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180 points gnabgib | 5 comments | | HN request time: 0s | source
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sitkack ◴[] No.43636938[source]
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...

https://www.cdc.gov/cancer/hpv/oropharyngeal-cancer.html

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0cf8612b2e1e ◴[] No.43637565[source]
Annoyed at how the guidance has changed on this over the years. At first it was just a narrow slice of 20 something women. Then girl teenagers. Then men and women under 30. Then under 40.

If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.

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1. tialaramex ◴[] No.43638858[source]
Medical ethics focus on the benefit to a specific individual - your patient.

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 ?

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2. odyssey7 ◴[] No.43638971[source]
You're not wrong about ethical considerations, but the CDC operates socially and politically as well.

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.

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3. sitkack ◴[] No.43639263[source]
What is it with people about the false ethics and recommendation around efficacy this and some bs calculus. The downsides are miniscule, the upsides are reduced cancers across the board.

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.

4. interludead ◴[] No.43641252[source]
We literally vaccinate people against diseases they might never personally catch because preventing transmission is part of the goal
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5. tialaramex ◴[] No.43641703[source]
> might never personally catch [emphasis mine]

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.