Talk:Gardasil

HPV and Cervical Cancer Prevalence

I believe that some information about HPV and Cervical Cancer rates in America should be mentioned clearly (such as the graph below). It is a popular belief that Cervical Cancer and HPV are one of the most common STDs and cancers in the United States.

The Center for Disease Control says that only 1.6% of the population has the four strains that Gardasil prevents (Strains 6, 11, 16, 18). "Overall, prevalence of types 6, 11, 16, and 18 was 1.3%, 0.1%, 1.5%, and 0.8%, respectively." Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e312a1.htm —Preceding unsigned comment added by 96.28.105.175 (talk) 03:56, 17 March 2008 (UTC)

Also, Cervical Cancer isn't even in the top 10 most common cancers. In fact, it is classified as one of the "most rare cancers."

Lung and Bronchus Cancer 23.5%
Breast Cancer 16.9%
Other cancers 21.7%
Colon and Rectum Cancer 12.1%
Ovary Cancer 5.2%
Pancreas Cancer 5%
Lymphoma Cancer 4.4%
Leukemia 3.6%
Brain Cancer 2.3%
Mult. Myeloma Cancer 1.8%
-->Cervix Cancer 1.9%
Stomach Cancer 1.6%

A graph like this one would really be helpful and educational. Most people do not realize that they have more of a risk to get brain cancer (which can randomly strike anyone who is around vinyl chloride (a chemical in plastics) than they do getting cervical cancer. Most adults believe cervical cancer is just as common as Breast Cancer.

Invention of HPV VLPs

As stated in the helpful review article, "Who Invented the VLP Cervical Cancer Vaccines?" (PMID 16595773), the development of the current virus-like particle (VLP) vaccines was an incremental process involving research in several different research groups. For example, Ian Frazer (note Z not S) and colleagues' first report concerning VLP production concluded that the major capsid protein L1 cannot self-assemble to form VLPs (see abstract of PMID 1656586). This major error was corrected by other groups who were ultimately awarded patents for the VLP technologies. Attributing the invention of the vaccine exclusively to Ian Frazer is at best a half-truth and clearly isn't NPOV. Retroid 20:57, 4 August 2006 (UTC)

Merge into "HPV Vaccine"?

Is there a need to have a separate article for each brand of a medicinal product? If we have an article for every brand of drug on the market, the amount of articles will be tremendous. Wouldn't it make more sense to merge Gardasil and the other brand of HPV vaccine, Cervarix, into the article HPV Vaccine? Jkpjkp 18:24, 25 November 2006 (UTC)

While I can appreciate not wanting a page for all medicines on the market, it is possible that people who want to find information will only know the name of the medicine. If these articles are merged, will a search bring people to the appropriate page? 71.233.8.90 21:50, 11 December 2006 (UTC)

It's also important to note that unlike, say, ibuprofen, for which the generic is basically identical to brands like Advil, Cervarix and Gardasil are actually different chemical compounds (and Gardasil protects against strains of HPV that Cervarix does not), so they're not just different brands of the same chemical. 67.180.143.202 08:17, 16 December 2006 (UTC)

I believe since Gardasil is so new, it should for the time being kept as a seperate listing because of the frequency of people that should be looking for specifically it, which is how i got to this page. I like the idea of every drug having their own page because as a medical professional I'm literally combing through those pages all day. Gardasil also should be kept in its own listing because of the perceived use and success rate expected from the drug, and it also will allow more thorough information to be listed on the single drug, like for example I need to innoculate a patient with the drug and found the innoculation regimen on Wikipedia, so yes I advocate leaving the article alone as well... — Preceding unsigned comment added by 69.17.18.2 (talk • contribs)

merging policy issues (see also Talk:HPV vaccine#Merger proposal as in the merger proposal - Government & Public Health Mandates - does not seem reasonable to have coverage of policy in a product article, should be in the vaccine article --Jkpjkp 14:11, 27 August 2007 (UTC)

In reviewing the VAERS (Vaccine Adverse reactions website) from Jan-July 2007, I see tha there are 1855 adverse reactions to Gardasil, out of 13,414 total listings (approx 14%). No wonder someone out there wants to merge/hide the Gardsasil information with the other brand...they have a lot to be embarrassed about. Do you work for Merck? —Preceding unsigned comment added by 71.146.21.127 (talk) 00:21, 9 September 2007 (UTC)

Only available to women

I understand this vaccine is new, but why is it restricted to young girls?? I am a young bisexual male at increased risk for HPV yet no doctor or clinic will administer the vaccine to me.

I hope it does not become discontinued like the Lyme disease vaccine (due to poor sales). Restricting a vaccine against a virus that infects 40 percent of the population makes absolutely no sense. This is a terrible way to introduce it to the market. — Preceding unsigned comment added by Tmthymllgn (talk • contribs) 6:32, 30 November 2006 (UTC)

To answer the question above, currently its use is retricted to adolescent women and young adults because that was the study group formed by the FDA at the time of the drug's clinical trials. I think in the long run Doctors will realize the drug is also beneficial to patients of both genders and upwards of 50 years of age who believe they may have recently contracted Genital Herpes, but as a full blown cure it probably will not have a similar therapeutic effect if the patient has been living with Herpes for some time. Unfortunately, the drug is restricted solely due to the study groups formed and evaluated by the FDA, and like most drugs will require time before a larger market is opened to it.

If it helps, this CNN article (http://www.cnn.com/2007/HEALTH/conditions/02/02/cancer.vaccine.ap/index.html) mentions that Merck is currently testing the vaccine on "older women and boys." I think that the beginning, it seems like it was just going to be something to prevent cervical cancer, and therefore they only tested on women. But I'm sure have now realized that since HPV can cause genital warts in both sexes, that it would be a good idea to get the vaccine to work for everyone. Alabasterchinchilla 00:03, 3 February 2007 (UTC)

We’re supposed to have this thing in modern western culture called gender equality after all. — NRen2k5 08:21, 3 October 2007 (UTC)

Adverse affects

I know that I'm not supposed to post things about myself on Wikipedia and am not suggesting anyone do, but want to share this for those who do write/edit the article. I posted a blog wondering about adverse affects from this vaccine and now have about 200 comments most of which are stories of serious events occurring after vaccination which the patient (or patient's parent) believe are adverse affects of the vaccine...many of them seizures, fainting, ongoing limb twitching, soreness to the point of being unable to use/limited use of limbs, and severe skin disruptions. (Most are at http://www.kkrasnowwaterman.com/blog/tabid/2962/bid/1691/HPV-Vaccine-fainting-seizures-and-other-side-effects.aspx and the remainder are spread as comments to a few other blogs.) I'm not a medical professional, don't normally write about medical topics, and have no way to judge whether these are verifiable adverse affects. Since Wikipedia is a common source of information and so many of the people who've written in to my blog say they wish they had better understood the controversy over what the side effects are, I'm writing to request that someone create a more complete description of the list of alleged side effects and an explanation of (or link to one) who will research and how long it normally takes to decide what is truly being caused by the vaccine. Kkraz (talk) 05:38, 22 March 2008 (UTC)

Why isn't there any mention of the reports filed involving seizures (some resulting in injury) following the vaccination? I would consider that an adverse reaction. There are two reports of Guillain-Barre Syndrome possibly related to the vaccine, neurological affects like temporary loss of vision, dizziness, and slurred speech. There are also reports about joint pains and fevers. None of this is mentioned. —The preceding unsigned comment was added by 83.108.244.64 (talk) 20:34, 9 February 2007 (UTC).

I added links to the FDA's product information and APIC's meeting on Gardasil. These are probably the most authoritative sources on adverse effects available now. You can summarize their findings in the article, if you'd like. --VAcharon 05:05, 14 February 2007 (UTC)

The de:Paul-Ehrlich-Institut has recorded 189 cases of adverse reactions after Gardasil vaccination in Germany in less than a year (which is still rare considering that 2.2 million doses have been sold, though sales started before official approval and IONO how much of the stuf has actually been used). There have been at least 2 cases of SADS in close temporal vicinity with Gardasil vaccination. There appears to be upcoming debate on whether the (expensive) vaccination is really worth the cost (i.e., how many cases of CC are actually prevented by it that could not have been prevented/discovered early and treated otherwise). If you know German, see the news article here. Dysmorodrepanis (talk) 12:35, 4 February 2008 (UTC)

Since the first SADS death mentioned in the news article, there seems to be some edit war going on on de:HPV-Impfstoff. Just thought I'd mention that, because there is the occasional useful nugget of information contained therein. Dysmorodrepanis (talk) 12:41, 4 February 2008 (UTC)

Monopoly and Parental Concerns

I think we could stand to have a second section on the two controversies involved with this vaccine. The first is that parents object to its use on the idea that it will make their daughters more promiscuous. The second, mentioned in passing, is that MERCK currently has a monopoly on the vaccine and is lobbying for the states to make it mandatory. Many of the scientists who've said good things about the vaccine had research funded by MERCK. For all that I believe the parents are mistaken and the scientists telling the truth, it could stand a mention.

This article from the Washington Post might make a good source. It also adds Virginia to the list of states contemplating a requirement. http://www.washingtonpost.com/wp-dyn/content/article/2007/03/03/AR2007030301356.html Darkfrog24 17:33, 6 March 2007 (UTC)

Michigan not the first state to require vaccinations

This passage was misleading:

• Legislation has been introduced in the state of Michigan to make Gardasil mandatory. If passed, this would make it the first state to require that its school children be vaccinated. diff from 7 September 2006

It implies that no other state has any vaccination requirements. I think it's common knowledge that many (if not most) U.S. states require immunizations against measels, mumps, rubella, etc.

I wonder how an error like this can stay undetected in an encyclopedia article so long (6 months).

I added changed it to say, "vaccinated against cervical cancer". [1] --Uncle Ed 13:58, 13 March 2007 (UTC)

"Against HPV" seems to be implied by the context. However, it doesn't hurt to be clearer. Darkfrog24 16:12, 13 March 2007 (UTC)

Texas and the cervical cancer vaccination

Schlafly wrote:

• Governor Perry issued an Executive Order requiring young girls to receive Merck's HPV vaccine in order to enter the sixth grade. [2]

Are there any other sources for this? --Uncle Ed 13:58, 13 March 2007 (UTC)

Yes, that source does seem a bit biased. Here's the Associated Press: [3]. Here's the LA Times: [4] And here's the Washington Post discussing similar events in Virginia: [5], [6]. —The preceding unsigned comment was added by Darkfrog24 (talk • contribs) 16:23, 13 March 2007 (UTC).

Note: HPV is not cervical cancer. It can cause it. Gardasil is NOT a "cervical cancer vaccine". It's an HPV vaccine. — NRen2k5 12:22, 2 November 2007 (UTC)

Source Needed

"It is worth mentioning that Rick Perry's former Chief of Staff is currently the head of Merck's Texas lobbying team, and that Perry recieved $6000 in campaign contributions from Merck. The high cost of Gardasil is to offset losses due to Vioxx settlements and an official-sounding recommendation by Perry would lead many to believe that vaccination in Texas is mandatory, thus creating a constant pool of customers for Merck and allowing them to regain their losses by Gardasil sales in Texas alone. Being a patent protected vaccine, Merck is Gardasil's sole producer."

An anonymous user left this. It's good stuff, but we need a source. I could see why Merck would raise Gardasil's price to offset Vioxx losses, but without a source it sounds like speculation. The same goes for the idea that a rec from Perry would make people think the vaccination was mandatory (which I'm fairly confident it is). And "patent-protected" needs a hyphen. Darkfrog24 21:33, 21 March 2007 (UTC)

Side Effects

While mentioning that we don't know the side effects of Gardasil is an excellent idea, the idea that these side effects would neccessarily affect all these women's descendants is a little excessive for a contribution with no source. Also, considering that the vaccine wouldn't alter these girls' ova, I can say with some confidence that it isn't true. I'll make some changes. Darkfrog24 00:25, 28 March 2007 (UTC)

Found an article that links HPV to throat cancer. What do you think?

http://www.nytimes.com/2007/05/10/health/10brfs-CANCERPROTEC_BRF.html?n=Top%2fNews%2fHealth%2fDiseases%2c%20Conditions%2c%20and%20Health%20Topics%2fHuman%20Papilloma%20Virus%20%28HPV%29 http://content.nejm.org/cgi/content/full/356/19/1944 Darkfrog24 21:09, 11 May 2007 (UTC)

South Dakota and Washington

I read in the NY Times that South Dakota and Washington are both considering voluntary programs like New Hampshire's, but I don't want to add them to the chart until I know the current state of the legislation (in committee, House, etc.). Does anyone know where I might find a source? Darkfrog24 17:52, 17 May 2007 (UTC)

Vandalism/Deletion - How to warn administrators?

Hi, I'm not sure who the administrator is for this page, but 68.62.0.97 has deleted all the "External Links" and "References" from the page. --Justine4all 22:12, 5 September 2007 (UTC)

Not 2nd cause of cancer death in U.S.

"Cervical cancer is the second leading cause of death from cancer in the United States"

Cervical cancer isn't the second most common cause of cancer death in the U.S. (For the white population, it's No. 13.) The Washington Post article said it's the second most common cause of cancer death worldwide (because underdeveloped countries don't have good pap screening or surgery). But for Gardasil, the relevant reference is to the U.S. rate (because women in underdeveloped countries who can't get screening or surgery aren't going to get Gardasil either).

Cancer
Volume 107, Issue 8, Pages 1711-1742
Published Online: 6 Sep 2006
Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations

http://www3.interscience.wiley.com/cgi-bin/fulltext/112777119/main.html,ftx_abs#TBL7

Table 7. Age-adjusted Incidence Ratesa for the Top 15 Cancer Sitesb for each Sex by Race/Ethnicity in the Selected Areasc in the United States, 1999-2003

I'm not changing it now because of the comment in the article. Nbauman (talk) 16:12, 29 January 2008 (UTC)

Those of us accustomed to reading medical literature recognise that it is almost a prerequisite in the opening paragraphs of any medical journal article to emphasise (if not exaggerate) the epidemiological importance of the subject of rest of the article. Nonetheless, misleading statements undermine the reliability of the rest of the piece, and so I concur that it is unhelpful and not honest to describe, to the Wiki audience, that cervical cancer is the second leading cause of cancer death in the US. In Western women the cumulative lifetime incidence of cancer of the cervix is around 1 in 80, whereas the risk of breast cancer is around 1 in 11 and bowel cancer 1 in 23. Perhaps a dozen other cancers have a lifetime cumulative incidence greater than that of cancer of the cervix. That is not to understate the importance or value of this vaccine. The risk:benefit ratio of Gardasil is irrefutably and overwhelmingly positive. But the global medical profession has a history of spin-doctoring the data it gives patients on a particular issue with some Macchiavellian flavour i.e. the end (getting everyone vaccinated) justifies the means (overselling the benefits and underselling the risks of the vaccination). This simply serves to alienate and disillude those few members of the medical laity who can perceive the "spin"; hence the ascension of anti-immunisation lobbies. Cervical cancer is hugely important in terms of loss of QALYs, and because its prevention is so simple and expeditious in comparison to other cancers. We need not exaggerate its raw incidence in order to convince patients honestly of the value of immunising against it.Drpeachy (talk) 13:09, 11 February 2008 (UTC)

Emphasize (if not exaggerate), indeed. Non-profit organizations that deal with a particular disease have a financial incentive to come up with statistics that exaggerate the importance of that disease. These exaggerated statistics get carried over to web sites about those diseases.

If you can make a simple statement that is relevant to the disease, like "Cervical cancer is the largest cause of cancer death in the developing world," then it belongs in the introduction. But if it takes a long statement of qualifications and distinctions, then it detracts from the purpose of the introduction, and doesn't belong in the introduction.

I think that statement about how cervical cancer ranks in the cause of death is irrelevant and detracts from the purpose of the introduction. Developing countries won't get Gardasil any time soon (which is worth a discussion further down). It should be deleted and discussed further down in the entry. If nobody raises any objection -- and they haven't so far -- I'll delete it.

I also think that complicated explanation of HPV types, and cancer types, are too unfamiliar for the general reader to belong in the introduction (although it could go further down). Wikipedia is written to be accessable to the general reader. You shouldn't have to be a medical professional to understand it. Nbauman (talk) 17:54, 11 February 2008 (UTC)

Nbauman, I completely disagree with pretty much everything you just wrote. You exaggerate the length and the complexity of the first paragraph. By including the strains of HPV that are covered by the vaccine, we a noting that not all strains of HPV are covered by the vaccine, and at the same time acknowledging the strains which are covered are the most virulent. In addition, the fact that cervical cancer is the leading cause of cancer deaths in developing countries is of the utmost relevance, particularly if we are going to make the usual Wikipedia effort to make the article global in scope. I cannot see how it would not belong in a prominent part of the article article. --IronAngelAlice (talk) 18:31, 11 February 2008 (UTC)

IronAngelAlice, let's take your objections one at a time.

I agree that Wikipedia is an international encyclopedia.

I agree (for purposes of argument, though I haven't checked it) that cervical cancer is the second most common cause of cancer worldwide.

However, I don't see the connection between cervical cancer death worldwide and Gardasil. According to NEJM, BMJ, Science, and everything else I've seen, no one is proposing to use Gardasil in the underdeveloped world in the forseeable future. It costs $600 for a series of vaccinations, and that's several times the per capital budget for health care in most of the countries in which cervical cancer is a major cause of death. (They're even having trouble with polio vaccinations, which is a higher priority.) In those countries, the public health people are dealing with cervical cancer by pap smears and surgery (cervical cancer is also one of the most curable cancers, if it doesn't get too advanced), which is much cheaper. In those countries, cancer isn't a major cause of death. Their major causes of death are infectious diseases.

Gardasil is not intended to prevent cervical cancer worldwide. So why include the worldwide incidence? Nbauman (talk) 19:06, 11 February 2008 (UTC)

I've read in several places that one of the main uses for Gardasil will be in developing countries since access to annual screenings is severely limited.

• http://www.cnn.com/2007/HEALTH/conditions/09/20/cancer.vaccine.ap/index.html
• http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=47621
• http://www.merck.com/newsroom/press_releases/product/2007_0926.html
• http://www.emaxhealth.com/48/16526.html
• http://www.bio-medicine.org/medicine-news/Developing-Nations-to-Get--Gardasil-at-Lesser-Rates-from-Merck-Soon-16787-1/

--IronAngelAlice (talk) 19:21, 11 February 2008 (UTC)