Wednesday, January 10, 2007

Pros and cons of HPV vaccine debated

Gardasil remains controversial despite FDA approval

Express Staff Writer

Opponents and proponents of the vaccine Gardasil have a lot to talk about. On one hand, the new Merck drug may help prevent the human papilloma virus, a group of more than 100 viruses, some of which are associated with certain types of cancer.

On the other hand, holistic health practitioners and parents are increasingly wary of giving vaccines at all. Gardasil, in particular, is recommended for girls as young as 9 years old. The idea is to get the vaccine to girls prior to their becoming sexually active.

"The reason for hitting girls at the age of 9 is that we're looking at preventing infection. It's not a treatment for cancer," Wood River Valley Ob/Gyn Dr. Joe Rodriguez said. "But it's a personal decision. I think it's important for the family to have a frank and open discussion about sexuality, diseases and pregnancy. Make sure she understands the risks of having sex."

Approved in the U.S. in June 2006, Gardasil was also recently approved for use in the European Union, Mexico, Australia, Canada, New Zealand and Brazil.

The viruses, known as HPV, are usually transmitted sexually and are usually symptom-free. They will generally go away without any treatment over the course of a few years. Yet, the virus can persist for many years, with or without causing cell abnormalities.

However, according to the National Cancer Institute, HPVs are recognized as the major cause of cervical cancer. Cervical cancer strikes nearly half a million women each year worldwide, claiming a quarter of a million lives. In the U.S., the numbers have dropped considerably, in the last decade, due to sex education and the availability of Pap smears. If cervical cancer is caught early, the chance of curing the disease is very high.

"I had several obstetrician/gynecologists ask me about the vaccine," said Larry Palevsky, a holistic pediatrician in New York City and Northport, Long Island. "I say, 'Answer one question. Has it ever been proven that HPV directly causes cervical cancer?' They say 'No.' Temporality leads to causality."

Dr. Palevsky, a colleague of Dr. Andrea Girman, of Ketchum, has been featured and offered advice in magazines such as Self, Natural Health, New Age, Mothering, and on television on the CBS Evening News, NBC's Live at Five, WOR Radio's Health Talk and Natural Alternatives Health Radio Network.

"These four viruses are present in 70 percent of (cervical cancer) cases, but it's never been proven. It doesn't mean it's the cause. It's unknown what really causes cancer. There's no direct correlation. My concern is that there is no literature to support causality.

"Don't get me wrong, we're all trying to prevent cancer in women. The answer is preventative medicine, education about nutrition, sexual practices, self-care and self-esteem."

The Centers for Disease Control says the vaccine is 100 percent effective in preventing cervical cell abnormalities when given to girls who have had no exposure. As well, the CDC says the vaccine is made up of proteins from the outer wall of the HPV virus and that there is "no infectious material in the vaccine."

However, there is aluminum in the vaccine, but vaccines often contain preservatives. It should be noted that aluminum is an ubiquitous element found in our environment. There are trace amounts in foods such as processed cheese and baked goods, medicines and vaccines.

Breast milk, for example, contains approximately 40 micrograms of aluminum per liter, and infant formulas contain an average of approximately 225 micrograms of aluminum per liter.

Gardasil contains 225 micrograms of aluminum in each of the three required doses.

According to the National Cancer Institute, aluminum-containing vaccines have more than a 75-year record of safety globally. Adverse side-effects caused by aluminum adjuvants are very rare. Most common are some redness, swelling and tenderness at the injection site.

The U.S.-licensed vaccines for children that contain aluminum adjuvants are:

-DTP (diphtheria-tetanus-pertussis).

-DTaP (diphtheria-tetanus-acellular).

-Some but not all Hib (Haemophilus influenzae).

-Pneumococcal conjugate.

-Hepatitis B.

-All combination DTaP, Hib, or Hepatitis B.

-Hepatitis A.



"The safety of individual vaccines in children has never been tested," Palevsky said. "I understand why parents and certain practitioners are concerned about the safety and efficacy."

But a differing and equally convincing stance comes from Tom Machala, the director of Communicable Disease and Prevention Program for South Central Health District in Idaho.

"You can find research on aluminum that shows it causes irritations. This is because it promotes the body to produce antibodies," he said. "There is also transient research on aluminum's passage into brain, but not from vaccine amounts."

According to the Alzheimer's Society, there is "circumstantial evidence linking this metal with Alzheimer's disease but no causal relationship has yet been proved."

"People are stringing together a series of research articles that seem plausible, and will support different theories," Machala said. "The majority of research has been positive. Millions of children are treated safely every year. Aluminum is in vaccines because it stimulates the body to absorb the vaccine. And because of that it's readily used in placebos and vaccines. You're buying a long-term effect. The best evidence is how it's being taken up by the body."

Studies have shown that women are protected for up to five years after receiving the vaccine. More research is being done on longevity and whether a booster vaccine is needed.

Nanette Ford has been a family practice provider for 20 years, first in California and now in Ketchum.

"I've done a lot of women's health," she said. "Cervical cancer is not that common. It grows very slowly, taking years from a normal Pap to true cervical cancer. The new virus immunization is kind of like when the Hepatitis B vaccine came out. The CDC wants everyone to get it. So parents are asking, 'Why am I immunizing my child?' It's a blanket fix.

"If women have yearly exams and responsible sex with protection they may be exposed, but they will never die, under those circumstances, from cervical cancer.

"I would rather tell young girls, 'Keep being responsible and have yearly exams.' With this vaccine, there's a little hysteria. It's overblown. It doesn't matter if there's one partner or 100. Eighty percent of (sexually active) people are exposed to HPV.

"That's a huge exposure rate but not many out of that go on to get cancer and die. Most women's immune systems will take care of it."

After a pause, Ford added: "I might feel differently if I practiced in downtown L.A. or Baltimore."

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