's pretty much non-existent?
No, the CDC says (at my previous link):
> A temperature of 100°F during the 15 days after vaccination was reported in 10% to 13% of HPV vaccine recipients. A similar proportion of placebo recipients reported an elevated temperature.
If you take some research subjects, do nothing to them, and then ask how they did 15 days after, I would be surprised if 10-13% reported a 100F fever during that time. But, that's a reasonable result from a saline or hpv injection.
It's not approved for those over 45. (AFIAK, simply because so few people in that age group would have risk without having had prior exposure. Basically only those who had divorced or lost their long time partner.)
This is not true any more. The vaccine has been shown to lower cancer risk for those who already carry the virus, so it is recommended even for people who are HPV positive
That feels like a wild assumption to me - we really think people 45+ aren't having casual sex? less casual sex maybe, but I would imagine still a decent amount, statistically.
If you’re having casual sex at 45+ you probably already carry HPV.
There are over 30 strains of HPV with just 2 causing the majority of cancers. So sure, most people may have had some strain of it, but that's not really relevant unless immunity is broad across strains.
Sure, but you probably don't already have all the strains which can cause cancer.
Yeah that makes much more sense as an explanation than OP.
Maybe, but all 9 cancer causing strains covered by the vaccine? HPV also clears on its own usually after some time afaik.
It's not "recommended" but your PCP can prescribe it off-label if you ask -- just ask.
I met with a new PCP a few weeks ago and it was recommended to me (at age 43). I got the first shot with the 2nd and 3rd scheduled for the coming months.
The issue is getting it covered by insurance. Otherwise it can cost over $1,000 for the full course of shots.
You can get costs down somewhat (half that) even uninsured with GoodRx.
I'm sorry, but you sound like the people who try to get me take ivermectine for Covid. "just get it off label" or "tell the doctor you just got back from pauea new guinea and saw worms in your stool."
I know you are very well intentioned, but American's actually have very good doctors.
This is very different from recommending horse dewormer; if you can't tell the difference, I'm sorry.
When I'm in my doctor's office, and the doctor is saying "don't do that" it is quite hard to tell the difference.
Did you actually ask your doctor and receive that guidance, or is this purely a hypothetical?
Multiple times. I’ve specifically asked about this vaccine again and again.
I’ve had a few GPs in the past 20 years. They’re consistent.
I admit it’s weird. And ideologically I feel like a bit of a laggard.
But I’ve had both the conversation with my doctor, and the conversation with online “smart people who know better than my doctor” many times.
Ok, great. I'm just asking people to have that conversation.
Ivermectin is also used by dermatologists to fight face parasites that cause bad acne.
It more like “I’d rather not have a current or future partner go through a painful LEEP procedure or cervical cancer because I exposed her to HPV”
> American's actually have very good doctors
Doctors aren't setting the rules on who gets what vaccine and when. RFK Jr is. Health insurance companies are.
RFK Jr wasn't doing anything worth talking about during the multiple times in the past 15 years my doctors have told me it wasn't recommended.
Please do not turn mainstream medical advice into a fringe position.
It's a standard vaccine for preteen/teen boys now too. If your doctor has been telling you not to get it for the past 15 years, they've been doing you a disservice.
I haven’t been a preteen boy for the past 15 years.
I got 3 doses of gardasil at 37 in Norway. I do not want to expose women to a potentially deadly virus (plus I’d also like to avoid having penile cancer and mouth/throat cancer myself). If your doctor is seriously advising you against taking the vaccine, you should consult another doctor for a second opinion.
If you’re not sexually active, is it still worth doing?
Yes.
“The route of HPV transmission is primarily through skin-to-skin or skin-to-mucosa contact. Sexual transmission is the most documented, but there have been studies suggesting non-sexual courses.
The horizontal transfer of HPV includes fomites, fingers, and mouth, skin contact (other than sexual). Self-inoculation is described in studies as a potential HPV transmission route, as it was certified in female virgins, and in children with genital warts (low-risk HPV) without a personal history of sexual abuse. Vertical transmission from mother to child is another HPV transfer course” [1].
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC7579832/
Right, but do the vaccines help against the strains of HPV that are transmitted via non-sexual contact? The vaccine being 9-valent implies (to me, a layman) that strains need to be targeted fairly specifically in order for vaccination to be effective.
Unclear. There are reports that warts (a form of hpv - but not one the vacine is directly for) are also reduced - but I'm not aware of formal studies
Yes. While direct genital contact is the highest probability way to spread it, any skin-skin, skin-mucosa, skin-object-skin contact can potentially spread it. Consider how much you trust others to wash their hands after using the restroom. Low probability, but possible.
You’ve got a low probability of getting polio, but there’s no reason not to be vaccinated if you can.
Even if you already have a strain, there are multiple types. In fact, people who got a vaccine early on, should consider an updated shot for more complete protection.
The protection from the vaccines lasts (probably) a lifetime, and HPV is quite widespread because it is: very easily communicable, and infections linger for potentially long periods of time without any obvious symptoms
Something like 80% of people are sexually active at all will be infected with HPV at some point. You may not have been sexually active, but your future partners may have been. I personally have a friend who went through stage 4 cancer contracted from her (now ex) husband.
So, of course not literally everyone needs to take it, assess your own risks, but it's quite an easy, highly effective vaccine: don't overthink it.
Life is long and unpredictable, while the cost is very low.
If you ever intend to be, yes.
Yes.
Why?
Rape, you might become sexually active in the future, and although sexual transmission is the most common way, there are some other ways to get infected.
Probably in reverse order
Unless you're never sexually active (meaning, you eventually do have sex), it's worthwhile getting since there is a risk to yourself if you get infected.
rape
Huh.
I'm male and read about this exposure vector back in 2012 when it was only rolled out to 12 year old girls, with a further guideline that nobody over 26 should take it.
this was pre- antivaxxer anxiety, and just run of the mill 'is the government condoning sex' anxiety, and it was controversial for that reason alone
the issue was that if you've been exposed already then the vaccine doesn't work. they had a test for women that can prove they've been exposed or not, and most adults have. they don't have a test for men that can prove they've been exposed or not, and most adults have. At the time, they had also only considered males to be carriers, with no cancers themselves.
so for the US government to recommend a limited stock and get insurers on board, it was all based on probabilities of exposure and utility.
I was younger at the time, naturally, I paid $600 out of pocket to get it across 3 doses because I figured it was worse than that, or I could get some 'male ally' brownie points from women. I wasn't wealthy then but figured this experience couldn't be taken from me even if I went bankrupt.
Since then, they've further linked it to throat cancers in males, because of our mouth's contact with genitals, and insurers are told to cover it across all genders and up to mid 40s. that's not really much of a difference now though, since the checkpoint is basically the same group of people, 13 years later.
They're still assuming older people are not worth bothering with, due to likely exposure.
There is an amusing side of this if you are male and not vaccinated yet, since nobody can tell if you've been exposed still: keep your sexual relationships with younger women. lol. in case you needed an excuse - higher probability they're vaccinated.
"this was pre- antivaxxer anxiety" - It was really, really not.
Another thing to keep in mind was that the initial trials were only using cervical cancer endpoints - the association between HOV infection and cervical cancer is really strong. At that time, vaccinating boys provided only indirect protection (you couldn't infect a female partner), rather than direct protection (you won't be infected) in the context of cervical cancer.
Women prior to sexual debut were the biggest "bang for the buck" and the obvious first recommendation target.
Researchers both at universities and in private industry then started working on other populations based on alternative endpoints.
The current recommended cutoff is 45 (well, pre the current US administration). So I think it was a question of we tested this at the time in these high risk age groups and we were still waiting on the results for other cohorts that were less important.
... did you finish the series? I think for adults it should be 3 doses. https://www.cdc.gov/vaccines/vpd/hpv/hcp/administration.html
> It consists of just 2 doses.
Wasn't it 3 doses before?
you're right its 3, updated message
I went to my local megacorp pharmacy out here in California, and asked about the COVID vaccine that’s no longer recommended by our anti-vaxxer overlords.
Apparently, it’s about as easy to get as an old-school medical marijuana card.
Results vary by state though. No need to travel to Canada or Mexico (yet).
Kaiser is continuing to cover it for everyone.
If you live outside of the US, you should get vaccine too. Even one dose is effective.
https://publichealth.jhu.edu/ivac/the-power-of-a-single-dose...
I've been through this with medical providers, and they say it's not recommended for me.
I don't take medical advice from internet strangers, especially when it contradicts my doctors'.
I'm not particularly interested in discussing the how's and why's. My doctor said he doesn't recommend I get it, so I don't.
In most countries it's recommended for everyone. It just isn't in the US because they don't want to pay for it.
From what I have heard, that is true for many, many vaccines.
I think it's weird and creepy people are selectively opting into vaccines that are not recommended for them.
It feels a bit like those ads that say "bring up Expedia with your doctor!"
This isn't a good PSA.
Should I be vaccinated against smallpox too? How about anthrax?
If we had as trivial of vaccinations for smallpox, anthrax, and rabies as we have for HPV, I'd collect them all. One fewer risk in my life, and a finite reduction in the risk of everyone around me's life, with no downside at all.
1 pin prick * 340,000,000 people > 340,000,000 people * 6.1 cases of cervical cancer * 0.9 efficacy / 100,000 people
Your world view assigns equally negative utility to at most 18,214 shots as 1 case of cervical cancer.
Put another way: If you were told you had to either take a shot every day, or you are guaranteed to get cancer, would you really choose the cancer?
If I was told by my doctor I shouldn’t get the vaccine I wouldn’t get it.
Good stuff. Australia has a target for eliminating cervical cancer by 2035 and ofcourse HPV is responsible for a large proportion of penile, mouth, throat and anal cancers as well. All my kids got free vaccinations at school.
It is shocking that there are still places in the world where this is controversial. You can tell a lot about the qualities of a society by the way they care for their own.
You should think about how you would react to “you can tell a lot about the qualities of a society by the way they [detain people on Nauru | reject asyl seekers | don’t care for indigenous populations]”.
I feel your comment is a generalisation and could be construed as provocation/trolling. Probably not your intention, but just so you are aware how this is coming over.
Better maybe: “societies that have good health care thrive” or something like this. Sounds less judgmental and it doesn’t put all US Americans in one basket.
I fully agree on the content though, only criticising the form here.
Good to hear what's happening in the more advanced countries.
RFK Jr may be a bit biased, his opposition has been profitable
> Kennedy for years has earned referral fees from Wisner Baum, a Los Angeles personal injury law firm that is currently suing Merck, alleging the pharmaceutical giant failed to properly warn the public about risks from its vaccine against human papillomavirus (HPV), Gardasil, according to financial disclosure documents filed by Kennedy with the Office of Government Ethics.
https://www.cbsnews.com/news/rfk-jr-confirmation-robert-f-ke...
The goal wasn't to eliminate the HPV strains, it was to decrease cervical cancer. Has Denmark encountered a drop in cervical cancer? If so, that's a great outcome!
> it was to decrease cervical cancer
HPV can cause cancers in the cervix, vulva, vagina, penis, anus and back of the throat [1].
[1] https://www.cdc.gov/hpv/about/cancers-caused-by-hpv.html
The lead time from infection to cancer is very long, we would not expect to see too much of a drop *yet*. But testing for those strains seems to be as useful for screening as a pap smear.
This seems to have some data that suggests they have seen a decline: https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.35081
There's a chart about 2/3 down the page that shows a drop in several age groups, and a particularly striking drop in the 20-29 age group: https://onlinelibrary.wiley.com/cms/asset/fd3e820c-4610-4c4e...
Does the vaccine benefit you if you've already been infected?
There are multiple strains of HPV and most people haven't been infected with all of the strains.
from https://www.health.harvard.edu/diseases-and-conditions/by_th...
Does the vaccine work against all strains ?
It has only been targeted against the strains known to cause cancer. I haven't looked but I would guess getting all strains would have been a greater challenge, and would not have greatly increased uptake of the vaccine. The false perception that it's a vaccine that will encourages unprotected sex has already greatly hindered adoption in the US.
No, it's targeted against those most associated with cancer.
Potentially, yes. HPV infections are cleared over time, and there are many strains of HPV.
That's really interesting, and from that I would assume that the risk of cervical (or other cancers) from HPV is associated with how often someone is reinfected? ie, someone who got HPV once in college doesn't have HPV their whole life? And potentially has a lower cancer risk than someone who is repeatedly re-infected?
Am I understanding that correctly?
https://www.hpvworld.com/articles/the-frequency-of-hpv-infec...
It's incredibly prevalent, but most people clear it within a couple years, and won't even know that they had it. The time to clear it is just variable and depends on your body's immune response, the longer you go without clearing it the higher the cancer risk.
> someone who got HPV once in college doesn't have HPV their whole life?
Doesn't necessarily have HPV their whole life - time-to-clearance is somewhat variable.
And yes, both slower clearance and just more infections are both associated with increased risk.
In a sense no, hence the choice to vaccinate younger children who will mostly not be sexually active yet.
But because the modern versions of these vaccines cover many strains (initial vaccines were two, Denmark chose a 4 way vaccine, now a nine way) it's very possible that you get a meaningful benefit by being protected from say six strains your body has never seen, even though the three it has already seen wouldn't be prevented.
It should be noted that the decision to vaccinate younger children is a combination of disease prevention and cost, not just vaccine effectiveness.
And access! If you vaccinate in earlier grades of school, the kids haven’t had a chance to drop out yet.
I've heard of it being administered post exposure as a way to help the body fight the existing infection. Seemed a little odd when I first heard it as HPV should clear on it's own.
The key is you want it to clear as quickly as possible.
Wasn’t this also the same conclusion for Australia? Cervical cancer plummeted to record rates. Men should still get it so they don’t effect their partners and HPV causes all sort of cancer too.
Yes, Michael Douglas had a throat cancer he said was from "oral sex" meaning HPV infection, and I remember social media berating him for saying that as if it were impossible, but it really is.
Random anecdote: with whole genome sequencing, which is fairly common among the rich with cancer, you can sometimes find the exact cancer driving genes that the HPV has amplified. I remember looking at one case where the HER2 gene was amplified with many copies, and you could see it attached to chunks of HPV genome. Fortunately there's now many drugs that specifically target amplified HER2, originally developed only for breast cancer, where there are diagnostic test to find the subset of breast cancers with the amplification.
Australia rolled out the HPV vaccine for girls in 2007. Boys were included in the program in 2013. Modelling says that "elimination" depends on both the vaccine and a screening program [3].
[1] https://www.cancercouncil.com.au/news/australian-success-sto...
[2] https://www.ncirs.org.au/sites/default/files/2022-07/HPV%20F...
[3] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
That's great to hear! Here where I am, Ontario, Canada, I just barely missed out on getting the HPV vaccine for free in high school. At the time, they were only vaccinating girls, but added boys a year or two after me.
By way of contrast, America's current top "doctor" organized a class-action lawsuit against the HPV vaccine.
https://www.reuters.com/business/healthcare-pharmaceuticals/... ("Kennedy played key role in Gardasil vaccine case against Merck")
> "Details of the Gardasil litigation show how Kennedy took action beyond sowing doubt about the safety and efficacy of vaccines in the court of public opinion and helped build a case against the pharmaceutical industry before judges and juries."
> "Kennedy, a longtime plaintiffs' lawyer, became involved in the Gardasil litigation in 2018 in collaboration with Robert Krakow, an attorney specializing in vaccine injury cases, Krakow said"
It's okay, he'll have us treat cervical cancer with a juice cleanse and vibes.
Don't forget prayer--the ultimate solution to everything!
Also the juice is whale juice.
I remember this being a big controversy in Texas in the 2000s. Our Republican governor, forcing girls to get the vaccine! What does he think Texan girls are, lusty?
Not like disease prevention is a universally good thing and some people tend to have sex.
At the end of the day, religious radicals like STDs because it enforces their worldview that having multiple sexual partners in a lifetime is a sin.
We have the first leaders.
And I can't get the shot in Germany because I'm "too old" and just assumed to be infected with it already, anyway.
What a great system.
Depends on your health insurance. My previous insurance company paid back the full cost when I was 30 years old. I can recommend checking https://www.entschiedengegenkrebs.de/vorbeugen/kostenerstatt... (and then also confirming that with the insurance company over text, just to be safe)
Can you pay for it?
In Denmark you can. I was in my mid thirties when I went to my doctor to ask them to prescribe it. Before each shot I would go to the pharmacy and buy one dose and go to the doctor to have them administer it for me (if I wanted to). At that time I think it was free for teenage girls, now it's free for teenage boys as well.
The evolution of who gets HPV vaccines is really interesting. At first it was young women, as vaccinating young men had a very marginal decrease in cervical cancer rates via indirect protection (which itself is a function of how many young women are vaccinated). Then as HPV infection was linked to more cancers, vaccinating young men crossed the cost-effectiveness thresholds many governments use.
Vaccinating older populations is similarly just a less clear-cut case, but it's a cost-effectiveness argument, not one purely driven by if the vaccine offers protection.
it's not just the cost of the vaccine roll-out though, you need test on your target demo and since these are healthy people the bar is very high. If the demographic (like males over 45) shows very little involvement in the infection vectors then testing might fail the cost-effectiveness, not the delivery of the vaccine.
Indeed. Generally for HPV, there were modeling studies showing this was probably a good idea before trials started.
Generally yes. I asked my primary care physician and would have been able to get the vaccine dose from the pharmacy (paying for it myself) and she would have administered it.
In the US, there is no male test for HPV
It’s insane to think that someday humanity will finally find a cure for cancer, and then after all this money and research and struggle people will just… choose not to use it.
A cure is a treatment, a vaccine is a prophylactic. The most dangerous, by far, cancer that this would help mitigate is cervical cancer which makes up about 0.7% of cancer deaths in the US, exclusively amongst women. The overwhelming majority of cervical cancers occur in Africa due to the fact that HIV/AIDS dramatically increases your susceptibility to developing it.
There will never be a single cure to all cancers. Different cancers have different underlying mechanisms and affect different tissues.
I think this is untrue. All work by uncontrolled replication of cells. This is why nanotechnology had the promise of being able to eliminate cancer - imagine a nano scale robot regularly cycling through your body on occasion, looking for and eliminating cancerous growths.
Drugs, though, probably have very limited potential.
Cervical cancer (uterus), not skin cancer from a bad papillomas as I thought after looking up what HPV meant
Also throat, mouth, tongue, anal and penile cancers.
Add in anal cancer too
It turns out a human body has a lot of surfaces facing the "outside" in some sense and we forget about the parts we can't see. Most of this surface is not covered in what we'd conventionally consider skin. It's bit like if you were looking at surfaces in a house and forgot the walls and ceiling.
Humans (and most animals) are just tubes with extra bits.
the
Good news.
Bad news is that many countries came close to wiping out measles et al. too, but it takes sustained effort to keep things like that.
Amazing how badly the United States is regressing. Literally measles is making a comeback due to idiots like RFK.
And even before the antivax nutters here went from fringe to a significant social force, HPV vaccines were already being decried for "promoting casual sex." Our culture is so broken in so many ways.
"Why haven't you cured cancer yet?"
"We have a vaccine to prevent some very serious cancers."
"But it might turn my daughter into a hussy."
Also, forget "She might die of cancer" just exactly how bad is it if your daughter is a whore ? What else are we ruling out, independent business owner, politician ?
What happened to "I just want my children to be happy" ?
I always thought "Cervical cancer is a just punishment for my daughter's mistakes" (leaving aside if it is a mistake) was horrific.
Of course, I for sure held off on having casual unprotected sex with multiple partners as a teenager because I was worried about contracting HPV, but thanks to Gardasil my slut era was legendary and enduring.
Teenagers are notorious for making decisions based on consequences that are decades away from manifesting.
I can't tell if you think what I said was serious, I tried to hard to convey the /s.
Don't worry; it was very obvious.
"you never want grandchildren?"
Maybe we’re seeing selection pressure against those prone to addictive cycles of social-media influenced misinformation?
Like, anti-vaxers died at higher rates in Covid [1]. This will continue across disease outbreaks, particularly ones for which we have near-comprehensive vaccines like measles. And given antivax sensibility is heritable (through parenting, not genes), one would expect this to stabilize the population over several generations to one that doesn’t have this defect.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC10123459/
The article you are referencing is based on CDC data which is not matched by a more complete data maintained by UKHSA. I think Norman Fenton commented on that at some point. I'd be careful when taking its conclusions at a face value. I actually went through that paper and looked at the UKHSA data back in 2023. And the government was spreading a lot of BS, too. I'll let the "CDC can do no wrong" crowd pile up.
very few people are against vaccines per se, they are just against *unsafe* vaccines. "anti-vax" is a term used to dismiss dissident without having to deal with their arguments i.e an ad hominem. As an analogy, if I object to high levels of mercury in fish, am I anti-fish? or anti-poisonous-fish ?
The people that are against "unsafe" vaccines do not do the proper research to determine whether a vaccine is actually safe. These people claim that safe vaccines, like the COVID shots, are actually unsafe because they googled up some claims that were not rigorously researched or reviewed.
I had seen attempts to engage with these arguments in good faith. It was wasted effort.
For just being "against *unsafe* vaccines" they sure tend to have some very weird ideas of what a safe vaccine is.
"unsafe" is a loaded term
in your fish analogy, you eat mecury directly, but wont eat fish that might have mercury.
the communicable disease is itself quite dangerous
I think you missed the point. Granted the disease is dangerous, but what if the cure is worse ? If we don't know this is true, we ought to assume the risk outweighs the benefits until PROVEN otherwise- that is the precautionary principle. As an analogy take Vioxx, a headache remedy that caused thousands of heart attacks. Merck the manufacturer started an advertising campaign for the drug AFTER the learned it was killing people - they were ultimately fined 4.5 billion.
https://www.nejm.org/doi/full/10.1056/NEJMp048286
The docket shows us that pharmaceutical companies are serial felons who have paid some of the largest fines in history for lying about their products. It is prudent to be skeptical until proven otherwise.
I agree. Pfizer settled more than a few cases. When talking about a low probability but catastrophic event, the burden lies on the side of the vaccine manufacturer and a mandating agency (and not on the side of the consumer) to prove beyond any doubt that the treatment is safe. I doubt Pfizer has met that bar.
Edit: To all the pro-Pfizer downvoters, feel free to take some Zantac. You have learned nothing.
> "anti-vax" is a term used to dismiss dissident without having to deal with their arguments i.e an ad hominem.
A slur.
We've been dealing with anti-vaxxers for years. I've yet to see an argument from one that holds any water.
Which vaccines that are widely used today do you believe are unsafe? And why do you believe they’re unsafe?
> “anti-vax" is a term used to dismiss [dissent]
No, it’s a term used to dismiss people who keep bringing up the same arguments that have been refuted over and over.
This is now a global problem. The guy who started it, Andrew Wakefield, is British, and we have long had antivaxxers in Europe too.
Prior to Covid, the antivaxx scene was vaguely left-and-green oriented, biomoms, vegans and other "very natural" people; you would expect them to vote for Greens or even more alternative parties. This changed abruptly and now the antivaxx scene is mostly rightwing, but the common base is still the same distrust.
I wonder if this is the price we pay for radical informational transparency. Nowadays, democratic countries with reasonable freedom of press cannot really prevent their own fuckups from surfacing in the worst possible way. Some people react by complete rejection of anything that comes from "official" channels and become ripe for manipulation from other actors.
i dont think its nearly so transparent. its easy to be recommended and read some viewpoints, but very technical and hard to be recommended others.
with radical information transparency, id expect both views to be equally easy to parse and to be recommended both, in which case the choice would be obvious to everyone, or at least they could very well describe their risk tolerance to different risks, or laziness, for why they made a certain choice.
i expect im not up to date on all the vaccines i should be, but its on laziness rather than gwtting bad information. ...also a lack of information on which ones i should have.
> I wonder if this is the price we pay for radical informational transparency. Nowadays, democratic countries with reasonable freedom of press cannot really prevent their own fuckups from surfacing in the worst possible way. Some people react by complete rejection of anything that comes from "official" channels and become ripe for manipulation from other actors.
Such people have always existed, unfortunately. I don't think it's a result of anything particularly new.
The people existed, but a portable always-running conveyor belt of bad news that is addictive enough to make them glued to the screen did not.
In the 1990s, you had maybe 15 minutes a day on average to consume news, either from a paper newspaper, or from an evening TV relation. Now, quite a lot of people spend 20 times as much time doomscrolling. Of course the impact will be much more massive.
Back then we had the National Enquirer and Weekly World News and similar for all the obscure conspiracy news you wanted.
I think that the social media is much more capable of turning various fence sitters and borderline cases into full blown conspiracy believers.
Unlike the paper products, which just lie around when not actively seeked for, the algorithms determining your feed have a lot more agency.
Sure, but this implies the only source of "manipulation from other actors" is the news, media, or government. Churches, cults, and just other ignorant people existed to cause distrust in authority.
Those organizations didn't have instantaneous global reach. Now everyone does.
I'm not denying that there's a difference - obviously technology has enabled the scale of things to grow quite a bit, both good and bad - but it's beside my point, which is that, given that it's not a new phenomenon, blaming it on technology seems doomed to failure. Without solving for the underlying issues, people will continue to mistrust authority, whether they're being told to by news or their neighbor.
Mistrusting authority might be good. What I see happening is in fact trusting too much into "authority" without penalizing it for inconsistencies - I would call it more like blind faith. I feel this happens because it makes it easier than questioning everything you hear and deciding for yourself, and accepting you might be wrong, or that the information is unknown. People want a savior and a simple solution!
> blaming it on technology seems doomed to failure
Recognizing that technology is now so convenient, psychology manipulative, and operates in a furiously fast feedback evolutionary regime, and that it has radically increased the spread of cultural irrationality isn't about "blame" in a judgy moral way.
It is about characterizing major factors behind the problem.
The enormous amount of near instant coordinated (by intention or dynamic), interactive misinformation, made so conveniently available that large percentages of the population routinely and enthusiastically expose themselves to it, participate in reinforcing it, throughout their typical day, is very new.
> "Not everything that is faced can be changed, but nothing can be changed until it is faced." -- James Baldwin
That's a little like saying nuclear bombs aren't a technology, but a human problem. And you bet, they sure are, but it's a lot harder to wipe out everyone, if the nutjobs in your community just have a pointed stick.
And 'nutjobs' may be pejorative, but I'll hold on to it as apt. At the same time I assign no blame, for it is an issue of cognition. The best way I can describe it is, intelligence is not a single factor. And it's not even a few factors. It's a massive bar graph, with 1000s upon 1000s of bars, each delineating a different aspect of intelligence.
A lucky few may score high on all those bars, yet even the most intelligent of us tend to score high on only some of those bars. And my point is, I've seen people immensely intelligent on some of those bars, yet astonishingly deficient on others.
We love to make fun of politicians, so I'll use one as an example here. Politicians tend to be incredibly personable, and very difficult to dislike in person. They exude congeniality, they read you like a book, and can often orate your wallet completely out of your pocket, and you'll thank them for it too. It's how they managed to go so far politically, yet some of these same politicians have severe and massive deficiencies in cognition.
Back to the pointed sticks, and the nutjobs who would wield them pre-tech, these people are simply as they are. Yet in the past, you'd see one nutjob in a community, and they'd be surrounded by normalcy, it would temper them, mitigate their effect, sand off their edges so to speak.
Yet as our communities grew in size and scope, these individuals could finally meet more of their ilk. A large city might have dozens of them, larger still cities hundreds, and they'd meet up. And as technology grew, and access to the printing press become possible for all, and for less and less cost, these same people could then send their madness in newsletter form to even those small communities where maybe only one nutjob existed.
But those people needed to still connect in some way. Maybe through an ad in the back of a magazine, or something akin yet far less gated by 'normals'.
Yet today? Now? Algorithms match you up with all those nutjobs. Where before you might live in isolation, and the friends you had might scoff at that weird idea you have, now you've found a community of hundreds, or thousands just like you! And they all affirm your madness, they pat you on the back, they congratulate you for seeing the light! They whisper all those sweet nothings into your ear, all those secret things you knew were true, and they listen to all you say on the subject.
For the first time in your life you have a home, a community, and before TikTok, or some weird forum, it would have never all been possible. You'd have been isolated, even in the age of magazines, and print, for you'd have never found one another.
And worse, now profit enters the system. Those who would steal, or thieve, or build bridges with sub-standard concrete for profit, or anything for money regardless of cost to us all, appear on this scene. They see those nutjobs, and they seek to profit from them. They own youtube, or tiktok channels, and often do not believe in anything but profit. They'll tell you anything you want to hear, espouse any crazy idea, and like that bridge built with substandard concrete, they'll take the money and run as society collapses around them.
This profit motive was always there, see cults. Yet the reach and scope was just not what it is today, there is so much more range given to a single person now.
People have had a mistrust in authority as far back as when nomadic tribes were the norm but somebody had to decide where to hunt or gather that day or to move on. Good luck changing human nature.
Chatty Kathy could only share her moonbat ideas with a couple people at a time. Now she has a TikTok and the ability to go viral. Even folks sharing her video to mock it are spreading her message.
And now there is code that says "This video is doing really well, I'm going to put it in front of every single human being I can"
Your local crazy used to get patronizing nods. Now they get 100 million views.
Unlike the measles, HPV is not a good eradication candidate due to the existence of non-human reservoirs.
I think you said that backwards. HPV does not have non-human reservoirs, per Wikipedia. (Do you have evidence that it's wrong?)
Ah, looks like I might have read the paper wrong. It's theorized that some HPV strains could also be carried by non-human primates.
Hence the "H"
Although you are (as I understand) right, the question itself is valid, lots of diseases spread to species other than the one that is in the name… Chickenpox, monkeypox, swine flu, or even the Spanish flu.
I remember arguing in favor of Gardasil as a teenager in highschool. And now RFK Jr calling it dangerous. Someday my head might just explode.
This article headline is a gross abuse of the conclusions of the actual study which is here: https://www.eurosurveillance.org/content/10.2807/1560-7917.E...
This site is full of people perfectly capable of reading most studies. I would much rather see these links go to studies than endless clickbait articles about studies.
The conclusion of the study show that about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection. This does appear to be a reduction from an earlier 2013 study but the earlier study was by different authors with different methodology so gauging the scale of the reduction is not straightforward. My opinion is that a safe conclusion of the study is that HPV prevalence has not increased.
That link says:
> What have we learnt from this study?
> Infection with HPV types covered by the vaccine (HPV16/18) has been almost eliminated. Before vaccination, the prevalence of HPV16/18 was between 15–17%, which has decreased in vaccinated women to < 1% by 2021. However, about one-third of women still had HPV infection with non-vaccine high-risk HPV types, and new infections with these types were more frequent in vaccinated than in unvaccinated women.
The conclusion seems to be that the vaccine is extremely effective at preventing infection by the strains included in the vaccine. One might reach a stretch conclusion and infer that the 9-valent vaccine would be even better as it would (probably) dramatically reduce the risk of several of the remaining “high-risk” variants.
The study is linked early in the article and is fairly dense, the article summarized it well and is a lot more readable.
16/18 are the most carcinogenic strains, they have been close to eradicated in Denmark. "Denmark close to wiping out leading cancer-causing HPV strains after vaccine roll-out" is the full headline and 100% accurate.
Those were the only two high risk strains covered by the vaccine used in the time frame studied. The study covers the first cohort of girls given the 2008 version of the vaccine when they recently reached age to start screening. It is expected to not see other strains affected in this study, even though current vaccines are broader. The total number of high risk HPV cases in the study went down post-vaccination.
The notion of numbered strains of HPV is about diverging lineages going back hundreds of thousands of years in a highly conserved, slowly mutating virus. They are not comparable to things like seasonal COVID or flu strains.
> about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection.
That number was referring to different strains not covered by the vaccine. The study says the rate of infection dropped to less than 1% among those strains the vaccine protects against.
Denmark is in a chronic baby shortage [1] and people in Western democracies are having less sex generally [2]. So, yay, less HPV. Go get vaccinated [3]. Unfortunately, there are some pretty significant (and sad, yes, sad) confounders.
[1] https://www.sdu.dk/en/nyheder/faldende-fertilitet
[2] https://www.google.com/search?q=western+democracies+decreasi...
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10399474/
Do you mean there is a causality between less sex and HPV vaccination, when you write “confounder”? I can’t find any study supporting this, hence double checking.