This post is a response to a post on Seth Godin's Blog about a marketing gig he does not want. I would not want to have that job either. But my reasons are a little different then Seth's. Let's take a look at the issue of administering a drug to 9 to 29 year olds in order to prevent cervical cancer. The science behind it is great, the application of the science I am not so sure about. Here is why.
Gardasil is supposed to protect women from cervical cancer and some sexually transmitted diseases. I take issue with the second part of the sentence first. I think this will give women a false sense of security of being protected against a sexually transmitted disease when in fact they are not. From what I discern from the information, the only STD preventable through Gardasil is venereal warts (Condyloma acuminata). It would take a great deal of educating the parents and in turn their offspring that only this STD could be prevented. Best protection against any sexually STD is still abstinence, but I am also a realist and abstinence is a great idea, but very unlikely. Second best protection against STD's, in my opinion, are condoms and/ or a monogamous long term relationship. That out of the way, what about the protection against cervical cancer. I did some digging and what follows below is the result of what I have unearthed.
I started with WebMD's and Merck's own press release websites. I shall focus on HPV (human papillomavirus) 16 and 18 for the rest of the article, since Merck's website touts that Gardasil prevented 100 percent of cervical pre-cancers and non-invasive cervical cancers associated with HPV Types 16 and 18. I think this is great news for women all over the globe. I also think that a little caution is warranted since we don't know of any long term side effects as of yet. Just to put my motivation into perspective, I have two teenage daughters and after looking at all the evidence I will help them to evaluate the data. First, they should consider the vaccination. Secondly, I would tell them about the scientifically proven, non-toxic approaches they could apply to PREVENT cervical cancer, and after a careful balancing act and assessment of their real risk (more on the risk factors below) of developing cervical cancer, I hope they would consider the non-toxic approach.
Let's turn to classification of Pap Smears. Merck's press release talks mostly about high-grade cervical pre-cancers and non-invasive cervical cancers CIN 2 and 3. Here is an explanation what this means:
There are several classification systems for pap smears which are used to describe the severity of the disease. They include the International Federation of Gynecology and Obstetrics classification, numerical classes I,II,III,IV classification. I being benign and IV indicating cancer, the CIN (Cervical Intraepithelial Neoplasia) classification, and the Bethesda system classification. CIN classification is as follows:
Numerical Class/ CIN/ Dysplasia/ Bethesda
I./ Benign/ Benign/ Normal
II./ Benign with inflammation/ Benign with inflammation/ Normal
III./ CIN I / (mild dysplasia)/ Low grade SIL (squamous epithelial lesion)
III/. CIN II / (moderate dysplasia)/ Low grade SIL
III./ CIN III / (severe dysplasia)/ High Grade SIL
IV./ CIN III / (Carcinoma in situ)/ High Grade SIL
The primary analysis of this trial evaluated the incidence of CIN 2/3 in women who received three doses of GARDASIL with no protocol violations. A secondary analysis evaluated the incidence of CIN 2/3 and AIS in a broader group of women, included all of the women in the primary analysis group, as well as women who may have become infected with HPV 16 or HPV 18 during the vaccination period and women who may have violated the protocol in significant ways. Read the full text and results of the study here: Merck
Vaccination V. Risk Management:
Up until now, the best approach to prevent cervical cancer is to avoid or eliminate all known risks associated with this disease. The prevalent risk factors for cervical cancer are sexual activity, viruses, smoking, oral contraceptives, and nutritional factors. If we immunize a nine year old girl, we are precluding the risk factors. Here is what I mean. We hardly can establish which lifestyle a nine year old girl will adopt. If she starts smoking, her eating habits dramatically decline, and becomes very promiscuous in her extra curricular activities, then she is definitely a candidate for the immunization. What if she adopts a healthy, more balanced lifestyle? Was the immunization a risk not worthwhile taking? Hard question to answer, and only you, if you are considering the immunization for yourself, or the parent of a youngster which is considered for immunization can decide which is the best way to proceed. The risk is a statistical probability of a factor causing cancer compared to women who do not have that risk factor.
Smoking
This means that if you smoke more than 10 cigarettes a day, your risk of developing cervical cancer is 3.06 times greater than that of a non-smoking woman. One study showed the risk to be as high as seventeen times greater in women who are smokers age twenty to twenty-nine.(1-4)
Sexual Activity
If the age at first intercourse is 18 or younger, the relative risk of developing cervical dysplasia or cancer is 2.76 times greater. Multiple sexual partners (two to five), elevate the risk to 3.46.(5,6). This evidence points to viruses being the most likely candidates as causative agents in developing cervical cancer. Especially two of them: Herpes Simplex Type II (HSV-II) and the human papillomavirus. This is also the virus which causes venereal warts. HPV 16 is the most likely agent involved in many cases of cervical dysplasia/ cancer. HPV 16 has been found in 90% (ninety percent) of all cervical cancers. Now you know why Gardasil targets HPV 16.
Nutritional Deficiencies
Beta-carotene deficiency of less than 5,000 IU a day increases the risk 2.814 fold. There seems to be a strong inverse correlation between beta-carotene intake and the risk of cervical cancer/ dysplasia. Inverse means that the higher the intake of beta carotene, the lower the rate of cervical dysplasia/cancer. (7-9) Dietary vitamin C consumption of less than 30-mg/day, increases the risk 6.717 fold. There are many nutrients at play but it is important to note that 67% (sixty-seven percent) of patients with cervical cancer have nutritional deficiencies. That suggests that multiple nutrient deficiencies are most likely the rule in cervical cancers, rather than the exception.(10,11) A high fat diet has been associated with increased risk of cervical cancer. This is in contrast to a diet rich in fruits and vegetables which seems to lower this risk.(12) Folic acid deficiency in red blood cells have been show to support the risk factors for cervical dysplasia/ cancer, especially human papillomavirus (HPV) infection. Low red blood cell folate could be a major risk factor for HPV infection of the cervix.(13,14)
Oral Contraceptives
Oral contraceptive use of 5-8 years, increases the risk of cervical cancer 3.66 times. In addition oral contraceptives are associated with a myriad of other ailments including increased risk of gallbladder disease, myocardial infarction, mental illness, hyperthyroidism, hypertension, as well as cancer of the cervix. (4, 15-18) "The Pill" is known to increase the negative effects of cigarette smoking and it decreases nutrient levels such as vitamin C, B6, B12, folic acid, riboflavin, and zinc.(19)
I believe that Merck needs to be applauded for their efforts to put a stop to cervical cancers and genital warts via immunization. Will that prevent a large number of deaths? I definitely believe so! Are there women out their who should get the vaccination. Totally. But I really believe the majority of women and parents of young women should carefully weigh the pros and cons of this immunization.
Again we are shown the sad state this reactionary model, which is our healthcare system is in. Yes, we live in a quick fix society and rather administer a "Cure" to nine year olds, long-term effects unknown as of yet, (data collected over two years hardly qualifies as long-term.) rather then address the real issue of abuse and neglect to our body and take natural, non-toxic approaches to prevent most diseases. When will this country wake up to the fact that the "Big Three" (heart disease, cancer, stroke) diseases we face, are indeed mostly preventable via life style modifications. I.e. proper nutrition, proper stress management, and moderate exercise. I know this sounds way to easy. Image the day when doctors quit shoving pills down their patient's throats and coach them, no, insist for them to adopt healthier lifestyles, this will be the day when our healthcare system moves into the 21st century.
I hope this post will contribute to your education about choices and options pertaining to your health. Further more, you need to make your doctor an ally in all of your healthcare needs, and if he/she is not willing to listen to you, or take you seriously, find one who will. I did. So can you.
Beste Gesundheit,
Werner
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