Subject: article on HPV vaccine

From: David Burton Fri, Oct 18, 2013 at 7:19 AM
To: Joann
Hi Joann,

[CDC / Markowitz 2013 found that] Girls who got Gardasil had higher HPV infection rates, but it is not clear whether Gardasil "increases cancer incidence," for two reasons.

Reason #1 is that correlation does not necessarily imply causation:

xkcd correlation vs. causation cartoon

Reason #2 is that it is not clear whether or not the higher HPV infection rates will actually result in higher cancer incidence (more about that below).

Also, I don't know whether girls who get the vaccine after they are are already infected are more or less likely to get cancer. I don't know whether that question has been studied. If you find any studies, I'd be grateful for the information. I do know that Gardasil is not recommended for older women, which suggests that it hasn't been shown to reduce cancer incidence in women who are already infected.

It is not known whether girls who get the vaccine are more likely to get cancer than girls who don't get the vaccine. That might or might not be true. In the CDC/Markwitz study, girls who got the Gardasil vaccine were substantially more likely to become infected with HPV strains than were girls who didn't get the vaccine. That's presumably due to behavior differences: the girls who got the vaccine were more promiscuous than were the girls who didn't get the vaccine.

The question of causality is harder to answer, though. Correlation doesn't necessarily imply causation, and even if the relationship is causal, it might be causal in the other direction. There are several possibilities.

It could be that girls who got the vaccine were more promiscuous because they felt safer, because they got the vaccine; in that case, the vaccine indirectly caused their higher infection rates.

But that is not necessarily the case. The causality could go in the opposite direction. I.e., it could be that promiscuous girls were more likely to get the vaccine because they knew they needed the protection, due to their promiscuity. In that case, the vaccine did not cause their higher infection rates.

Or there there might not be any causal relationship at all. It could simply be that there's some demographic commonality between promiscuity and likelihood of getting the vaccine, such as liberal parents, family income level, type of college, religion, etc. E.g., maybe Unitarians and Jews are both more promiscuous and more likely to vaccinate than Baptists and Muslims. In that case, the vaccine did not cause their higher infection rates.

The girls who got the vaccine were, as expected, much less likely to be infected with Type 16 or Type 18 HPV. But they were more likely to be infected with other high risk strains of HPV, so much so that they were at slightly higher risk, compared to unvaccinated girls, of being infected with high risk HPV strains.

That might mean that girls who got the vaccine are at higher risk for cervical cancer than girls who didn't. But not necessarily. There is some evidence that HPV types 16, 18 & 45 might have higher oncogenicity than some of the other high-risk types, because in women infected with those HPV strains cervical cancer seems to develop at a somewhat younger age. So it is possible that, even though girls who got the vaccine had higher infection rates with "high-risk" HPV strains, they still might not be at higher risk of cervical cancer.

No one really knows. But what is very clear is that Merck's claim that Gardasil will prevent 75% of cervical cancers is utter nonsense. It might reduce the incidence of cervical cancers, slightly. Or it might increase the incidence of cervical cancers, slightly. But it certainly will not prevent 75% of cervical cancers.

Anyhow, here is the CDC / Markowitz 2013 paper, along with the supplemental files. Note Table 3, especially:
http://tinyurl.com/markowitz2013.

OTOH, here's an article (though not peer-reviewed) which claims that Gardisil provides some limited protection against some of the other high-risk HPV strains:
http://www.hcplive.com/publications/internal-medicine-world-report/2007/2007-11/2007-11_24

Also, here's an interesting article: "Japan Withdraws HPV Vaccine Recommendation for Girls"
http://www.medscape.com/viewarticle/806645

BTW, the shingles vaccine is another dubious one. My doc says it's better to skip the vaccine, and instead get medical treatment quickly if you ever show symptoms of shingles. He says the shingles vaccine is very expensive, and only marginally effective, and has a lot of side-effect issues. He also says shingles is easily & effectively & inexpensively treated if caught early. Untreated, shingles is a horrid, painful disease. But if caught early, it can be effectively treated with [relatively] inexpensive antiviral drugs.

Your brother in Christ,
Dave



On Thu, Oct 17, 2013 at 8:15 PM, Joann wrote:

Hi Dave,

If you don’t mind, could you send me the Markowitz study showing HPV vaccine increases HPV incidence? I think I read about this, that girls who are already infected and get the vaccine are more likely to get cancer



See also: http://www.burtonsys.com/Gardasil_vs_Gardasil9.html
and: http://www.burtonsys.com/gardasil--ltr_to_drphilips2.html
and: http://www.burtonsys.com/ABC_HPV_story.html