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A recently-concluded legal battle over the custody of IVF-created embryos involved at least one person who felt a lot more attached to her embryos than I ever have to any.  A couple created several embryos with the aid of reproductive tech, and only ended up having one child before they eventually divorced.  The mother, as it turns out, won custody of their daughter, and sued for custody of the embryos, which she won and eventually destroyed.

When it comes to reproductive choice, I've liked to discuss hypothetical situations about artificial wombs and claims to embryos and fetuses that would exist outside a woman's body.  It's sort of difficult to think about because it's so different than what humanity has been dealing with for all of our existence, but some court cases are demonstrating the simple-to-me principle that the right to abortion is one that exists because incubation occurs in a woman's body.  Once an embryo or other proto-kid of two parents is no longer in her body, the mother has lost her veto power.

Personally, I think that either parent should retain the ability to destroy embryos that are not in a woman's body.  In general, I think veto power should be retained when it comes to creating whole new people, so long as it doesn't require forcing abortion on an unwilling woman.  But I can understand why people would err on the other side.

If it's already broke, don't break it more

It was really annoying to watch stem cell therapy get so heavily oversold in the 06 election cycle. Stem cell therapy seems to me like a fantastic way to give people cancer, and it turns out (registration required) that it is, at least in a recent case. Cancer is when your cells decide they're just going to keep reproducing past what the rest of your body can stand, and messing with the signals your body long ago relied on to stop making more of you strikes me as pretty dangerous - especially in the case of brain tissue.

Basically, if your brain keeps growing when you're out of the womb, your brain is growing cancer. A lot of brain cancer occurs in very young children, when the process of stopping the proliferation of brain tissue is critical, and prone to error. Introducing non-native cells that will proliferate according to signals out of sync with what is going on in the rest of your body strikes me as extremely dangerous. When the rest of your body is letting your cerebral tissue degenerate, what is in-sync is already quite dangerous, but trading a degenerative disease for a malignant cancerous one doesn't make things much better.

But hey, I can't blame people for trying. Or give up on the idea after seeing a case report.

Big Nutra's direct-to-consumer scams

Feministing pulled a post about the "feminine" aspects of naturopathic medicine to post on the front page, and I am quite the skeptic of alternative medicine, but I was also annoyed at the "conventional medicine is patriarchal and for lame men who might as well spend all their money on useless, dangerous treatements and get sick and die while their doctor is being a jerk to them" vibe.

ericamatluck said:

Historically, women's voices have been excluded from medicine. Medical research has been conducted by men, for men. There was actually a time when hysterectomies were performed because women were considered "hysterical". Although we have seen progress with regard to women's involvement in medicine, the situation remains inadequate. Our understanding of pathology is based on how a condition presents in a man. This understanding is applied to women, ignoring the fact that we have a unique chemical and structural composition, and may respond differently to the same pathology.

This brings up real problems with medicine as it's been applied to caring for women, but is not any kind of argument for naturopathy as feminine, and therefore more-suited to female patients.

The comments erupted into a huge flamewar over "natural," "homeopathic," and "herbal" medicine, which seem to be used interchangeably. "Natural" is a marketing term that basically means nothing (see"all-natural" on the side of the bag of chips you're eating), and homeopathy is truly superstition-based and ridiculous. Homeopathy relies on an essential characteristic of a substance being imbued upon a diluent, even as the substance is diluted to minute, if even still present strengths.

Ever hear about the homeopath that drank a glass of water?

He died of an overdose.

I'm not really clear on the difference between "natural" and "herbal," but I'll bet a Venn diagram where the "herbal" circle was completely encompassed by the "natural" circle would represent that relationship. I've spent almost a solid year working to straighten out some medical problems, mostly with conventional doctors and pharmaceuticals. When things began, I really didn't have much capability to decide what I should do. I basically just did what doctors told me to do at first.

I've since warmed up a little to "alternative" medical practices, since hey, I don't mind taking a few vitamins or other substances that I know won't hurt me (ie valerian or hops or fish oil). I also usually run a search on pubmed with any new snake-oil-ish thing I'm considering trying.

Googling anything medical is almost always a disaster. If it's not on pubmed, it's someone trying to sell you something. I've learned that there are no bigger conspiracy theorists than people who have chronic, incurable diseases.

The thing I saw over and over again in the thread on Feministing that I thought was weird was all of the "pharma's corrupt, but try my $30 bottle of fish oil tablets" kind of stuff. You don't get the kind of exclusive manufacturing rights for a naturally-occurring substance, but people selling omega-everything are sure making themselves some money.

People are rightly suspicious of pharmaceutical direct-to-consumer advertising, but the same branding and appeals to emotions are applied to the overpriced supplement products. They don't make as much money as Pfizer, but they don't have the same liabilities either.

I don't think there's anything more consumer-friendly in the business of wringing the oil out of fish and putting it in little caplets, than there is in the business of creating novel compounds and testing them against diseases/symptoms, and then manufacturing and selling them.

With substances that aren't exclusively owned and manufactured by one entity, there's room for competition, which can open up the field to better-produced or plain better products. I bought a bottle of cheap fish-oil supplements, and the fish burps were in-freaking-tolerable.

This phenomenon has played out with generics of brand-name hits, and there are definite preferences for different generics. Generics aren't actually required to be precisely equivalent to brand-name drugs (they have to be within 80%, to my knowledge), so lots of people stick with their brand-name greatest hits drugs. I'm sure that competing in the supplement marketplace is a lot like competing amongst generics. You're all selling the same substance, but you need to make some kind of superficial distinction between yours and theirs. Make a supplement that is branded such that people feel good about buying it, and have an advantage such as convenience or user-modifiability. I've taken two generic forms of Ambien, and the first I took was a pill in an oblong shape that was easily broken in half so I could use a half-dose if I wanted. I preferred it to the one I currently have, that's tiny and unsplittable. They both do what they're supposed to do, but it's not efficacy on which I am basing my preference. I once had the birth control pills I was taking switch to a generic, and I switched back to the brand at my own expense(despite being made fun of by the pharmacist), because the generics really didn't feel right - I'd started a new type of pill when I was having really terrible menstrual cramps, and the new pill cleared that right up. They came back with the generic, and I'm not going to take birth control pills about which I feel iffy.

Leverage

Kevin, M.D. is concerned that single-payer healthcare plans dictate the prices of medical procedures to providers.

But that's exactly the point, Kevin. If providers don't like the contracts they've negotiated with insurers, they need better negotiators, or to find ways to cut the costs of procedures. It costs a heck of a lot more to get an MRI in the US than in Japan, and this isn't merely because the technology is more available in Japan.

Eliminate the variables

Feministing.com commenters are predicting doom and gloom in the event that a libido-increasing, appetite suppressing pill for women enters the marketplace. I'm more optimistic (assuming there's any good science behind the idea that this drug could one day be used by humans). Samhita says:

As the article asserts, low libido often has more to do with unhappiness in relationships than with actual lower libido. But why deal with that when you can have a quick fix drug to help you ignore the cause and allay symptoms.

I think this drug could be a good tool for identifying a problem relationship. Right now, if you find yourself in a situation where you and your partner are fighting a lot and not connecting sexually, it's pretty hard to figure out exactly what's wrong. Is your new antidepressant screwing with your libido? Are you ready to move on from the relationship? Are you too concerned about the way your body looks to enjoy yourself in bed? It's pretty tough to separate out all your feelings on these issues.

If you began taking this drug, and were still unhappy, you at least could no longer blame it on your spare tire or how often you're getting it on. If you take this drug and things get better - then things are better. There's the possibility that people will confuse a busy sex life with a good relationship, but that happens without this drug around. Your relationship is going to be terrible with or without this drug if you have no ability to assess your own happiness in it.

Building families around fear

I can't add much to the legal, medical, and policy analysis that I've seen regarding today's Supreme Courth decision upholding the "partial-birth" abortion ban.

What I can say is this: it makes me, personally, a little more afraid of bearing children. The law prohibits a procedure that exists to reduce danger to a pregnant woman, a procedure that only comes into consideration when something has gone horribly wrong with a pregnancy that a mother wished to carry to term.

Do I want children? I don't know. Maybe. Probably?

What would I do were I to unexpectedly become pregnant? I don't know.

I do know that I would rather make my decision about what kind of family I'd like based on the life I want to live and what kind of love I want in it. Now when I consider having children, I'll have to wrestle with new fears of dying after suffering a perforated uterus, or giving birth to a child whose life can only be blessed by brevity in the face of the physical suffering it will endure.

I deeply resent this cruel and painful intrusion on my decisions about the most beautiful and loving relationships I will ever have.

Disappearing the sick

You may have heard about the increasingly-common practice of jailing people carrying highly-contagious, drug-resistant tuberculosis. I've seen more than one news article on the subject over the past year, but was really surprised when I heard this report on NPR yesterday, where the reporter was unable to get ahold of the patient, Robert Daniels, and had to resort to slipping her number to him through a messenger so he could call her collect, only to be cut off after ten minutes. He's been totally isolated in a criminal facility because he happened to catch the wrong bug.

While I recognize the real danger someone unknowingly or recklessly spreading dangerous diseases, I just can't believe that this is the best approach. A few years ago, Moscow had a with similar attributes, where a local man was convicted on felony charges of "knowing he was HIV-positive and transferring or attempting to transfer body fluid to women in Moscow without informing them he was infected." The problem with this when it comes to actually stopping the spread of disease is that if the man in the HIV case, Kanay Mubita, had never been tested for HIV, he would never have gotten in trouble. It creates a perverse incentive against being tested.

On the other hand, I do recognize that knowingly exposing others to deadly disease is not behavior that should go unpunished. If we're going to make what Mubita did a crime, we also need to make HIV testing mandatory. And if we're going to jail people like Daniels, we need legislation that defines his behavior as criminal, and to try them in court. I would accept some distinction between diseases that manifest themselves obviously (like TB) and those that one might not know they were carrying. But as it is, there are plenty of idiots out there who don't wash their hands before leaving the bathroom or undercook hamburgers, and they're not facing jail time. Mubita and Daniels have both put people around them at risk, but unlike the guy who didn't wash his hands, they're carrying sensationalistic diseases that people get excited about. Legislation can be a useful tool for preventing public health problems, but it needs to be tailored towards actual risk reduction, and not just making people feel less scared or more vindicated in the face of the latest scary disease.

Happy back up your birth control day!

Today, NARAL Pro-choice America is celebrating Back Up Your Birth Control Day by promoting awareness of emergency contraception and how to access it. See Vanessa's post at feministing for more information on EC, but also don't forget that every once in a while, it's a good idea to reassess how your birth control regimen is working for you, and what steps you could take to make it more reliable.

In keeping with the spirit of the day, I thought I'd share what I do, as a user of oral contraceptives.

1. I take my pills right before bed and leave them in my night stand. When I first started using oral contraceptives, I tried taking them in the mornings, and felt uncomfortable with the idea of maybe oversleeping and taking pills at dangerously inconsistent times.
2. My partner is on guard to remind me to take my pill every night. I forget everything, even things I do every day. I can accept this fact. I even forgot to pack a lunch today and had to eat crappy overpriced campus food. A reminder is always useful.
3. I keep backup methods of birth control in my nightstand. What I've got on-hand right now is the sponge, which I actually haven't had occasion to try, but I'm willing to give it a go someday.
4. I store my pharmacist's number in my phone. If I've missed a pill or have questions about how a course of antibiotics will interact with it, I give them a ring. I've been using the same pharmacy for several years now and have built up a good relationship with the pharmacists who work there, but even if you haven't any pharmacist is likely to answer your questions about using medication. Find one that will provide answers and keep their number close at hand.
5. (Possible TMI warning) I look on the bright side. A week where I've missed the pill doesn't have to be abstinence week or condom week - it can be oral sex week! Can't complain about that.

Anyone with other tricks to share to correctly and consistently use oral contraceptives - or any other type of contraception - please leave your ideas in the comments. If you'd like to post your list on your blog, I'll link to it. To paraphrase the old saying, effective birth control is part medication and part inspiration. Gimme all you've got, feminist hivemind.

That's more like it

Washington State is offering the HPV vaccine to girls for free. In the article, Gov. Christine Gregoire says:

Addressing the Washington State Medical Association's annual legislative assembly and again in a news conference Monday, Gov. Chris Gregoire said such action [requiring the HPV vaccine for entry into school] seemed premature.

"I told the medical association that I was reticent to dictate when I think there is a lot of public education that needs to go on," Gregoire said. "To go out and start just saying everybody mandatorily has to have this is a little bit troublesome for me.

If I were Merck, I'd be scrambling to get the takers to participate in a study on the long-term effects of the vaccine. If, in 2 or 5 or 10 years the country decides to buy into requiring the HPV vaccine, Merck will still stand to make a mint. If they really believe in Gardasil's potential, they can wait.

Leaning in a new direction

In case it wasn't obvious in the last posts I've written about it, my first reaction to the news that the HPV vaccine is going on a roster of required vaccinations for school in Texas was, "Heck yes!" Cervical cancer kills, genital warts are a drag, and yearly pap smears are no party either. I'm not a doctor or a public health expert, but the information about Gardasil's efficacy and safety make it look like a pretty good bet for eradicating most cases of cervical cancer.

Still, I've come to the conclusion that I don't think it's wise to require vaccination against HPV in schoolchildren at this point. Loquacious commenter stickdog - who has an axe to grind, but I was wrong to call a troll - has given every possible reason to oppose widespread HPV vaccination, and while I'm not buying all of it, my change in position has definitely been guided by the info stickdog has brought.

I really, really want Gardasil to work, and nothing that I've learned about its approval process has set off alarm bells in my head. But the fact remains that there isn't a huge body of evidence supporting Gardasil's long-term efficacy and safety, and the health problems associated with HPV don't seem pressing enough that we ought to embrace Gardasil so enthusiastically. The current system of keeping a close watch on American cervices has failed many, but in my view, not so many that we couldn't take our time in evaluating Gardasil. Think of it this way: if we're going to be instituting a large and expensive public health program aimed at preventing cervical cancer, we might as well devote the money to access to the medical care that already works pretty well (say, refunding this program) as we wait to get a better picture of what Gardasil has the capacity to do.

I predict that Gardasil will be a valuable tool in eradicating cervical cancer in America. On the other hand, responsibly prioritizing public health spending means that if we're going to make an investment in a new tactic, we ought to be as sure that it will work as we can afford to be. If Gardasil is used on a country-wide scale and it flops, we'll be stuck with not only a huge bill and an unimproved HPV rate, but we'll have also spent money that could have been used to address other public health concerns. Considering the relatively low urgency of the problem that HPV presents for Americans overall, I think it would be smarter to wait for more information to roll in as people voluntarily vaccinate.

Questioning Gardasil

Maia at Alas, A Blog, as well as brownfemipower at Woman of Color Blog, are voicing some concerns about the idea of requiring the new HPV vaccine Gardasil for entry into public school, and as someone with a little training and knowledge in biology and public health, I thought I might weigh in with a few ideas.

Consider this from Maia's post:

As I understand it the only way a vaccine can be available to all, and publicly funded in America is if it is compulsory before a child can attend school (there are exemptions available to parents for conscience reasons). I can understand the public health argument which says that a kid must be immunised from certain infectious diseases before they start school (I don’t necessarily agree with it, but I understand it), disease can travel very quickly among unorganised children at school and this can cause an epidemic. But this logic does not apply to the HPV vaccine, HPV is a lot harder to contract than measles, so it isn’t going to spread round a school in the same way (it is clear that the vaccine is as important for later in life as it is for 6th grade, unlike other vaccines) and any genuine worry about the disease spreading would require both boys and girls to be immunised. There appears to be two reasons to support compulsory vaccination, either because your in the pay of the drug company, or you believe that it’s important that poor women get access to the vaccine (or both). Neither of these are based on genuine health concerns.

There are a couple of reasons to vaccinate children against HPV before they enter school. It's a good way to reach most children, and as they're entering school, they're young enough and have been isolated enough that it's not likely they've been exposed to the diseases they're going to be immunized against. Maia's right that going to school isn't what exposes a kid to HPV, but most kids go to junior high, and most kids haven't been exposed to HPV as they're entering junior high. We don't know whether Gardasil will confer lifetime immunity, but from what we know now, it is likely to have a protective effect on a woman through the time in her life when she is most likely to have multple partners.

Maia is also right that if we're going to try for herd immunity against the strains of HPV against which Gardasil protects, the most effective way to do it would be to vaccinate everyone - but there's also the consideration of cost, too. You can see my post I wrote about it earlier for details, but last month there was a study released that looked at the costs versus benefits of different vaccination strategies with Gardasil, and it was in fact vaccinating only girls that had the best cost-to-benefit ratio. It wasn't perfect, but they did predict a 78% reduction in HPV transmission, at a fraction of the cost of vaccinating people of all genders.

An example from the field I work in - animal health - would be vaccination against Brucella abortus in cattle. B. abortus is a bacterium that causes abortion in cattle (and is also transmissible to humans; Florence Nightengale is thought by some to have suffered from Brucellosis, aka "undulant fever," during her last decades as an invalid), and is transmitted through fluids such as milk or semen. Female calves are the only ones vaccinated against Brucella, and through this regimen all but two states in the US are considered Brucellosis-free by the USDA. One, Texas, is a state that imports many animals from countries that have different animal health requirements. The other, Idaho, borders on Yellowstone park, whose bison populations carry Brucella.

brownfemipower wonders why we're simply accepting the idea that HPV causes cervical cancer, and I think the answer is pretty simple: we have good data backing up the assertion, as well as a good idea of how it could be true. If HPV is a virus that can direct your body's cells to divide uncontrollably but benignly as genital warts, it's not a difficult leap to the idea that other strains could cause your body's cells to multiply uncontrollably and malignantly, as is cancer's m.o. She says that she suspects her use of Depo-Provera as contributing to her own cervical cancer, but I don't think that Depo-Provera in itself could reasonably be suspected to cause cervical cancer. There are higher incidences of cervical cancer in users of Depo - and of oral c0ntraceptives - but it's widely suspected that this statistical finding reflects the fact that people already using one type of contraception are less likely to use condoms. If you're still having sex but you're not using condoms, you're still at risk to contract std's.

In the comments to my post about vaccination strategies, I attracted some sort of push-spammer (who came by after looking up Gardasil on Technorati) who left me a nice, organized, bulleted list about the "dangers" of Gardasil that actually left me feeling a little more secure about Gardasil to begin with. I imagine that "stickdog" has been spreading this list all over the blogosphere, so I'll go ahead and address the points one by one, just to have it on the record.

1. GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.

Well, great. Gardasil is targeted towards the most virulent strains of HPV, the ones most likely to cause cervical cancer and genital warts.

2. HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four "bad ones" protected for in GARDASIL) results in no known health complications of any kind.

So far, so good.

3. Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don't get pap smears until after the cancer has existed for many years.

Here's where things veer off course. It is true that cervical cancer deaths have declined sharply due to widespread detection of precancerous lesions through pap smears, but cervical cancer is still the second-most common cancer amongst women. Cervical cancer is treatable, though treatment can be drastic, with removal of the cervix and/or uterus, and I don't see any reason to worry less about "old women, women who are already unhealthy and women who don't get pap smears."

4. Merck's clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the "placebo") and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.

No, not really. It is difficult to do drug testing involving children, so I don't think that the small proportion of young people involved is very unusual, nor do I think that using a component of Gardasil that is not the active ingredient is a poor control. Test controls need to be selected such that they isolate variables, and removing only the components that confer immunity seems to me the ideal control to use in the test.

5. Both the "placebo" groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications -- as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.

Okay - so what? Injection-site irritation or infection are very minor complications and were apparently distributed across the control and test subjects.

6. Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM -- MUCH LESS DIED OF IT. Instead, this vaccine's supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and "precancerous lesions" (dysplasias) than the alum injected "control" subjects.

Is this capitalized because it's good news? Cervical cancer is a very preventable disease, and we're seeing exactly how that's true with the point above. It would have been extremely unethical for doctors to have allowed any precancerous lesions to have progressed to cancer or even death, no matter how much more convincing the data would have been for stickdog. The fact is that cervical cancer is not satisfactorily prevented by the CDC recommending that all women have yearly pap smears. Some can't afford to go; some don't want to go, some precancerous lesions fall through the cracks. Women are still dying of cervical cancer, with women of color and poor women represented disproportionately amongst the dead. If Gardasil stands to have a better effect than what we've been able to manage with our flawed health care system and pap surveillance, let's go with Gardasil.

7. Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.

As a highly skeptical reading of the data, this is fair enough, though it can be said for any number of drugs that are approved in the US. Vaccines do have the advantage of being small doses that aren't taken every day or every week, so they avoid some of the potential problems that are present with drugs that are used continuously.

8. GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck's biggest cash cow of this and the next decade.

Pap smears are also expensive, and need to be undertaken every year. Additionally, they do not have the advantage of taking possible disease vectors out of the game. I have medical insurance and have been able to have yearly pap smears since I became sexually active. Once, a smear came back with bad results, and while things worked out okay for me, there's really no telling who might have contracted HPV from me, and maybe given it to someone who wasn't insured and doesn't have the opportunity to get yearly pap smears. If I'd been vaccinated against HPV, I would be just as safe, but so would my past sexual partners, and my partners' partners.

Furthermore, the sad fact is that large drug companies deal only in cash cows, and that drug manufacturing is a business that demands profit. It's entirely possible that there are cheaper ways of preventing the spread of HPV, but Gardasil has the advantage of being available right now.

Skepticism is healthy, and I'm sympathetic to Maia and bfp's perspectives. Both of them must know a lot more about racism in medicine and race and gender issues when it comes to reproductive rights than they do about how vaccines work and public health practices. That's fine - we can't specialize in everything. My training in science and inexperience with race and class issues probably make me a little Polyannaish about these issues. Luckily, each of our perspectives can inform the others', and we can thank the blogosphere for facilitating that.

Thoughts?

Herd Immunity

I saw this conversation at feministing about the CDC's recommendation to add the HPV vaccine Gardasil to the regimen of immunizations required for children enterting public schools, and it turned out to be part of a happy coincidence. It just so happens that a lot of the questions being asked in the thread were addressed in a study in a copy of Emerging Infectious Diseases that I picked up today. (The happiest part of the coincidence? It gives me a chance to brag. The cover paper in the issue is something to which I actually contributed a minor amount of elbow grease. It's like I'm a real scientist, kind of!)

The paper, entitled Model for Assessing Human Papillomavirus Vaccination Strategies, by Elbasha et al, took a statistical look at the possible costs and benefits of different HPV vaccination strategies. The cheif concern is preventing HPV-associated cervical cancer, though check out this first sentence:

Human papillomavirus (HPV) causes cervical intraepithelial neoplasia (CIN); cervical, anal, penile, vaginal, vulvar, and head/neck cancers; anogenital warts; and recurrent respiratory papillomatoses, resulting in disease and death in both women and men (1).

So, worry not wingnuts: we're not just trying to save women's lives here.

Feministing commenters wondered why boys and men aren't recommended to be vaccinated. See the paper's abstract:

We present a transmission dynamic model that can assess the epidemiologic consequences and cost-effectiveness of alternative strategies of administering a prophylactic quadrivalent (types 6/11/16/18) human papillomavirus (HPV) vaccine in a setting of organized cervical cancer screening in the United States. Compared with current practice, vaccinating girls before the age of 12 years would reduce the incidence of genital warts (83%) and cervical cancer (78%) due to HPV 6/11/16/18. The incremental cost-effectiveness ratio (ICER) of augmenting this strategy with a temporary catch-up program for 12- to 24-year-olds was US $4,666 per quality-adjusted life year (QALY) gained. Relative to other commonly accepted healthcare programs, vaccinating girls and women appears cost-effective. Including men and boys in the program was the most effective strategy, reducing the incidence of genital warts, cervical intraepithelial neoplasia, and cervical cancer by 97%, 91%, and 91%, respectively. The ICER of this strategy was $45,056 per QALY.

By their metrics, every quality-adjusted year added to each American's life by ppting for the strategy of vaccinating both males and females would cost almost ten times as much as the less-effective-against-disease strategy of vaccinating girls 12 and under with a "catch-up" program for females up to the age of 24. This only augments the case that Ann lays out in her TAPPED piece about the opportunity for public health that Gardasil presents; there's much to be gained, but there's also much to be spent. Elbasha et. al. use the amount of $360 per vaccination regimen in their calculations, an amount that would be difficult to come up with on a less-than-living wage job. With excessive pork-barrel spending adding up by the second in Washington, public health officials would be irresponsible not to take the relative bargain in the female-only vaccination strategy.

A 78% reduction in cases of cervical cancer would mean 2886 fewer deaths in the United States per year (according to these stats).

UPDATE: More conversation about Gardasil inspired me to write another post about other issues people are debating. See it here.

Sexy Nurses

Amongst the sexy archetpes, the sexy nurse always seemed odd to me - what about intensive medical care would make so many people think "do me?"

I recently read Nightingales, Gillian Gill's biography of Florence Nightingale, and got my answer:

Florence's inspection and research confirmed that female nurses came from the humblest classes of society and were employed mainly to watch patients and keep them clean. Most were drunken, callous, and, willingly or not, accustomed to prividing sexual services for the doctors, dressers, and patients. (Page 277)

Silly me, I thought it was society's impulse to make everything that women pursue out to be a sexual game, a heterosexual male fantasy where the ultimate goal of every female pursuit is to get on him, personally. Little did I know that the classist and sexist forces in Western society ensured that this was not a game or a fantasy in Victorian England, but reality.

Also, the book was fascinating (and the author's writing style very witty and sometimes hilariously bitchy) and I highly recommend it. Anyone interested in a feminist bookswap should write me an email.