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Commentary

Medical Nihilism and the HPV Vaccine
Ivan Oransky, The Boston Globe, 3-4-07

Oransky voices his concern that, while the pharmaceutical industry is open to some well-deserved criticism, therapeutic "nihilists" have come to treat drugs as worse than the diseases they are meant to treat.

Society has somehow swallowed the idea that it's not disease that's killing us, it's drugs and the evil drug companies that make them. To parents of the 1950s watching their children and their friends become paralyzed by polio, the infinitesimal risks inherent in a vaccine were tolerable. Today, we seem to have forgotten the existence of so many diseases that maim and kill—polio, measles, mumps, rubella—that no degree of risk due to medical treatment are acceptable.

Pharmaceutical companies have committed sins that should prompt skepticism and criticism. But the nihilists have held up progress too much. Sometimes well-intentioned, other times motivated by their own financial interests—selling scientifically unproven "natural" remedies, or filing huge lawsuits, while railing against Big Pharma—the nihilists are often scientific illiterates on the hunt for new drugs to scapegoat. And that is how the lifesaving measles-mumps-rubella vaccine becomes falsely accused of causing autism.

We are watching the same thing happen with Gardasil, Merck's vaccine for human papillomavirus, or HPV , approved last June for use in girls and women ages 9 to 26. The idea is that preventing infection by certain strains of HPV will prevent most cases of cervical cancer. And yet we are hearing suggestions that HPV infection isn't a real problem, despite a recent study, published in the Journal of the American Medical Association, that found higher rates of infection than previously thought. More than a quarter of US women ages 14 to 59 in the large study were infected, 3.4 percent of them with HPV strains known to cause low-level and high-grade cancers.

But the nihilists have a response for that too: "It reinforces our concerns that we know too little about the epidemiology of this disease in this country," Barbara Loe Fisher, president of the National Vaccine Information Center, an advocacy group, told The New York Daily News. (To save the nihilists some time: The study was funded and carried out by the Centers for Disease Control and Prevention, not Merck.)

The situation is even worse when it comes to the developing world. In 1998, the FDA approved Rotashield, a vaccine for another infection, rotavirus, which causes debilitating diarrhea. Soon thereafter, the vaccine was linked to a serious side effect that affected a small number of people. In the West, there is little risk of death due to rotavirus, so Wyeth properly pulled their vaccine from the American market in 1999. Not so in India, where rotavirus is a killer. The nihilists don't get that. Their power over public opinion sank proposals to have the World Health Organization promote the vaccine. As a result, hundreds of thousands of children will die—deaths that could have been prevented. A new vaccine by Merck was approved last year, but its story is likely to follow the same trajectory, as there have been reports of the same side effect after use of that vaccine.



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