davis sq plan p offering gardasil vaccines

[lyonesse.livejournal.com]

i really need to write a good essay about this, but here's the quick scoop, since folks are starting to ask.....

. there's no easy test for hpv. the way the test works at all is, you take a pap smear (aka some cells). if they're overtly normal, nobody generally frets. HOWEVER, you can culture the dna in the cells (or presumably penile cells by counterpart) to find the *unexpressed* viral dna in an infected but normally behaving cell. this also allows for viral-subtype analysis.

. regardless, gardasil (a vaccine) protects against 4 of the 20 or so hpv subtypes (6, 11, 16, 18). 16 and 18 cause 70% of cervical cancer cases, and 6 and 11 cause 90% of genital warts cases.

. but even if you haven't been tested, it's unlikely you carry all four of these viruses. so even if you've been sexually active for awhile, or even if you've had genital warts, it may be a good idea to get the vaccine if you don't want to get more warts or to reduce your chance of cervical cancer.

. and if you're not yourself female, you might still not want to get warts, nor to expose your partners to either warts or cancer-causing viruses that you don't already have.

. AND HERE'S THE IMPORTANT BIT: the fda has only really signed off on giving the vaccine to girls 9-12, who presumably have not yet been exposed. they're iffier but signed off for women up to age 26, too.

. BUT IT'S OKAY TO GET THE VACCINE EVEN IF YOU ARE OLDER OR NOT FEMALE. it's a killed-virus vaccine, and the mechanisms are well understood; it is unlikely to pose say a grown man any danger that it doesn't pose a little girl (say swelling at the injection site). IT'S ALSO LEGAL -- it's an "off-label use", but these can be and frequently are used for prescription drugs.

. AND -- the PLAN P DROP-IN CENTER in davis square will gladly give you gardasil, even if you're an old hag like me. they'll try to bill your insurance, though i expect to have quite the fight over this one (and i'll pay cash if it comes to that, i'd rather spend $500 than die of cervical cancer).

SO -- VACCINES AGAINST DEATH "R" GOOD. i would recommend this to anyone who intends or imagines having sexual contact. it's readily available. despite the press, you can get it if you are older (planned parenthood believes that people over 26 have sex, too) and the np i talked to seemed optimistic about the vaccine starting to act as a "barrier" in men between cases passed between heterosexual women.

it weirds me out that there was resistance against vaccinating the young because it "encouraged premature sex" or whatever, but weirder yet is the idea that women over 26 can't make the choice for a vaccine for safer sex. so i'm telling you, you can go off-label if you like. planned parenthood is on your side.

Comments

[plumtreeblossom.livejournal.com]

Is there any known reason why the FDA caps on-label use at age 26? Other than utter blind ignorance or denial of the sexual activity of we old biddies over 26? Feh. Good that PP is bucking that.

Thanks for this.

[hrafn.livejournal.com]

I seem to recall something about how they are assuming, by that age, you've already been exposed to the virus(es), so it's not worth the expense of getting vaccinated. I'm glad not everyone is following the FDA's rules/assumptions on this, though!

[lyonesse.livejournal.com]

no, the cdc estimate is that only about 15% of the american population has the hpv virus at all. perhaps you are thinking of hsv (herpes simplex, cold sores) which is much more endemic (90% or so for hsv-1), for which vaccines are still under development?

[hrafn.livejournal.com]

Oh, good! Is that CDC figure for just the strains that are implicated with cervical cancer, or does it include the strains that cause warts on hands/feet/other areas?

No, I was thinking about HPV, since I had in my head that HPV is the most common of the lot, with something like 75% of the population having it/will get it. But I guess the sources I've been reading that from (and I keep stumbling across it) are either dead wrong, or were themselves confusing HPV with HSV.

[lyonesse.livejournal.com]

i think it's a total, but i'm quoting from a drug-company faq, not the original cdc study (which was cited as 2005, if you want to track it down).

and yeah, hsv is the endemic one. hpv is a lot less common, though it rose sharply over the last decade or so. maybe hpv's that endemic in some particular group (say, a high school) from some particular study?

[hrafn.livejournal.com]

Hmm, well, the next time I run across stats about the prevalence of HPV, I'm going to look up the sources.

[lyonesse.livejournal.com]

always an excellent idea. if you want to look for them specifically, try pubmed or the cdc.

directly from the CDC website

[glitterbec.livejournal.com]

"Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year."

http://www.cdc.gov/std/HPV/STDFact-HPV.htm

Re: directly from the CDC website

[lyonesse.livejournal.com]

that is correct. note that 20 million people is about 15% of the us population, as i said.

[aspasia02.livejournal.com]

according to my doctor there is something that happens in a woman's body chemistry around age 27 that makes her react differently to viruses, vaccines, etc, and they think it might render this particular vaccine useless. But they don't really understand what happens, why, or how to counteract it if possible.

[lyonesse.livejournal.com]

hm. the doctors at pp seem to disagree, and i (who am a neuroscientist, not an md, but i'm on the faculty at harvard medical school and not unfamiliar with such issues) can't imagine a reason this would be true, nor can i think of another vaccine to which such an age rule is applied. for that matter, australia has been promoting the vaccine for boys as well, unlike the fda. i also note that none of the public press coverage i've found has even asked the question about older women; they all focus on the issue of giving std-related vaccines to kids.

i suspect the testing was done the way it was b/c hpv is most commonly diagnosed in the 20-24 age range, which would make testing a vaccine for efficacy in that age range more efficient, and then the recommendation came out for reasons of conservativity.

[lyonesse.livejournal.com]

the official word is that the studies were conducted on girls and young women, so that's what the fda has labelled it for. but i think denial is a fine, fine word.

[aspasia02.livejournal.com]

do you have any idea how much they're charging for the total 3-shot round?

[lyonesse.livejournal.com]

about $500. they started by taking my $15 copayment and billing my insurance, though. if my insurance doesn't pay, i mean to protest it, as there is (a) no rule against off-label prescriptions and (b) no suitable substitute for this vaccine.

[sly-salkie.livejournal.com]

One of my friends is against this vaccine because he's wary of the fact that it's brand new, and that Texas is making vaccination mandatory for sixth graders. That's the too-liberal side of anti-vaccination.

What I don't get -- why do doctors over-diagnose? They over treat, over diagnose, and pretty much freak out about abnormal pap smears, or at least they did a few years ago when I and many of my friends were first diagnosed. One girl I know was subjected to an extremely painful electric shock treatment of some sort in her uterus. I was biopsied without a local anaesthetic and told that it wouldn't hurt, which was utterly insane, and then within 6 months the spot cleared up by itself and the following pap smear was absolutely normal. A nurse told me that vitamic C helped to clear it, and another nurse told me that the cancer takes years and years to develop, and can be easily caught and prevented with regular checkups.

I'm glad there's a vaccine. Does anyone know if it does anything for people who already have a form of the virus? This is one of those STDs I just don't understand. You hear so many different things, and even gynecologists don't seem to know what's going on.

[lyonesse.livejournal.com]

if your friend is against the vaccine, of course he should not get it.

i've been under- more than over-diagnosed myself, but i'm guessing it's insurance-related -- they don't want to be sued for malpractice (malpractice insurance is the most expensive part of medical practice) for failing to do everything they possibly can. (i've also never had an abnormal pap, so i can't speak to that in particular.)

the viral subtypes are exclusive -- if you have one of the four types this addresses, it will still protect you against the other three, say. it won't affect the one you already have at all, nor the other types that the vaccine isn't designed for.

it does take time (variable, though) for cancer to develop. and since the vaccine only affects the forms of the virus responsible for 70% of cervical cancers, you do still need to get a pap to check for cancers that might have fallen into the other 30%. so yes, even with the vaccine there is still the need to have regular checkups.

i hate it when people say "this won't hurt" and then it does. i've had the worst experiences of that sort with dentists :/

[artic-monkeys.livejournal.com]

I just saw something interesting on this today. Texas governor pushes vaccine through even though Bush lives in State:

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/02/AR2007020201528.html