Monday, October 19, 2009

Gardasil won regulators' approval for use in males

The Wall Street Journal reported that Gardasil (the vaccine against HPV which can lead to cervical cancer in women) has been approved for regular use in males. The choice of what to do with this information represents an interesting study in economics.

What do males get from HPV? Well, they can get genital warts--those are not as life threatening as cervical cancer. There has been an increase in cancers of the neck and throat. And, most importantly, a male with multiple partners would have the chance to pass the HPV on to another female placing her at risk for complications of the infection including cervical cancer.

Is there any harm in allowing Gardasil to be given to males? Not really as far as this economist's read goes.

Are parents of boys likely to decide to give their boys a vaccine that will have much more benefit for the women they may eventually have sexual relationships with? Perhaps, but it does not seem likely. Why not? First, most parents don't like imagining their children with multiple sex partners. (At least not most parents I know.) If two individuals are completely monogamous for their lifetimes, this is a non-issue. Maybe that is unrealistic, but it is a possibility and some/many parents like to maintain the idea that could describe their children. Second, the risks for the women are much higher than the risks for the men. This is an example of an externality. The boys (and the parents on behalf of the boys) do not necessarily see the benefit of such a vaccination.

Should we mandate that boys get the shot? That seems a bit overly paternalistic and like a boon for the manufacturer of Gardasil.

Would a voluntary program for boys be more cost effective than trying harder to get girls to get the vaccination? Not according to the latest research in the area.

So, the FDA's decision is probably clinically acceptable but a lot more thinking needs to be done before the opportunity to vaccinate boys is turned into any sort of policy.


  1. I think one important aspect of getting the Gardasil vaccine for men or women is the cost. The vaccine is given in three doses and cost $120.00 per shot. Many private plans do not cover this vaccine and the patient must pay out of pocket. In addition to this a large majority of the individuals without health insurance in the U.S. are between the ages of 20-30 years old. Without coverage and in tough financial times, this vaccine for men is going to be a hard sell, even with healthcare provider counseling on the vaccine. Cervical cancer accounts for 80% of HPV-related cancers. Cancers in men such as penile and anal cancer account for 20% of HPV-related cancers.A significant number for men, but no way near 80%. As a healthcare provider I am for this vaccine in men and women and I have personally counseled women on getting the series of vaccines, but the cost issue was always a factor. As stated in the BLOG posting about parents reluctant to imagine their children in a relationship, I also found many moms of girls reluctant to give their daughters the vaccine. I do think these same parents would have the same feelings for their sons.

  2. Well, i think the "reluctant" to get this vaccine is because parents have a lot of tough choices in general. First, take the hype with the autism/psuedo link and mmr, regardless if it is real or not, the concern is that not enough testing and information is given to parents, regarding long term side effects. Second, take the huge money making industry that pharmaceuticals are and health care. Too much money being made, you are gonna have questions of "well, do they really care about being upfront when this much money is to be made". Second, look at all the breast cancer lately, and why have their not been correlation studies made very public and circulated, about invitro hormones, and breastcancer (money?), lack of breastfeeding and risks of breast cancer (money to the docs that first perform zillions of c-sections, and then pharmaceuticals that give you a can of formula and diaper bag as a parting gift.
    I think in my opinion, it is a definite question of empowerement, and women giving power away. Tradititional cultures, such as mine here in Greece i feel suffer even more so with this backwardness in womens roles. In America, it is a giving away of sex too easily, here too, and the multiple partners thing is all too common. However, it has been my view that at least in Anglo culture, more men are willing to have vassectomy. To some degree take responsibility of reproduction by giving of their bodies.
    Again, the problem with this vaccine targeted to young girls is first, that they are already identified as having multiple sex partners, and in a position where they will not use perfalactives, second, they are gonna go through more medical procedures to keep their reproductive health in tact. I don't know in the end is sex even gonna be worth it to women? Give them the pill for so many years, then fertility drugs, then pump silicone into their mamary glands, then tell them to go out there and compete and give their babies formula, make sure you take away their birthing power, completely by doing and i have heard this c-sections so they don't lose their sight from the strain of birthing! HUH! yup i have heard, this. What is more amazing is how women give away this power. I would spend more time empowering my girl rather than making her more of a reseptacle for almost anything that comes down the line.
    How do i do this, by letting her in on her own power, and not to give it away lightly. Giving her the power to chose partners for sex, or to be satisfied even without sex. I don't believe that we are all hormone driven beyond control. And why not use condoms, if she should not be able to regulate this urge. Although, i think it can be made manageable. Maybe i have dissapointed people in that it sounds ridiculous that i would not want to protect and vaccinate, the issues are not simple issues of the technology is available there needs to be a deontology, an ethical framework following our decisions, at all times this is what needs to be developed in the individual. Aristea

  3. All good points. Interesting issue of 20-30 year olds. My non-clnical understanding is that for Gardasil to be effective it must be given before sexual debut--for both men and women.

  4. These rules or regulations mainly affect the development of venture capital even though they are meant to guard against defaults.