Re: Gardasil question

[Guest guest]

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Awesome handout!

I would add that the vaccine only protects against 4/100+ strains of HPV. Although the strains chosen for vaccine account for most of the cancers (maybe 65-70%), it definitely is not 100% protection.

Also, I am afraid that having the vaccine may give some young women a false sense of security - you point out that women still need to have PAP screening, but I wonder if it may decrease compliance with safer sex practices (I have seen some confusion with what the vaccine can do - some moms have asked me if the vaccine protects against all STD's!).

I am glad I am not the only doubting thomas!

, MD

Palm Desert, CA

IMP since Oct 2005 - No insurance, opted-out of Medicare

Subject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 7:56 AM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella

is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.What do you guys think?Annie-- Annie SkaggsLexington, KY

[Guest guest]

-

Awesome handout!

I would add that the vaccine only protects against 4/100+ strains of HPV. Although the strains chosen for vaccine account for most of the cancers (maybe 65-70%), it definitely is not 100% protection.

Also, I am afraid that having the vaccine may give some young women a false sense of security - you point out that women still need to have PAP screening, but I wonder if it may decrease compliance with safer sex practices (I have seen some confusion with what the vaccine can do - some moms have asked me if the vaccine protects against all STD's!).

I am glad I am not the only doubting thomas!

, MD

Palm Desert, CA

IMP since Oct 2005 - No insurance, opted-out of Medicare

Subject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 7:56 AM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella

is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.What do you guys think?Annie-- Annie SkaggsLexington, KY

[Guest guest]

Annie,

I went to a lecture a couple of years ago where the lecturer (neurologist) was talking about childhood vaccination of varicella. I thought it was interesting because he correlated it with an probably INCREASED risk of adult shingles in the future. The logic being that adults' immune systems are revved up by their kids (petri dish of germs). His theory was that a revved up immune system from exposure to varicella deceases the incidence of shingles. Therefore, less revving up from chicken pox= more adult shingles

Soma

Subject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 3:56 PM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella

is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.What do you guys think?Annie-- Annie SkaggsLexington, KY

[Guest guest]

Annie,

I went to a lecture a couple of years ago where the lecturer (neurologist) was talking about childhood vaccination of varicella. I thought it was interesting because he correlated it with an probably INCREASED risk of adult shingles in the future. The logic being that adults' immune systems are revved up by their kids (petri dish of germs). His theory was that a revved up immune system from exposure to varicella deceases the incidence of shingles. Therefore, less revving up from chicken pox= more adult shingles

Soma

Subject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 3:56 PM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella

is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.What do you guys think?Annie-- Annie SkaggsLexington, KY

[Guest guest]

Soma, that thought had occurred to me as well. I didn't include that concern in my handout because I felt it muddied the waters too much, but it certainly is in the back of my mind. The good news? By the time today's 14 year-olds hit their 60s, it won't be my problem anymore!

(At least I sure hope I'm not still practicing in my 90s)Annie

Annie,

I went to a lecture a couple of years ago where the lecturer (neurologist) was talking about childhood vaccination of varicella. I thought it was interesting because he correlated it with an probably INCREASED risk of adult shingles in the future. The logic being that adults' immune systems are revved up by their kids (petri dish of germs). His theory was that a revved up immune system from exposure to varicella deceases the incidence of shingles. Therefore, less revving up from chicken pox= more adult shingles

Soma

Subject: Gardasil question

To: " practiceimprovement1 " < >Date: Monday, December 15, 2008, 3:56 PM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.

The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella

is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.

What do you guys think?Annie-- Annie SkaggsLexington, KY

-- Annie SkaggsLexington, KY

[Guest guest]

I like your handout, .I have two primary concerns regarding Gardasil. First, we only know that it protects against the 4 strains of HPV that are in it for about 5 years. That doesn't seem like long enough to me. If it does give lifelong immunity, it might be cost effective, but that isn't know yet.Second, it is recommended for girls and women 9-26, and the focus is on giving it to 11-12 year olds. The studies that were done on the vaccine were primarily on girls 16-26. There were very few younger girls in the studies; read the package insert for a start. It is somewhat amazing that we are giving it to an age group that was studied so little.In this country, where most women get paps and we have a relatively good system set up for cervical cancer screening, the vaccine does not seem

necessary. Perhaps in other countries with less access it makes more sense, or perhaps as our country spirals into chaos, the vaccine will become more needed, but the money is better spent elsewhere, like on improving access to primary care.LonnaSubject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 7:56 AM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.

The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.

Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.

What do you guys think?Annie-- Annie SkaggsLexington, KY

[Guest guest]

I like your handout, .I have two primary concerns regarding Gardasil. First, we only know that it protects against the 4 strains of HPV that are in it for about 5 years. That doesn't seem like long enough to me. If it does give lifelong immunity, it might be cost effective, but that isn't know yet.Second, it is recommended for girls and women 9-26, and the focus is on giving it to 11-12 year olds. The studies that were done on the vaccine were primarily on girls 16-26. There were very few younger girls in the studies; read the package insert for a start. It is somewhat amazing that we are giving it to an age group that was studied so little.In this country, where most women get paps and we have a relatively good system set up for cervical cancer screening, the vaccine does not seem

necessary. Perhaps in other countries with less access it makes more sense, or perhaps as our country spirals into chaos, the vaccine will become more needed, but the money is better spent elsewhere, like on improving access to primary care.LonnaSubject: Gardasil questionTo: "practiceimprovement1" < >Date: Monday, December 15, 2008, 7:56 AM

I know on this list we usually talk in terms of how to get paid for immunizing, where to buy vaccines, etc...but I have more of a clinical question. Am I the only one not thrilled with Gardasil ? Sure the CDC recommended it...and surely they are smarter than I..but I really wonder how smart we are to spend that much money on something with such limited potential benefit. I mostly don't see kids, so it doesn't come up for me that much, but see my handout that I whipped up because there is a family bringing in a young gal today and they specified that they want Gardasil.

The other vaccine I lie awake worrying about is that for varicella... .We now have a generation of teens, soon to be young adults who do not have natural immunity...and lucky for the vaccine manufacturer (Merck, I think) will now need a lifetime of periodic boosters...and they don't dare just blow it off and take their chances...varicella is much more wicked in adults.. We have seen what the fear of shigles has done for the sales of Zostavax.... yet another vaccine I have doubts about.

Don't get me wrong, I'm not against immunizations. My kids got all the recommended ones.... I get a flu shot every year....My horses get a whole pile of them every January and West Nile boosters in the warm months, and Flu-rhino 2-4 times per year...but these newer ones worry me.

What do you guys think?Annie-- Annie SkaggsLexington, KY