PSA, everyone should be getting the HPV vaccine, regardless of age and gender.
https://en.wikipedia.org/wiki/HPV_vaccine
https://www.mdanderson.org/publications/focused-on-health/wh...
replies(10):
https://en.wikipedia.org/wiki/HPV_vaccine
https://www.mdanderson.org/publications/focused-on-health/wh...
If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
Because approval involves evaluating a risk-benefit tradeoff, and the benefits for those groups are wildly different, as are the risk profiles, due to the way HPV strains[0] work. If they tested against a wide and heterogenous population from the start, it would risk demonstrating insufficient effect, which would eliminate the possibility of the vaccine for everyone. Instead, by testing against the group most likely to benefit from it (women, and specifically women of the age to have no prior exposure to HPV) they can see whether the vaccine has any potential at all, and expand from there.
As it turns out, the vaccine was incredibly effective for them, and as we studied it further, it turned out that other groups which had potentially lower benefits (men, older women) or higher potential risks (teenage girls) had a risk-benefit tradeoff that still overwhelmingly supported approval for those groups.
[0] yes, plural, because there are hundrends, and the vaccines (again, plural, because there are more than one) protect against a handful of them (although that fortunately includes the strains that account for 80-90% of HPV-caused cancers
It is annoying to be told something from your doctor, internalize it, have your doctor suggest flu and covid vaccine for years but never HPV, and then be told on HackerNews "you should have the HPV" and now I am supposed to tell my doctor I can do his job better than him because I read something on the internet even though most doctors specifically grimace when you do that?
I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.
You're assuming that the purpose of the EHR (Epic) is to implement public health recommendations or to establish minimum standards of care. That's a reasonable assumption for someone who doesn't work in the field, but unfortunately it's incorrect: neither of those are top-level goals for EHRs.
1. Reducing costs by hiring fewer people.
2. Increasing profits by decreasing care.
Did I nail it or what?
That sounds like a quid pro quo with some trigger shy lawyers. I can't possibly imagine the long game for Epic is to never use that. It is a shame people are dying of HPV caused cancers because Epic can't use the data it has. Sad. Probably why American medical outcomes are so poor.
This defuses the "Should I kill one to save ten?" moral dilemma - the individual is your patient, even if the other ten are also your patients, you must not harm the one. But for vaccines it also means that the wider societal implications are not ethically relevant
So, medics won't recommend that you give patient A an intervention which is of no benefit to A but is really helpful for everybody else. For example, that you vaccinate teenage boys in the expectation that this way they won't infect teenage girls (with whom statistically many of them will have sex) with an STI that harms those girls.
As a result, the guidance cared about proven benefits to you even though taken neutrally you might have been enthusiastic about a vaccine that might or might not protect you but is definitely a good idea for the wider population. The initial studies understandably focused on the numerically larger problem: If we vaccine young female patients does that prevent relevant HPV infections, and then, as a proxy we might assume they also won't get cancer. Such studies can't tell you whether it prevents men getting cancer because that wasn't measured.
So the recommendation to vaccinate boys was delayed because first somebody has to study what might seem obvious - does the vaccine also prevent HPV related cancers in males? It is, after all, possible that some subtle mechanism means the vaccine isn't effective for this purpose, and it would not be ethical to give schools full of boys a vaccine that they personally do not benefit from having - even if societally maybe that's a good choice.
Beyond the female/ male differential, for adults and older, it's basically a stats game. Most adults have sex. Having sex means you're likely to contract HPV, more sex, more exposure. Is it worth getting vaccinated when there's a 50% chance it's useless? How about 95%? 99.5%? Do you always wait for the crossing lights? Did you ever drink beer or eat bacon ?
It is either A) underreporting risks or B) not acknowledging risk unknowns and plowing ahead with advice anyway.
This was the major problem and behavior that CAUSED anti-vax opinions. They made safety claims that they couldn't logically make, because they couldn't know. A new vaccine using a new vaccine technology vs a new virus. They did not correctly report the amount of uncertainty and they lost trust. Then folks who "knew better" did their best to manipulate the narriative.
And speaking of manipulating the narrative, you can't use google to find the bits of history that shows the CDC giving contradictory advice because the results aren't there any more. Nearly every result gives the same tone and they're almost all CDC links.
This kind of information control and lack of transparency isn't science, it's power dictating truth.
The actual truth is that the risk of cancers as a result of HPV have a pretty high chance of being prevented if young females get the vaccine, but as you get further away from that group the risk avoided by getting vaccinated gets progressively smaller and runs into the safety uncertainty of taking the vaccine. When you're doing population level risk management you also have to do things like comparing the risk of getting hit by a bus going to the clinic against whatever the clinic could do for you. It is often safer to do nothing than to avoid a very tiny risk because of the very mundane risks you face day to day.
Back when the vaccine was new, an objection from some parents was that the vaccine might be viewed as a license or permission for their daughters to be promiscuous. There was a substantial headwind.
The public wasn't yet generally aware that HPV could cause head, neck, and anal cancers in men. If a doctor approached a parent back in 2010 and said they wanted to vaccinate their son against head, neck, and anal cancer, that advice wouldn't have been heeded in many cases, and would have cost the CDC some amount of its standing with the public.
When you hear something from the CDC, there's a decent possibility that it's a blend of medical advice that's been compromised with some value judgements that haven't been expressed to the listener.
Multiple reasons.
The first one is basic ethics. Similar on how you should do rolling upgrades of your SaaS software to catch errors before everything goes down, you got to do the same with vaccines. For there, go for the target group with the highest risk and highest potential of averting damage - and for the HPV vaccine, mid-20 women are the best such group: young enough that they might be lucky and not exposed yet, old enough to fall out of the scope of the usual ethics bureaucracy that (rightfully) comes with doing experimental research involving minors, and not so old that they definitely got exposed and making the effort moot. Then it got rolled out to teenage girls as it was proven safe, and eventually to men as well because we can be asymptomatic carriers (as we are for a lot of STDs).
Obviously if you got the speed of Covid vaccines in mind as a comparison, the HSV vaccine appears slow in rollout speed - but please do not forget, the Covid vaccines went through very speedy trials. We were extremely lucky it worked out the way it did.
The second one is availability. Again, unless it's Covid where everything went into full production power in a matter of months, production has to be ramped up carefully, matching rollout strategies - it doesn't make sense to have a mismatch into either direction.
And the third one is time. With Covid, it was easy to prove effectiveness: the people that got the shot got Covid at waaaay lower rates than the control population (and the risks of side effect were way less than the risk of severe Covid). But with something like HPV that can have years if not decades worth of time between exposure and symptoms, it becomes harder to reasonably judge effectiveness and safety.
I just had a doctor offer the HPV vaccine for my daughter as optional, 1, I thought we had already gotten it (my bad) because we ask for all the vaccines and 2, anal, throat and neck cancer. There are many scenarios where HPV could be contracted that aren't voluntary. But preventing HPV is.
Shingles is also incredibly painful.
I find about 1/3 of doctors are dipshits and utterly shocked that someone would read a scientific paper, or learn about their own conditions or diseases. Half of the doctors are overjoyed when they come across a patient like me.
Shingles vaccine may reduce the risk of dementia | 90 Seconds w/ Lisa Kim https://www.youtube.com/watch?v=unnePZUqi1o
They didn't use young girls as some safety experiment. They just had the largest benefit and so, in scarcity, they're prioritized. It's not that scarce anymore.
As an aside, the HPV vaccine also prevents some male cancers, like penile cancer. It also prevents cosmetic, but relatively safe, conditions - like genital and anal warts. That's not the goal of the vaccine so it's not really taken into account. But you, someone who may take the vaccine, should consider it anyway.
This is one reason why so much medication not to be used by pregnant women. The trials have not been done, and trials involving pregnant women are particularly expensive and risky.
And there's the mistake in your understanding. The personal benefit rationale is that they might catch it if they aren't treated. The public health benefit is a reason a government might promote this, but the reason medics will recommend it is personal benefit.