<p>cangel-- we will look into the competitors as they come on the market. I agree that it is a medical decision-- not a “sexual actvity” decision. Not only would it be foolish of me to believe that I will know the time when my children will become sexually active, it is foolish to assume that the only way my daughters will only be exposed through their own, voluntary, sexual activity.</p>
<p>Blossom–I didn’t say no one should get it. I said, if a woman is getting regular medical checkups (as do the majority of families on this site), it’s not automatically necessary. For all, it’s a case by case issue. Please show where I stated no one should get it. </p>
<p>I also said that the rate in this country is very low. Which is true.</p>
<p>We have five family members who are physicians and seven close friends. We discussed Gardasil with each of them when it was close to becoming available to the general public. All of them, particularly the two who are ob/gyns, had no reservations about recommending that it be given. This was a group of MDs with diverse experience and of varying ages. Our family physician and our gynecologist also recommended the vaccine. I trust them. All four of my Ds have had the vaccine.</p>
<p>Garland, you never said that no one should get it, nor did I say everyone should get it. However someone who quickly reads this thread might get the idea that people “know” if they’re in a high risk category or not. Most public health studies have shown that people generally overestimate the risk of highly unusual, catastrophic events (plane crash and the like) and underestimate their own lifetime risk of more mundane issues- melanoma, high cholesterol, etc. I can safely assess my own risk profile for multiple sex partners, frequent gynecological check ups, etc but would not assume that for a daughter of mine once she has left my home.</p>
<p>It would be a great world if everyone read the literature and made their decisions based on the data. In the real world-- we often have to rely on a trusted physicians recommendations without assessing the clinical trials. YMMV.</p>
<p><a href=“http://talk.collegeconfidential.com/parent-cafe/534006-gardasil-revisited.html?highlight=gardasil[/url]”>http://talk.collegeconfidential.com/parent-cafe/534006-gardasil-revisited.html?highlight=gardasil</a>
This is the earlier thread about garadasil</p>
<p><a href=“http://talk.collegeconfidential.com/parent-cafe/517086-possible-side-effects-gardasil.html?highlight=gardasil[/url]”>http://talk.collegeconfidential.com/parent-cafe/517086-possible-side-effects-gardasil.html?highlight=gardasil</a>
This is the other earlier thread</p>
<p>My D was vaccinated. I am so glad this was possible.</p>
<p>qM,</p>
<p>Yes, I know the Rotashield situation well. We discussed it at length at work.</p>
<p>Keep in mind that pediatric vaccines are a different situation for several reasons:
- their immune systems are immature, so the response to antigen challenge is different. Indeed, there are a number of vaccines that do not work in infants.
- The risk/reward equation (as others have stated, no vaccine is truly risk free) is a bit different, and much more political, for infants.
- clinical research is tougher in infants for a variety of reasons.</p>
<p>You can read more about the Rotashield story and get an idea of some of the challenges that vaccine researchers face in this well written article:</p>
<p>[The</a> Rotavirus Vaccine Story: A Clinical Investigator’s View – Rennels 106 (1): 123 – Pediatrics](<a href=“http://pediatrics.aappublications.org/cgi/content/full/106/1/123]The”>http://pediatrics.aappublications.org/cgi/content/full/106/1/123)</p>
<p>I “know someone” (deliberately being vague here) who found out that her husband was gay (and sleeping around) when she developed venereal warts (which is one of the things Gardasil vaccinates against). </p>
<p>I was thrilled that my daughter got vaccinated with Gardasil, as soon as it was available.</p>
<p>(It’s hardly “brand new” anymore–that was four years ago. Relatively new, yes.)</p>
<p>In general, agree, Blossom. I am always in the camp of–get the facts, assess honestly, use critical thinking.</p>
<p>I think in some instances (and posts and threads) there can be a “you’re crazy if you don’t agree” tinge, which I try to leaven. I trust the readers (and my own kids) to read, assess, and think.</p>
<p>I’m an RN and have always taken my D to the pediatrician with trepidation come time for vaccines. I always brought the tylenol with me and monitored my daughter so closely for all the fears and problems that I have seen and read. Colleague’s D developed almost continuous seizures after the MMR many years ago, so that has always been in the back of my mind, don’t really knowi f it was the cause but there was speculation. Another colleague’s son developed Asperger’s syndrome after his MMR, same thoughts at the time. I do believe in Vaccines, but not concomittently. It is a chance we take and we still have the right to not vaccinate. Thats another thread. I’m glad though that we waited for D to take Gardisil now as she heads off to college.
Cervical cancer can be a very silent killer and sometimes there is no warning. The 2 strains of the HPV virus that the vaccine protects against is responsible for 70% of the cervial cancers diagnosed. I do feel a little better knowing that she is somewhat protected.</p>
<p>My D’s Pediatrician recommeded the vaccine last year when D was 16. I’m glad that she received the shots while she was still covered under our family’s health plan (It’s my understanding that the series of 3 shots costs upwards of $300).</p>
<p>The 2 biggest factors in me deciding to get the vaccine:</p>
<p>-Even though I will be a virgin when I get virgin, my husband won’t necessarily be one as well.
-I’m still at risk of getting HPV if I’m sexually assaulted or raped.</p>
<p>I had the first shot in early July and never experienced any side effects (and got it at the same time as my meningitis vaccine). I will take the second over Thanksgiving, and the third over Spring Break.</p>
<p>O2B@C-I’ve heard of it costing upwards of $1,000.</p>
<p>Well, I was very hesitant to chime in on this discussion because I think it may be a “no win” situation for my viewpoint but, possibly, it could help some of you out there (while angering others).</p>
<p>First, and foremost, I am an experienced practicing pediatrician and a parent of 2 teenagers of the opposite sex. Second, I am a very firm believer and proponent of vaccines, and a non-believer in a direct “cause and effect” relationship between autism and vaccines. So, I don’t have a particular pro/anti vaccine agenda that I’m pushing. But, interestingly, I’m in the minority camp among my professional peers when it concerns Gardasil – I don’t blindly recommend it to any and all females in its recommended age range. It all depends upon the risk/benefit ratio for an individual patient.</p>
<p>There are 3 things in the current Gardasil recommendations that I find troublesome (not in a conspiracy theory sense). I don’t like the idea that this vaccine is basically utilizing our daughters as the very large scale test population for its long term efficacy and safety surveillance. The 4 viral strains that it is protecting against from HPV are contracted through sexual activity for all practical purposes. And, for the overwhelming majority of our daughters, they will contract this virus by having such activity with a man. As a public health policy, ALL individuals, male or female, should be in the recommendation to be vaccinated, which isn’t the case – disease prevention works best through “herd immunity” which we are not practicing with this vaccine. I would compare what we are doing with HPV vaccination to the analogy of us only providing mumps vaccine to males (because sterility is a potential complication when males come down with mumps) and not females in the population. The bottom line is that if it’s good enough to give to our daughters, then our sons should also be included in the recommendation. By not including the boys, it does make me question the intent of the recommendation.</p>
<p>The other troublesome part of the recommendation to me concerns the age that it is given – why isn’t it given at a younger age (say less than 2yrs.of age). We vaccinate our less than 2 yr. olds with hepatitis A and hepatitis B vaccines without issues – Gardasil would be operating on the same immune principles. Why are we not doing it? We have child pedophiles out there, so it would make sense in my head to vaccinate all children as young as possible with Gardasil – except if there’s a question of long term efficacy which I think there is. We really don’t have a good idea of how long this vaccine is truly going to induce immunity for at this time (or even the long term safety profile); that’s the only reason I can imagine for not vaccinating young children on a large population scale.</p>
<p>The last aspect of the Gardasil recommendation that bothers me is that it makes the grand assumption that our daughter is going to have sex with someone (who isn’t a virgin) who previously had sex with someone else (who wasn’t a virgin); thereby, causing our daughter to contract HPV. This recommendation makes an assumption about what values you brought your daughter up with; it assumes that you don’t have an open and candid relationship with your daughter; and it assumes that she will do whatever she wants regardless of what you recommend. Because, let’s face it, if the previous assumptions are not true, then there is no reason for you to worry about your daughter contracting a sexually transmitted disease – unless you gave her reason that it is ok to have sex as a teenager.</p>
<p>So, what do I do in my exam room – I have this very same discussion with both the teenage girl and her parent (with both of them together, and also with my patient alone). They need to make an informed decision. If they want the vaccine, then I have no issues with giving it.</p>
<p>And, I am a very strong proponent of giving this vaccine to girls who either I or her parent don’t trust her current/future actions, or if the girl tells me in confidence that she is or may become sexually active within the coming year, or if someone is concerned about the risk of future rape (but to be very honest, I personally know of more people who died in the World Trade Center attack then who have been raped - it depends on where you live or travel).</p>
<p>I think the most important aspect of this vaccine is that it should open the communication channels with your daughter so you have a better idea of what she’s about. Your daughter needs guidance from you much more than any vaccine. But, if even with your guidance you have your doubts with potential current or near future sexual activities, then she should definitely get gardasil. If this isn’t the case, then I would rather see how the future HPV vaccines are, especially the second generation ones, which tend to be better than the first generation vaccines.</p>
<p>WillyWankaWannaB, thank you for your post. It gives me good food for thought. Personally, I did weigh the pros of this vaccine before D received it. She is 17 and going to college in a few days. I approached this vaccine with her, not as protection in case she may have sex, but more of a proactive means of decreasing her chances for potential future risk. But personally, I feel an 11-12 yr old girl is rather young for the vaccine and yes discussion is important with your teenager. With that said, I do feel that an 18 yr old woman should be able to make that decision for herself.</p>
<p>WWW–much of what you say echoes what my former-pediatrician H says, including being a proponent of vaccines while doubting the autism link, and questioning why it’s only given to girls. I also think your comparison to how we approach mumps is very illuminating. I like your approach, tailored to the actual life of the young woman, and predicated on her and her parents’ abilities to be honest with themselves and weight their particular circumstances.</p>
<p>WillieWankaWannabe-- you pose some interesting points- But I question some of your assumptions:
Unlike say, death in the World Trade Center, evidence of past rape in neither immediate obvious nor likely to be brought up in casual conversation. Thus, I think it is vey likely that you are acquainted with more women who have had unwilling sex than you know.</p>
<p>I have no vested interest in my daughters entering marriage as “virgins” to other “virgins”. If they choose that fine, if the choose to enter into responsible sexual activity with a caring partner at some point prior to marriage, I am also fine with that. Or several partners over the course of time-- who will quite probably have also had previous partners…</p>
<p>Third, the every vaccine has some level of risk, without direct benefit, no ethical doctor could recommend a vaccine to benefit others-- so we don’t recommend vaccines for boys to benefit girls via herd immunity. I think mumps is a poor analogy as the mumps pose real risks of illness for girls as well (although not sterility). I think boys are vunerable to genital warts (although I could be wrong on this), so maybe they would recieve sufficient benefit to justify the vaccine.</p>
<p>Lastly, although I have no statistical evidence to back this up-- I suspect very few people discuss their plans for sexual activity with their parents. I don’t think hoping my children will is sufficient protection.</p>
<p>There is a long front-page article in today’s NY Times about Gardasil:[Drug</a> Makers Push Leads to Cancer Vaccines Fast Rise](<a href=“http://www.nytimes.com/2008/08/20/health/policy/20vaccine.html]Drug”>http://www.nytimes.com/2008/08/20/health/policy/20vaccine.html)</p>
<p>I thought this was an important point, which garland also made earlier in this thread:</p>
<p>
</p>
<p>“The last aspect of the Gardasil recommendation that bothers me is that it makes the grand assumption that our daughter is going to have sex with someone (who isn’t a virgin) who previously had sex with someone else (who wasn’t a virgin); thereby, causing our daughter to contract HPV. This recommendation makes an assumption about what values you brought your daughter up with; it assumes that you don’t have an open and candid relationship with your daughter; and it assumes that she will do whatever she wants regardless of what you recommend. Because, let’s face it, if the previous assumptions are not true, then there is no reason for you to worry about your daughter contracting a sexually transmitted disease – unless you gave her reason that it is ok to have sex as a teenager.”</p>
<p>I find it very difficult to believe that a pediatrician who lives in the United States could have written the previous paragraph.</p>
<p>Thank you WillyWWB. Booklady’s post can not be emphasized enough, Pap smear screening is still necessary, regardless of vaccine status.</p>
<p>As to the vaccine being recommended to boys to benefit girls, hold your horses. MEN also get hpv and it is not great for them, regardless of the possibility of cancer.</p>
<p>WWWB, you said:
</p>
<p>The answer to both of these questions is one of clinical research. You, as a physician, should be aware that label claims (i.e. those pesky small print package inserts) are regulated by the FDA. More importantly, the FDA only allows label claims of efficacy for groups where efficacy has been proven through a clinical trial. To prove that vaccinating boys will avoid cervical cancer in women is a rather tough thing to do! In spite of that, Merck is indeed (at least it was a year ago) to get a label claim for males. Details I know not.</p>
<p>Vaccinating younger children? Similar problem. How long would we need to wait to show in a statistically sound fashion that vaccinating a two year old will avoid a problem later in life?</p>
<p>It is so curious how we want our “evidence” both ways. We want absolute safety, which is impossible to demonstrate (how do you “prove” a negative - the absence of a problem? You can’t) and at the same time absolute efficacy.</p>
<p>“The last aspect of the Gardasil recommendation that bothers me is that it makes the grand assumption that our daughter is going to have sex with someone (who isn’t a virgin) who previously had sex with someone else (who wasn’t a virgin); thereby, causing our daughter to contract HPV. This recommendation makes an assumption about what values you brought your daughter up with; it assumes that you don’t have an open and candid relationship with your daughter; and it assumes that she will do whatever she wants regardless of what you recommend. Because, let’s face it, if the previous assumptions are not true, then there is no reason for you to worry about your daughter contracting a sexually transmitted disease – unless you gave her reason that it is ok to have sex as a teenager.”</p>
<p>WWW - All opinions on teen sex aside…the immunity from the vaccine probably/presumably lasts long past the teen years. In all likelihood, when a girl gets married (forget her virgin/nonvirgin status for a second), her partner isn’t going to be a virgin, which still puts her at risk for HPV if the partner previously had sex with someone with HPV. So it isn’t really a matter of your teenage daughter being a skank, its about possible repercussions of responsible and normal behavior down the road…</p>