The Gardasil Problem: How The U.S. Lost Faith In A Promising Vaccine

Thu, Apr 5, 2012

Oral Cancer News

Source: Forbes Magazine, written by Matthew Herper

Neal Fowler, 50, the chief executive officer of a tiny biotech called ­Liquidia, was assuming a position common to road-warrior entrepreneurs: leaning his elbows on the seat-back tray in an airplane so he could gaze at the screen of his laptop. That’s when he felt the lump in his neck.

Fowler, a pharmacist, figured his lymph node was swollen by a recent cold, but the oncologist seated next to him—his chairman of the board—thought they’d better keep an eye on it.

The chairman was right. Over the next week the lymph node got bigger and harder. It was not sore to the touch, as happens during a cold. Fowler went to the doctor, then a specialist who knew exactly what he was seeing: a new form of throat cancer that ear, nose and throat specialists across the U.S. now say dominates their practices. Some 8,000 of these tonsil tumors turn up each year nationwide, courtesy of strain 16 of the human papilloma virus—the same sexually transmitted virus that causes cervical cancer. Usually transmitted when men perform oral sex on women, it can also spread through other forms of contact, perhaps even just kissing.

His prognosis was good—80% of those with this new tumor survive. His status as a drug industry veteran and chief executive of a biotechnology company didn’t hurt, either. He went from diagnosis to having the primary tumor removed from his tonsil in just a day. His first team of doctors wanted to do a second surgery, opening up his neck, but by polling other experts he found a ­different team and a different option: chemo­therapy and radiation.

But it gnaws at Fowler, who thinks about vaccines all day long—Liquidia’s vaccine work made it the only startup to receive an equity investment from the Bill & Melinda Gates Foundation—that one that might prevent other boys, including his teenagers, from ever developing this cancer isn’t being used. Gardasil, one of two HPV vaccines, is already approved in boys to prevent anal and penile cancers, but because these diseases are rare, only 1% actually get it. And tests that might well prove that this Merck product can prevent the new throat cancer strain would take at least 20 years, until the boys sampled actually became sexually active and then contracted the disease.

“We’ve got this two- or three-decade window where more and more of these patients like myself are going to emerge,” says Fowler. “To me the ­[vaccine] risk is minimal, and I’d say, why not do that?”


The incidence of HPV throat cancer is rising

A big part of the answer is politics. Drug safety, vaccines, antibiotics and reproductive medicine—all have become proxies for the culture war, often tripping up public health in the process. Big Pharma hasn’t helped, with deep p.r. wounds that have made it anathema to both political parties. Nor has the FDA, which has shifted the goalposts on ­approving new antibiotics enough to scare away many innovators just as ­resistant bacteria have become a big health problem. Both parties undermined the FDA further by overruling it on how the Plan B emergency contraceptive should be used, weakening the agency’s authority. Now a coalition on the right is pushing to remove all testing of whether some medicines are ­effective, while many on the left still think the FDA ­remains too cozy with the drug industry.

“If you look at both sides of the political spectrum I’m amazed and appalled by the lack of knowledge that’s being put forward as knowledge,” says Robert Ruffolo, former head of research at Wyeth. “They’re not scientists, they’re not physicians, and many politicians will say almost anything during election season.”

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

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One Response to “The Gardasil Problem: How The U.S. Lost Faith In A Promising Vaccine”

  1. hilllaguna Says:

    This reply originally posted on the Knight Science Journalism web site. Written by Deborah Blum

    Let me begin here by acknowledging that I am big fan of Matthew Herper‘s medical reporting at Forbes, enough so that any day now I may charter a Madison, Wisconsin based fan club and start passing out leaflets and lapel pins.

    His work on the business of big pharma and how it works, his insights into the actual pharmaceutical products are clear, rational, and always leave me with the feeling that I am joining a civilized discussion of issues that matter. In fact, civility and rationality are hallmarks of the typical Herper piece.

    He’s also a reporter who has been willing to stand up for the public health importance of vaccines in story after story. To mention just a few examples: from last November, With Vaccines, Bill Gates Changes the World Again; from February, Who Would Ever Have Thought That A Vaccine to Protect Babies Brains Would Be A Hard Sell; and from early April, The Gardasil Problem: How the U.S. Lost Faith in A Promising Vaccine.

    And just last week: “Why Bill Gates is a Hero and Donald Trump is a Zero”.

    The last post picked up on Trump’s recent appearance on CNBC, part of a series of pronouncements from the celebrity real estate developer that he believes that (loud sigh here from Deborah) vaccines cause autism. This, as Herper tartly notes, went entirely unchallenged by the network host, despite the fact that any such connection has been debunked by numerous sources possessing actual scientific knowledge. He continues: “Luckily for me, someone smarter and richer than Trump – twenty times richer – has already done the bulk of the job of correcting this statement. On national television no less,” Herper writes. He’s talking about an earlier interview, on CNN, with Microsoft founder Bill Gates.

    In that 2011 interview, Gates didn’t mince words. He called the so-called connection between vaccines and autism “an absolute lie” responsible for the deaths of thousands of children. And Herper doesn’t mince words either: “Trump’s statement that we have nothing to lose by trying out giving fewer vaccines or even changing the vaccine schedule, which makes it more likely that kids will miss shots, is simply wrong.”

    Herper then backs us his case by reviewing the solid evidence behind vaccination as well as reviewing the reasons why a certain segment of society refuses to accept that evidence. He provides links to the studies that support his comments and he concludes by reminding us that we shouldn’t blindly follow where politics and celebrity lead us: “We should at least admit that medicine is more complicated than an episode of ‘The Apprentice’.”

    Did Herper’s readers then admit that point, you ask? The post got 160, 807 views (at least according to Forbes when I wrote this piece). It logged 441 comments; 257 were called out. Some agree – “I have my “issues” with Bill Gates on several items, but on vaccines he is spot-on 100% correct. Donald Trump is a chump.” But the majority are firmly, and often furiously, anti-vaccine: “What a ridiculous statement. Vaccinating kids causes many illnesses far and above what the vaccine is designed to do.” And many are less, um, polite on that point than the one I quoted.

    In other words, this is actually the kind of comment thread any of us expect when we dive into an issue that has drawn a very organized, very passionate opposition. But the predictable storm-and-fury is not what makes this such an interesting comment thread. It’s worth reading because you can find Herper patiently answering even the crankiest comments, carefully offering up evidence that supports his points. And however cranky the readers, his tone remains respectful and rational throughout.

    So here’s what I end up wondering. Can a good journalist taking this much time and trouble help turn an issue around? Can a multitude? Do we have a multitude trying this hard? I’d like to think so but even if so – again if we take a lesson from this particular comment thread – it isn’t obvious that rational argument is actually behind hear. . Still without it, and without this kind of determination to tackle the problem, we face the risk of going even further backwards in the matter of public health.

    And that’s why I wanted to offer up this shout-out to Herper’s work. And it’s why you’ll find me, this weekend, working on my leaflet and lapel pin designs.

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