The Day We Figured Out How To Stop Cancer… And Then Didn’t.

8

September 17, 2014 by rebelwithalabelmaker

Oropharyngeal cancer is one of the hardest cancers to treat.  Hard on the physician, I mean.

Hard on the patient, too.  They’re usually young, in cancer terms… below fifty.  They start with radiation and chemo—which involve massive pain and other discomforts.  If that doesn’t work, Gary usually splits the man’s (it’s usually a man’s) jaw.  The patient is more likely to live than die, but a lifetime of pain and trouble swallowing is common.  A feeding tube can be needed, sometimes permanently.

Used to be, you got this cancer from heavy smoking and drinking.  Then some public health people did some great things to address those problems, and those cancers have been falling off steadily.  So now, when the patient asks “Why did this happen to me?” (as patients often do), there is a sense of injustice.  Often, the guy is a non smoker, and doesn’t drink much.

“Well…” Gary will say in these cases “Did you, uh, perform a lot of oral sex when you were younger?”

Usually the patient grins when he nods.  Gary tells me that they usually own up to this as a bit of a badge of honour.  Some cancers you get from bad choices, and some cancers you get from… generous choices.

It’s not the worst cancer Gary treats.  I mean, it’s pretty bad.  It’s got worse lifetime complications than Cervical Cancer, and higher odds of killing you than Breast Cancer.  But the kicker, the thing that makes it so hard on him isn’t that it’s a bad cancer.  Or that the men getting it are young.

It’s that it’s almost entirely preventable.

The HPV vaccine works—not perfectly, but pretty well.  We can prevent the strain of HPV that causes this cancer and we…  well, we just don’t.

“Why aren’t we vaccinating the boys?”  I asked, when my son was a baby.

“If the girls are all vaccinated,” replied the public health lady, patiently “then it can’t spread.”

I’m sorry, whaaaaat????

A)  They aren’t all vaccinated (around 3 out of 4, although it varies widely from region to region, B) The vaccine isn’t 100% effective (different rates or different strains of HPV, but think “pretty good”), and C) THERE ARE TYPES OF SEX THAN DON’T JUST INVOLVE A MALE AND A FEMALE.

This isn’t about money.  The cancers that are prevented by HPV vaccines are expensive to treat, and they more than make up for the cost of prevention.  It’s about short-sightedness.  It’s about a limited way of thinking of sexuality… as something that happens between a man and a women, preferably in the missionary position and ideally with not very many people over the course of a lifetime.  If you’re having trouble imagining your adorable Mindcraft-loving cherub ever wanting to do all that stuff, don’t worry.  Nobody’s asking you to imagine all that.  Instead, try imagining him in a cancer surgeon’s office.  This is not about sex.  It’s about Cancer.

When the vaccination form comes home from school, know that you don’t have to just fill out the designated blanks.  You can attach a letter asking for better policies.  You can email the public health nurse.  You can ask for more for your son (the vaccine is available, and recommended for boys by just about every professional in the field).

You can ask for more for your son’s classmates.  Or your daughter’s classmates (who she might be sleeping with in a few years, FYI, protected by a vaccine that is only pretty good in terms of effectiveness.  Think about that for a minute).

Gary:  How do you do this?  Do I click on your picture, or on your statement?  Who are all these people with comments?  I don’t know these people.

Me:  What are you doing?

Gary:  I’m trying to Facebook.  I want to comment on that thing you posted about Oropharyngeal Cancer.  There is a presentation by the American Head and Neck Association that I think the Facebook would find informative.

Me:  You click here.  Beside the picture of you, where it says “comment”.

Gary:  How do I upload a file?

Me:  I can’t believe you are on Facebook.  You didn’t go on for the bed bugs or the hepatitis or when I wrote all that stuff about you almost dying in Paris.

Gary:  This is about people who have actually died, Liz.  The public health people get it.  They just need public support to make the changes, and we will prevent those kids from getting sick.

Me:  I could blog about this.

Gary:  You should.

Me:  I don’t know how to make it funny.

Gary:  Liz.  We discovered how to prevent a horrible disease and then used that knowledge to protect only half of the children.

Right.  It’s never going to be funny.

8 thoughts on “The Day We Figured Out How To Stop Cancer… And Then Didn’t.

  1. Good post. Bad policy. Let me be very clear that I am liking the post, not the policy. I think you might be able to change bad policy with good writing like this, though, so GO LIZ!!!!

  2. http://www.cbsnews.com/news/gardasil-researcher-speaks-out/

    As soon as the lead researcher has confidence in her vaccine and is willing to say the benefits outweigh the risks, I’ll jump in line for the vaccine. Until then, your husband may want to bone up on the current research behind this particular ‘vaccine’.

  3. Thanks for the link, Allison! Gary and I have both been following Dr. Harper’s statements. I’m not sure I would characterize her as “the lead researcher”, but as I understand it she was heavily involved in designing several of the safety trials, and I definitely think her concerns are worth looking at closely.

    I certainly feel that she’s right about the need to evaluate programs in the context of the health care of the countries they’re in (and access to Paps is excellent in Canada). As I understand it, her efficacy statements were derived using a methodology that compared efficacy across different populations from different studies–which of course raises concerns for me. Also worth noting is that Dr. Harper has not said that the vaccine is not effective beyond five years–she has said that the data is inadequate, and that if it turns out that the vaccine protection drops suddenly, boosters would be required for it to have the preventative effect we’re counting on. I agree with that position. As for using the Pap in lieu of the vaccine, I see her point… but I am not convinced that on a population basis it is realistic to assume that we’re going to be able to enforce that. For males, of course, there is no equivalent of a Pap program to use in lieu of vaccines to reduce risk.

    My biggest concern with the reporting I see of her statements is to do with the shoddy journalism that often accompanies her statements in various articles. The discussion of ALS in the article you linked to is a great example of this. When a vaccine is used in huge numbers, there will be a very small percentage of people who will have significant conditions after getting the vaccine. In order to draw conclusions, of course, we can’t just cite that number–we have to compare it with the number of people who get these conditions WITHOUT the vaccine. This article talks about both ALS and immune disorders in a way that implies a causal link when we know that both are conditions that develop spontaneously and a control group is a necessity to draw any conclusions.

    The research I’ve seen that includes appropriate controls does not find those connections–with the possible exception of blood clots and a definite exception in loss of consciousness and increased pain (both in the short term). This is probably because the vaccine has an unusually high saline content, so it hurts more than other injections, and people faint. I’m not saying it’s not possible that we will find other complications–but every indication I’ve seen so far that involved a control group seems to demonstrate fairly comparable rates of most of the conditions that people are listing on the internet.

    Dr. Harper’s final comment, about the potential of vaccination programs resulting in lowered vigilance around Pap smears is, in my opinion, absolutely spot on. The vaccine is not 100% effective, and I believe it absolutely could create a false sense of security. Especially since a Pap is, well, not the most fun test to undertake… and people will be looking for reasons to avoid it.

    Although, of course, this applies only to female vaccinations.

    • I need to add a disclaimer here. None of what I just wrote is Gary’s opinion (he said he has followed Dr. Harper’s statements but supports the vaccines anyways and I didn’t get a lot more details out of him after that because of something about catching a plane). All of the views in my comments above are my own. And I’m not a doctor, to be very very clear. I am a blogger. All my research skills come from Carl’s class in University, which did seriously rock but is not really the same as a medical degree.

  4. […] James is outraged by health policy that only offers the HPV vaccine—which prevents cancer—to young girls, and not to young […]

  5. Keiran says:

    Really interesting article – thanks for sharing. This is an aspect of HPV and the links with cancer that I hadn’t really thought about before.

    There have been other examples where concerns about the risk of possible side effects has resulted in an outbreak of serious illness. In the UK recently there were measles outbreaks of epidemic proportions due to parents being worried about the MMR vaccine.

    In the MMR example the researchers published evidence that was subsequently discredited, but the news media really went to town highlighting the supposed risks. They would argue it was in the public interest, but it actually lead to a huge public health problem.

  6. Only half the children, but well over half the cancers. Cervical cancer is by far the most common cancer connected to HPV. The others are rare, and that’s something that figures in public health decisions such as which vaccines to promote. Being upset because we only offer it to half the people is like being upset because we only promote self-checks for breast cancer to women. We really ought to promote them to men, too, since men do get breast cancer. Nevertheless, it’s not the case that we are ignoring half of the problem.

    I agree that HPV should be offered to everyone, though, with an explanation of why it’s beneficial.

    • Great point, Amy–thanks. And sorry it took me so long to approve the comment (I thought I had, but it seemed like I hadn’t).

      Absolutely, I agree with your statement about the proportions. If we could only produce so many vaccines, they should go to the females. But we can produce enough for everyone, so the question (at least in Canada) becomes about cost efficiency… not “is vaccinating males as beneficial as vaccinating females (clearly not)”, but “is vaccinating males more cost effective than not vaccinating them” (i.e. “is it more expensive to treat HPV cancer in males or to vaccinate in males?”). Since Gary treats the throat cancer, we sat down and added up how many he sees, what the costs of treating those would be, and what percentage of those cancers he feels were caused by HPV… and compared that against the cost of the vaccine. The math checked out, and that’s taking into account only the one cancer, and not factoring in things like the public health benefits of not having the males infected and spreading it to others (since the vaccine isn’t 100% effective and not all girls are getting it). So yes, I do think that females should be a priority, but I also think that anywhere it pays for itself to prevent cancer we should do it (and that this is one of those cases).

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