Because boys are carriers and infection vectors? It seems pretty self-evident that if you want to stamp out an infection you need to take out its infection carriers.
It's just absurd to me that a completely preventable cancer with this vaccine is shunned by groups across this country, because of the implication.
Also, a PSA for young adults and parents of children in the age groups - the HPV vaccine is usually covered (free) with insurance if you're in the recommended age groups, regardless of sex.
I'm mid 30s and paid the ~$750 (using my FSA) for the three doses of Gardasil 9 post FDA approval but before the CDC has finished updating their guidelines that would prompt insurance coverage. There are few reasons you shouldn't get it if you have not yet been immunized, as it pays for itself if you prevent even one case of cancer that would've occurred from HPV transmission (whether that be a case you would've experienced, or a partner experienced).
Agree parents need to get over it (disclaimer: am parent, kids getting HPV vaccination as soon as they're old enough). Your kids are eventually going to have sex. BFD. Protect them from possible future harm with a cheap vaccine.
Ouch, thats pricey. I guess there's a price for being an early adopter. I work with one of researchers that was involved in developing the HPV vaccine and even I didn't realize it was so pricey.
completely covered by insurance if within the CDC guidelines for recommended age groups (around 11-21 for both males and females, but double check first!)
Ideally, you get the vaccine before you're sexually active, as it won't inoculate you against strains of the virus you have already been infected with [1].
I recommend it to everyone who will listen. Cheap risk mitigation (comparatively speaking). Australia made it compulsory, and they will have eliminated cervical cancer in a few decades because of it [2] (and my hunch is that gene therapy will pick up the remainder until then [3]). It's literally a vaccine that prevents cancer [4]. Who says no to that?
"In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18–20 years to 69 years, to primary HPV testing every 5 years for women aged 25–69 years and exit testing for women aged 70–74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks."
I'd still get it no matter how late in life. For instance warts on your feet can also be caused by HPV. There are a ton of strains of HPV so perhaps the vaccine wouldn't protect you but with insurance coverage and no (AFAIK) downside why not get it?
True enough, but it covers some of the most important ones. So it's better than nothing. Copying my other post:
... three vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (1, 2). Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts (3). Gardasil 9 prevents infection with the same four HPV types plus five additional cancer-causing types (31, 33, 45, 52, and 58) that together account for 10 to 20% of cervical cancers.
Source, please? That seems really unlikely given that these are genetic vectors and do not rely on stimulating the immune system (which also means fewer side effects).
Wild, right? I'll try to dig up the ref when I have a moment.
The WHO report, linked above, mentions that the bivalent vaccines also have limited effects on other strains, but they're mostly covered by the newer 4/9-valent ones. I'm pretty certain I saw another report suggesting it can hit other strains too, though again, not very effectively. This was the rationale for some of the ancedotes about people's warts disappearing and all that.
Also, I think there's some confusion about how the vaccines work.
They're definitely intended to provoke an immune response, but the new ones don't use virus products. Instead, they contain particles (made by yeast) that assemble themselves into something that closely resembles the virus's structure. The immune system raises antibodies against that, priming it for dealing with future infections. More here (including a picture of the virus, which is quite pretty): https://www.ncbi.nlm.nih.gov/pubmed/23800545
There are multiple strains of the virus. Even if infected with one wouldn't you like protection against the rest, particularly as Gardasil 9 is the vaccine you'll get in the US and covers the most strains?
Three vaccines that prevent infection with disease-causing HPV types are licensed for use in the United States: Gardasil®, Gardasil® 9, and Cervarix®. All three vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (1, 2). Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts (3). Gardasil 9 prevents infection with the same four HPV types plus five additional cancer-causing types (31, 33, 45, 52, and 58) that together account for 10 to 20% of cervical cancers.
Gardasil 9 is now the only HPV vaccine available for use in the United States. Cervarix and Gardasil are still used in other countries.
Cdc guidelines don't include your age group so it's doubtful that insurance would cover it even today..
And it's not even that they're going to eventually have seen as kids, what if you get married and want to have kids? You don't know your partner's sexual history.
Thats really interesting. I was looking at HPV as a cervical cancer only, not a male oral cancer. I'm going to chat with a researcher I work with that was involved in the development of the HPV vaccine and see what she thinks about it.
Getting the vaccine because you might decide to sleep around (oral or otherwise) is like carrying a weapon because you might decide to get in a fight. Rape exists, but so do murderous assaults. The logic that says you need this vaccine is the same logic that says you need to carry a weapon.
> The logic that says you need this vaccine is the same logic that says you need to carry a weapon.
Assuming both are as common, but they aren't. Most people will have multiple sexual partners and engage in oral sex, few people get murdered.
Then there's herd immunity which is great at protecting everyone, but carrying around weapons seems to have the opposite effect in makes you more likely to be murdered.
Sex is a normal part of life, but even if it wasn't this is a ridiculous analogy.
If I get this vaccine I protect both myself and any future partners I may have. There is no downside (barring potential vaccine side effects).
Your statement is essentially equivalent to:
Buying condoms because you might decide to sleep around (oral or otherwise) is like carrying a weapon because you might decide to get in a fight. Rape exists, but so do murderous assaults. The logic that says you need to use a condom is the same logic that says you need to carry a weapon.
Hopefully it's clear how damaging that thinking can be?
Getting this vaccine is cheap and effective, and in no way similar to carrying a gun.
The worst part, of course, is that you can contract the virus (and the cancer) through kissing! I guess if you make sure you only ever kiss one person, and you know for sure that they have only ever kissed you, and will only ever kiss you in the future, and you and they both have never performed oral sex on anyone, or had sex with anyone else - maybe then you don't need the vaccine.
Deriding the suggestion that we should prevent easily preventable cancer (you call up images of rape and murder!) is way off base.
It can prevent them from getting cancers caused by the specific HPV strains included in the vaccine assuming they completed the entire 3-dose over 12 months course of treatment. It does nothing to prevent cancer from other causes.
Nowhere in the article does it mention the cost to the healthcare system per innoculation. It's also an article written to make it sound like Merck just wants to save lives but you need to also consider the billions off dollars this would net them. Also, buried in the article was this gem:
"Though most experts have little doubt that the vaccine prevents HPV infections anywhere in the body and therefore the resulting cancers, technically, this has not been proven."
I wouldn't put much concern on that not proven thing. Most vaccines aren't technically proven to work in the way we think about proving things in other areas of science. For starters, vaccines are not required to go through double blind studies. We give you the vaccine and if antibodies show up we say it works.
That isn't the problem. The problem is it takes too long to run this hypothetical study from "Vaccinate 12 year old boys" to "These 50 year olds didn't die of cancer at the expected rates". Nobody wants to wait 40 years to run a study that says this thing we suspect is a good idea is, in fact, a good idea. 40 years is a long time. If you follow a patient for six months, they're easy to find. Maybe a handful of them move city once, but they remember they were in a medical trial, "Oh yeah, sorry, I will come in for the follow-up appointment". If you try 40 years it's hopeless. They move ten times, they leave the country, they've forgotten all about your medical trial. So you start with 100 patients and 40 years later you can only trace eight of them, and now your trial is statistically invalid.
The existing efficacy demo for HPV vaccination against cervical cancer relies on the fact that Pap smears are a thing to get answers in just a few years not decades. The smear test gets us a bunch of cells that a pathologist can look at under a microscope and inspect to see if they're normal or maybe "pre-cancerous" meaning they aren't normal but they are not yet cancer. And we know (from having tried it) that if we just ignore it some of that not-yet-cancer turns into cancer and kills people. So if we see that in a smear today you'll get called back and they'll treat it, even though you haven't got cancer.
This means they could give girls an HPV vaccine and then not only show that those girls didn't get the strains of HPV vaccinated against as often as unvaccinated peers, but further show that they don't get as much not-yet-cancer. And _by implication_ that means it protects against cancer.
There is no smear test for these less common cancers in men. If there are pre-cancerous cells we don't see them. We only find out about the cancer, years and often decades later.
I think the "anywhere on the body... technically, this has not been proven." is also an infelicitous bit of wording. The links to anogenital cancers have been studied pretty thoroughly. There's less data on the head/neck/throat ones and virtually none at all on the vaccines' possible effect on warts elsewhere on the body.
It's presumably all the same mechanism whereby HPV infection stresses cells and eventually causes cancer, but it's much further from "proven".
Odd that you would suggest the article is written to show Merck in a good light, and then choose that exact quote to make your point.
To give the whole quote in context:
"Merck, its maker, wouldn’t be likely to mention the potential benefit in advertisements. Though most experts have little doubt that the vaccine prevents HPV infections anywhere in the body and therefore the resulting cancers, technically, this has not been proven."
It's not exactly calling Merck out, but the author is clearly not giving them a pat on the back over it either.
In the UK, the NHS's NICE organisation casts a fairly critical eye over cost effectiveness of medication. All girls &and boys are now offered the HPV jab at 12-13 years.
By contrast, we don't routinely vaccinate against chickenpox.
This has been extensively studied, and virtually every analysis comes to the same conclusion: it's cost-effective.
Here's an old analysis: https://www.ncbi.nlm.nih.gov/pubmed/12533280, which puts its effectiveness on-par with MMR vaccines and cost-effectiveness significantly better than the median $/QALY for existing interventions (~$42k, I think).
Well...Suppose the vaccine did nothing at all when administered to males but--for some reason--we did it anyway. This would double the price while leaving the effectiveness unchanged, but the $/quality-adjusted year of life (QAYL) would still be a in range that we typically consider worthwhile.
In reality, the vaccine has beneficial effects for the men themselves, as the article points out. It also contributes to "herd immunity", which benefits vaccinated men and women alike. Increased demand for the vaccine could also drive down the unit cost (most drug-related costs are fixed, rather than marginal). These three factors all suggest it's even more cost-effective than my naive analysis above.
Also, definitely talk about stuff like this. It's important and interesting; I'm actually surprised there's less interest in the pharmoeconomic modelling itself, as it's a very HN-friendly topic. That said, it is a little frustrating when people assume everyone involved in something biological is an innumerate dummy. A lot of this stuff has been analyzed, often by fairly clever people.
Why does it matter? Most men don't get to have sex and have no choice. Just look at tinder, women have all choice and so why most men should foot the bill for those enjoying sex the most?
My friends and me aren't having sex - we get no matches on tinder. Prostitute is illegal in my state. We are choosing to be monk and most men are experiencing same.
The ethical constraint is that the _patient_ must directly benefit from any medical intervention. Doctors are not supposed to do things that have a negative result for their individual patient even if they have some hypothetical big picture benefit for society.
So for this reason the story isn't about how it's be great for women if more men were vaccinated, that's an interesting public health statistical consideration but it can't help doctors decide whether to vaccinate men.
Maybe it'd be way more convenient for sixteen family members if Granny dies this week not next week, but the doctor looking after Granny needn't care about that, he's only considering what is best for her.
The article which explains how this vaccination results in a personal benefit for male patients? And so therefore we should vaccinate boys? Yes, I'd assume so.
The parent I'm replying to suggests it's appropriate to vaccinate boys in order to achieve herd immunity. Herd immunity is something public health officials are interested in, but as I explained ethically individual doctors are obliged to focus on the direct benefit to their patient. "Now you are less likely to get cancer" is a direct benefit, whereas "Now somebody else you may not even have met is less likely to get cancer" is pretty hazy.
No, from a "herd immunity" perspective just vaccinating the girls should be pretty effective. Assuming girls only transmit the virus to boys and boys only transmit it to girls (I know, not PC, but a good first approximation), then if you only have resources to vaccinate half the population, it's much better to vaccinate all the girls than a random sample of the population.
The article is specifically arguing that boys should get vaccinated for their own benefit - not a herd immunity argument.
I don't think I have ever seen another Hacker News thread where half the commenters and the upvoters actually haven't read the article and are basing their comments on the title.
There are many strains of HPV, the vaccine prevents several of the worst but not all strains. Even if you are already infected with one strain it makes sense to get the vaccine to not become infected with the others.
Gardasil is described as a prophylactic vaccine, rather than therapeutic, so no- it sounds like you would have to be vaccinated prior to infection in order for it to be effective. However, it sounds like there are therapeutic vaccines in development [0, 1].
I've often wished I retained where I read it,
but I read that in human trials in China, that in some test subjects, all warts on their body cleared.
Also the researcher who developed the vaccine was my step-son's grandmother's next door neighbour.
That's not at all what the actual linked document says. From pg. 17/257:
"There is conflicting evidence on whether HPV vaccines are
efficacious in preventing vaccine type HPV associated
anogenital pre-cancer in women who had evidence of prior
HPV exposure to the same vaccine type."
This section cites Miltz et al. (2014; PLoS ONE) and Lehtinen et al. (2013; Nature Reviews Clinical Oncology).
My impression is that efficacy against the same strain hasn't been demonstrated, but it's very clear that people infected with one strain (say, 6) can be subsequently infected with other strains. In that case, there's a partial benefit of the vaccine, since it'll help with the other 1/3/8 strains that the vaccine targets (plus maybe a few more, as there are also off-target effects).
That's the exact opposite of the point of the article. Men and boys don't get the vaccine because they and their parents perceive it as a female-only problem (cervical cancer induced by HPV). The article is trying to get apathetic men and boys to realize that not only are they acting as carriers of HPV that can kill their wives and partners, but they themselves can die from HPV induced cancers.
When I wrote my comment, the headline was something along the lines of "Why we should vaccinate boys against HPV too". The headline has now been changed, and my comment seems really odd.
The meaning of the title hasn't changed much though. Is it too much to expect people to read the article before making inflammatory MRA style comments? Looks like a common problem in this thread.
The headline for the STAT article was “New evidence shows why the HPV vaccine is as important for boys as girls” and I shortened it to its current form in HN. I hope this hasn’t caused any confusion.
Looking at my HMO's website it seems like the vaccine is not recommended for males over 26. The CDC also backs this up. Does this mean those of us over 26 are screwed? Is there anything we can do to check for cancers to catch an infection early?
It is approved but not recommended, which means insurance doesn't have to cover it to satisfy the ACA.
I'm 35 and one dose in (about due for the second dose) - what this has meant for me is that it's no trouble to get my doctor to give me the vaccine (but the county's vaccination lab refused) but insurance didn't cover the vaccine.
For me it's worth the $600 or so it'll end up costing, just for the peace of mind that I'm doing what I can to minimize the risk.
If you are going to have intimate contact with more than a few people (perhaps even just a few) the doctors I have talked to recommend getting the vaccine.
Does it mention why? Is it because the adverse reaction rate for (e.g.) Gardasil is higher than the probability of catching one of the HPV strains it targets after 26?
I’m a firm believer in vaccines, but HPV for boys is where I draw the line. I get why sexually active females would benefit from it but having every single child, boys and girls alike, reeks of institutionalized pharmaceutical fear mongering, and trying to profit from every single citizen taking the vaccine.
I don’t believe 360M Americans need to all be vaccinated for HPV such that 0.01% of the population avoids cancer.
I would rather do things like get rid of pollution that poisons our food supply that causes more incidents of cancer than HPV.
You know HPV is what gives you genital warts, right? I'm going to assume you're male for a moment – imagine if you developed genital warts, and then found out it could have been prevented if you had gotten the HPV vaccine when you were 9. Wouldn't that motivate you to make sure the next generation of youth doesn't have to go through the same experience?
Diagnosis of HPV-positive oropharyngeal head and neck squamous cell carcinoma is increasing in males. It is mostly in the 4th through 6th decades when these malignant neoplasms are discovered. It hit home recently when my best friend, a physician, was diagnosed with it and underwent surgery followed by debilitating radiation therapy. We both agree that our children and grandchildren, both male and female, should have the vaccine. We suspect that the recommended age for getting the vaccine will continue to expand.
"HPV vaccination is also recommended for everyone through age 26 years, if not vaccinated already.
Vaccination is not recommended for everyone older than age 26 years."
https://www.cdc.gov/hpv/parents/vaccine.html
Does anyone know why? Is it because most sexually active people would already have HPV at that point?
> However, some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.
The vaccine actually works. If it lowers your risk of fairly nasty cancers (and other less debilitating—-but embarrassing—-conditions), while earning them a few bucks, isn’t that a solid win-win scenario?
At least it’s not the usual trope about how Big Pharma is hiding all the cures....
There's no 40 year record, obviously, since the vaccine itself is only about 25 years old. However, the extant data shows a giant drop (30-50%, depending on age group), in HPV infections. That's already a huge win for everyone but genital warts, and we haven't even gotten to cancer.
The link between HPV infection and cancer is also well established. There's good quality observational data: one clever study looked at cancer incidence in the spouses of HPV patients (Mirghani et al., 2017). The molecular mechanisms are at least partially understood and seem to overlap with what we know about other kinds of cancer too.
Maybe it "works" but the actual benefit is minuscule? Nope. Even estimates based on the older, less effective versions of the vaccine find that it's cost-effective. See, for example, Sanders and Taira (2003): https://www.ncbi.nlm.nih.gov/pubmed/12533280
In short, all of the available evidence suggests it's a highly effective intervention, with minimal risk to individuals and big gains for their own health and the population's. You don't have to take my word for it either. You can look at the CADTH reports (Canada; CADTH.ca), NICE (UK; https://www.evidence.nhs.uk/search?q=HPV) and basically every other set of guidance on the topic, which all recommend vaccination.
EDIT: Ok, sorry about the snark, but I do think this is actually a constructive comment.
From what I saw their poison isn't guaranteed to prevent the cancer. On the contrary... So rest assured their income from throat cancer will remain safe.
And a bunch of other countries with routine vaccination programs. These programmes make extra sense in a country with universal healthcare because the country is paying for cancer treatment if its people get cancer, so preventing cancer actually saves the whole country money.
And the Netherlands.
I got it when I was 18 as the girls were getting it, the government decided it would be cheaper and more effective to do boys at the same time.
HPV effects have plummeted, but this is hard to prove.
What shocks me is that a lot of comments show a understanding of the average Facebook-mom. (misinterpreting workings of herd immunity, whilst the article doesn't even mention that, it clearly is about direct effects.)
This is HN!
"The risks of serious adverse events including death reported after Gardasil use in (the JAMA article by CDC's Dr. Barbara Slade) were 3.4/100,000 doses distributed. The rate of serious adverse events on par with the death rate of cervical cancer. Gardasil has been associated with at least as many serious adverse events as there are deaths from cervical cancer developing each year."
We have another 10 years of evidence since this was posted in 2009 [1]. That article quotes Diane Harper quite bit, and has also been discussed since [2].
Thank you, also. These are good discussions to have, particularly that we’ll make the decision to vaccinate on behalf of others, our children. Many parents are fearful or confused before the large amount of information pro and against (unfounded) vaccines in general. Add the association of HPV and sexual transmission, and it becomes more difficult to go ahead and vaccinate. I’ve read the evidence carefully and have no doubt that despite the (low) risk of adverse events, children of both sexes should have the HPV vaccine. As I said in another comment, I think the recommended age will continue to expand given the new favorable evidence in ongoing studies.
The snark does not add much to the discussion. The preponderance of evidence has convinced most experts in the fields of immunology, infectious diseases, pediatrics, internal medicine, virology, microbiology, epidemiology, and many other scientists in related areas.
I'm a 33 y/o male and just found out last week that the eligibility range has been expanded, so I opted to get the vaccine. It's a three dose course over a few months. Everybody should do it!
> HPV gives 34,800 Americans cancer every year, according to the Centers for Disease Control and Prevention. Of those, 20,700 are women and 14,100 are men.
> the burden of HPV positive oropharynx cancer in men in the United States now exceeds the burden of cervical cancer diagnosed each year
41% of all cancer victims of HPV are men and there is almost no public awareness.
This is often the case in society's reaction to problems of men and women, and the result is that there's 4 years (5%) life expectancy gap between the sexes.
And it's completely ignored while salary gap (where the discrepancy is the other way) is a hot topic for decades already.
It's ironic, that the response for male problems is "whatever, you're an adult, deal with it", and for female problems it's "we need to help you".
After reading this article and a quick search, I was pleased to find that the NHS in the UK has recently decided to extend Gardasil vaccination to boys too -
Also, if you or your partner are having receptive anal sex, ask your doctor about getting an anal pap smear. 90% of anal cancers are caused by HPV. They are slow growing and treatable. Screening is quick and easy.
The reason that insurers dont cover it is because there isnt a test to see if men have been exposed, the vaccine doesnt work if men have been exposed already, and after a certain age you can assume that men have been exposed and function as carriers. The cancers men get from hpv are either due to cunnilingus or smoking, and there is no way to tell
>HPV in men causes a significant number of anal and mouth cancer, it is not symptomless. And of course, vaccinated men can't pass it on to unvaccinated women.
136 comments
[ 4.2 ms ] story [ 177 ms ] threadAlso, a PSA for young adults and parents of children in the age groups - the HPV vaccine is usually covered (free) with insurance if you're in the recommended age groups, regardless of sex.
Agree parents need to get over it (disclaimer: am parent, kids getting HPV vaccination as soon as they're old enough). Your kids are eventually going to have sex. BFD. Protect them from possible future harm with a cheap vaccine.
My kids are 100% going to get it along with any other vaccine which is available and effective.
Some vaccines just half the risk of infection so need high coverage in the population.
But I haven't been that sexually active in my life :( so I know the stat about most ppl having some form of HPV but it may not apply to me.
Do you have to get it earlier in life?
I recommend it to everyone who will listen. Cheap risk mitigation (comparatively speaking). Australia made it compulsory, and they will have eliminated cervical cancer in a few decades because of it [2] (and my hunch is that gene therapy will pick up the remainder until then [3]). It's literally a vaccine that prevents cancer [4]. Who says no to that?
[1] https://www.health.harvard.edu/diseases-and-conditions/by_th... (Harvard Women's Health Watch | By the way, doctor: Should I get the HPV vaccine if I'm already infected?)
[2] https://www.nytimes.com/2018/10/03/world/australia/cervical-... (In Australia, Cervical Cancer Could Soon Be Eliminated)
[3] https://www.abc.net.au/news/2019-10-09/cervical-cancer-cure-... (Cervical cancer 'cure' closer with gene-editing breakthrough, scientists say)
[4] https://www.cdc.gov/media/releases/2019/p0822-cancer-prevent... (An Estimated 92% of Cancers Caused by HPV Could be Prevented by Vaccine)
"In 2007, Australia was one of the first countries to introduce a national human papillomavirus (HPV) vaccination programme, and it has since achieved high vaccination coverage across both sexes. In December, 2017, organised cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 18–20 years to 69 years, to primary HPV testing every 5 years for women aged 25–69 years and exit testing for women aged 70–74 years. We aimed to identify the earliest years in which the annual age-standardised incidence of cervical cancer in Australia (which is currently seven cases per 100 000 women) could decrease below two annual thresholds that could be considered to be potential elimination thresholds: a rare cancer threshold (six new cases per 100 000 women) or a lower threshold (four new cases per 100 000 women), since Australia is likely to be one of the first countries to reach these benchmarks."
Correction: Gardasil 9 covers 9. Prior version withdrawn.
... three vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (1, 2). Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts (3). Gardasil 9 prevents infection with the same four HPV types plus five additional cancer-causing types (31, 33, 45, 52, and 58) that together account for 10 to 20% of cervical cancers.
The WHO report, linked above, mentions that the bivalent vaccines also have limited effects on other strains, but they're mostly covered by the newer 4/9-valent ones. I'm pretty certain I saw another report suggesting it can hit other strains too, though again, not very effectively. This was the rationale for some of the ancedotes about people's warts disappearing and all that.
They're definitely intended to provoke an immune response, but the new ones don't use virus products. Instead, they contain particles (made by yeast) that assemble themselves into something that closely resembles the virus's structure. The immune system raises antibodies against that, priming it for dealing with future infections. More here (including a picture of the virus, which is quite pretty): https://www.ncbi.nlm.nih.gov/pubmed/23800545
https://www.cancer.gov/about-cancer/causes-prevention/risk/i...
From the link above:
Three vaccines that prevent infection with disease-causing HPV types are licensed for use in the United States: Gardasil®, Gardasil® 9, and Cervarix®. All three vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (1, 2). Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts (3). Gardasil 9 prevents infection with the same four HPV types plus five additional cancer-causing types (31, 33, 45, 52, and 58) that together account for 10 to 20% of cervical cancers.
Gardasil 9 is now the only HPV vaccine available for use in the United States. Cervarix and Gardasil are still used in other countries.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006801/
And it's not even that they're going to eventually have seen as kids, what if you get married and want to have kids? You don't know your partner's sexual history.
That's because of a huge increase in mouth and throat cancer among men, likely caused by an increase in oral sex.
Boys getting the vaccine can prevent them from getting cancer decades later, basically.
https://www.theguardian.com/film/2013/jun/02/michael-douglas...
Getting the vaccine because you might decide to sleep around (oral or otherwise) is like carrying a weapon because you might decide to get in a fight. Rape exists, but so do murderous assaults. The logic that says you need this vaccine is the same logic that says you need to carry a weapon.
Assuming both are as common, but they aren't. Most people will have multiple sexual partners and engage in oral sex, few people get murdered.
Then there's herd immunity which is great at protecting everyone, but carrying around weapons seems to have the opposite effect in makes you more likely to be murdered.
Sex is a normal part of life, but even if it wasn't this is a ridiculous analogy.
If I get this vaccine I protect both myself and any future partners I may have. There is no downside (barring potential vaccine side effects).
Your statement is essentially equivalent to:
Buying condoms because you might decide to sleep around (oral or otherwise) is like carrying a weapon because you might decide to get in a fight. Rape exists, but so do murderous assaults. The logic that says you need to use a condom is the same logic that says you need to carry a weapon.
Hopefully it's clear how damaging that thinking can be?
Getting this vaccine is cheap and effective, and in no way similar to carrying a gun.
The worst part, of course, is that you can contract the virus (and the cancer) through kissing! I guess if you make sure you only ever kiss one person, and you know for sure that they have only ever kissed you, and will only ever kiss you in the future, and you and they both have never performed oral sex on anyone, or had sex with anyone else - maybe then you don't need the vaccine.
Deriding the suggestion that we should prevent easily preventable cancer (you call up images of rape and murder!) is way off base.
Not that I specified "gun", but I know people who regularly carry one. It is cheap and effective, and it will protect partners too, just like condoms.
"Though most experts have little doubt that the vaccine prevents HPV infections anywhere in the body and therefore the resulting cancers, technically, this has not been proven."
The existing efficacy demo for HPV vaccination against cervical cancer relies on the fact that Pap smears are a thing to get answers in just a few years not decades. The smear test gets us a bunch of cells that a pathologist can look at under a microscope and inspect to see if they're normal or maybe "pre-cancerous" meaning they aren't normal but they are not yet cancer. And we know (from having tried it) that if we just ignore it some of that not-yet-cancer turns into cancer and kills people. So if we see that in a smear today you'll get called back and they'll treat it, even though you haven't got cancer.
This means they could give girls an HPV vaccine and then not only show that those girls didn't get the strains of HPV vaccinated against as often as unvaccinated peers, but further show that they don't get as much not-yet-cancer. And _by implication_ that means it protects against cancer.
There is no smear test for these less common cancers in men. If there are pre-cancerous cells we don't see them. We only find out about the cancer, years and often decades later.
I think the "anywhere on the body... technically, this has not been proven." is also an infelicitous bit of wording. The links to anogenital cancers have been studied pretty thoroughly. There's less data on the head/neck/throat ones and virtually none at all on the vaccines' possible effect on warts elsewhere on the body. It's presumably all the same mechanism whereby HPV infection stresses cells and eventually causes cancer, but it's much further from "proven".
Of course they are. So much vaccine misinformation in the world.
https://www.cdc.gov/flu/vaccines-work/effectivenessqa.htm
To give the whole quote in context:
"Merck, its maker, wouldn’t be likely to mention the potential benefit in advertisements. Though most experts have little doubt that the vaccine prevents HPV infections anywhere in the body and therefore the resulting cancers, technically, this has not been proven."
It's not exactly calling Merck out, but the author is clearly not giving them a pat on the back over it either.
By contrast, we don't routinely vaccinate against chickenpox.
A typical jab costs like £50 and lasts a decade
Here's an old analysis: https://www.ncbi.nlm.nih.gov/pubmed/12533280, which puts its effectiveness on-par with MMR vaccines and cost-effectiveness significantly better than the median $/QALY for existing interventions (~$42k, I think).
It's on the WHO list of recommended vaccines, and there are a ton of country-specific ones too; I linked to some elsewhere in the thread. Wikipedia has a giant list here: https://en.wikipedia.org/wiki/HPV_vaccine#Vaccine_implementa...
Today I learned do not talk about money when it comes to healthcare initiatives on ycombinator.
In reality, the vaccine has beneficial effects for the men themselves, as the article points out. It also contributes to "herd immunity", which benefits vaccinated men and women alike. Increased demand for the vaccine could also drive down the unit cost (most drug-related costs are fixed, rather than marginal). These three factors all suggest it's even more cost-effective than my naive analysis above.
Also, definitely talk about stuff like this. It's important and interesting; I'm actually surprised there's less interest in the pharmoeconomic modelling itself, as it's a very HN-friendly topic. That said, it is a little frustrating when people assume everyone involved in something biological is an innumerate dummy. A lot of this stuff has been analyzed, often by fairly clever people.
My friends and me aren't having sex - we get no matches on tinder. Prostitute is illegal in my state. We are choosing to be monk and most men are experiencing same.
So why should we foot the bill?
So for this reason the story isn't about how it's be great for women if more men were vaccinated, that's an interesting public health statistical consideration but it can't help doctors decide whether to vaccinate men.
Maybe it'd be way more convenient for sixteen family members if Granny dies this week not next week, but the doctor looking after Granny needn't care about that, he's only considering what is best for her.
The parent I'm replying to suggests it's appropriate to vaccinate boys in order to achieve herd immunity. Herd immunity is something public health officials are interested in, but as I explained ethically individual doctors are obliged to focus on the direct benefit to their patient. "Now you are less likely to get cancer" is a direct benefit, whereas "Now somebody else you may not even have met is less likely to get cancer" is pretty hazy.
The article is specifically arguing that boys should get vaccinated for their own benefit - not a herd immunity argument.
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586871/ [1] https://www.ncbi.nlm.nih.gov/pubmed/30955915
"There is conflicting evidence on whether HPV vaccines are efficacious in preventing vaccine type HPV associated anogenital pre-cancer in women who had evidence of prior HPV exposure to the same vaccine type."
This section cites Miltz et al. (2014; PLoS ONE) and Lehtinen et al. (2013; Nature Reviews Clinical Oncology).
My impression is that efficacy against the same strain hasn't been demonstrated, but it's very clear that people infected with one strain (say, 6) can be subsequently infected with other strains. In that case, there's a partial benefit of the vaccine, since it'll help with the other 1/3/8 strains that the vaccine targets (plus maybe a few more, as there are also off-target effects).
People sometimes get hinky with the edit button, or mods change the title, sometimes even the swapping out an entirely different url...
I'm 35 and one dose in (about due for the second dose) - what this has meant for me is that it's no trouble to get my doctor to give me the vaccine (but the county's vaccination lab refused) but insurance didn't cover the vaccine.
For me it's worth the $600 or so it'll end up costing, just for the peace of mind that I'm doing what I can to minimize the risk.
I don’t believe 360M Americans need to all be vaccinated for HPV such that 0.01% of the population avoids cancer.
I would rather do things like get rid of pollution that poisons our food supply that causes more incidents of cancer than HPV.
Does anyone know why? Is it because most sexually active people would already have HPV at that point?
> However, some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.
The vaccine actually works. If it lowers your risk of fairly nasty cancers (and other less debilitating—-but embarrassing—-conditions), while earning them a few bucks, isn’t that a solid win-win scenario?
At least it’s not the usual trope about how Big Pharma is hiding all the cures....
There's no 40 year record, obviously, since the vaccine itself is only about 25 years old. However, the extant data shows a giant drop (30-50%, depending on age group), in HPV infections. That's already a huge win for everyone but genital warts, and we haven't even gotten to cancer.
The link between HPV infection and cancer is also well established. There's good quality observational data: one clever study looked at cancer incidence in the spouses of HPV patients (Mirghani et al., 2017). The molecular mechanisms are at least partially understood and seem to overlap with what we know about other kinds of cancer too.
Maybe it "works" but the actual benefit is minuscule? Nope. Even estimates based on the older, less effective versions of the vaccine find that it's cost-effective. See, for example, Sanders and Taira (2003): https://www.ncbi.nlm.nih.gov/pubmed/12533280
In short, all of the available evidence suggests it's a highly effective intervention, with minimal risk to individuals and big gains for their own health and the population's. You don't have to take my word for it either. You can look at the CADTH reports (Canada; CADTH.ca), NICE (UK; https://www.evidence.nhs.uk/search?q=HPV) and basically every other set of guidance on the topic, which all recommend vaccination.
EDIT: Ok, sorry about the snark, but I do think this is actually a constructive comment.
https://www.cdc.gov/vaccines/acip/recs/grade/HPV-adults-etr....
"The risks of serious adverse events including death reported after Gardasil use in (the JAMA article by CDC's Dr. Barbara Slade) were 3.4/100,000 doses distributed. The rate of serious adverse events on par with the death rate of cervical cancer. Gardasil has been associated with at least as many serious adverse events as there are deaths from cervical cancer developing each year."
[1] https://infectagentscancer.biomedcentral.com/articles/10.118...
[2] https://scienceblogs.com/insolence/2013/08/16/yet-another-an...
> the burden of HPV positive oropharynx cancer in men in the United States now exceeds the burden of cervical cancer diagnosed each year
41% of all cancer victims of HPV are men and there is almost no public awareness.
And it's completely ignored while salary gap (where the discrepancy is the other way) is a hot topic for decades already.
It's ironic, that the response for male problems is "whatever, you're an adult, deal with it", and for female problems it's "we need to help you".
https://www.nhs.uk/conditions/vaccinations/hpv-human-papillo...
I would not be salty if insurers covered men and future people didnt have to pay for it.
http://www.colonrectal.org/services.cfm/sid:7580/Abnormal_An...
It's a bottom not a top. (Antonym is insertive)
>HPV in men causes a significant number of anal and mouth cancer, it is not symptomless. And of course, vaccinated men can't pass it on to unvaccinated women.