Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, September 25, 2006

I'm Still Not Convinced

The numbers in my anti-Gardasil (HPV vaccine) rant have been challenged.

So be it. I confess: I'm a doctor, not a statistician. But I still don't think it's a particularly good value, nor an appropriate use of increasingly scarce health-care funds. And I've come up with a better analogy:

If there were a very expensive rain hat that would lessen your children's chance of being hit by lightning, would you buy it for them? I'm betting most parents would say no. The baseline risk is ridiculously small, and is reduced even further by common sense, such as not standing outside in thunderstorms.

Likewise, even relatively minimal attention to regular preventive GYN care will pretty much catch all HPV infections at least a decade before it advances to invasive carcinoma. If you want to start attacking me by pointing out all the money and anguish saved by reducing the overall burden of HPV disease in the form of treatment of dysplasias and the like, at least you're on steadier ground.

Bottom line, though, is that I don't believe the vaccine itself will truly save a single life in the US. That is, the women who get the vaccine (ie, that have insurance that pays for it or the ability and willingness to pay for it out of pocket) are not the ones who will then waltz on through life without ever submitting to stirrups. The women who get the cancers -- the poor, the immigrant, the marginalized, and the doctor-phobic -- will never get the shots. I believe it would be a better use of resources to use all that money Merck wants us to spend on Gardasil for GYN outreach, making sure every woman has access to this basic healthcare right.


At Mon Sep 25, 10:16:00 PM, Blogger Big Lebowski Store said...

Okay, I'll supply the bottom-of-the-barrel cynicism for you: The Gardisil debate is not about the epidemiology of HPV-related cervical cancer, it's a debate about sex. Don't want to think of yourself as a prude? Get with Gardisil.



At Thu Sep 28, 03:53:00 PM, Anonymous Anonymous said...

Hi, Dinosaur,

I think that some of your argument in badscience had been misunderstood.

I posted what I thought was your views here:

Was this a correct summation of your views?

In summary I said "Dinosaur's arguments are specifically aimed at his patient demographic:"

I would have liked to email you rather than leave a post, but, I guess you don't like spam (seems fair enough)

I still think that at $70K/life it is possibly OK given (20?) odd economically productive years later. (But this is a *ppublic health issue, not private health)




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