Vaccination has greatly diminished death, illness and suffering in the world. But no other medical technology has been so dogged with controversy. The book chronicles the development of the key lifesaving vaccines since the 18th century. It tells the stories of great scientists and their discoveries, of the protests and pain along the stumbling path of progress. This is the first book to tell the whole story of vaccination for a general audience. In light of controversies about flu vaccine and autism, it will be of particular interest to parents, pediatricians, public health workers and anyone fascinated by medical history. Read More>>

Also Available: Table of Contents and Index

Arthur Allen is a Washington DC-based journalist who has written on vaccine issues in The New York Times Magazine, the Washington Post Magazine, The New Republic, Atlantic Monthly, Salon and Slate.

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HPV - The Ad

Last week, late at night in my Japanese-style 8x6 New York City hotel room, I was zapping through the TV channels when I came upon a most peculiar advertisement. In it, black, white and Hispanic tweens, teens and young women were skipping rope, running in marathons, waiting for subway trains and generally looking proud to be young and female. They were also smiling happily and holding up signs that had the number "1" printed or painted on them. This, it turned out, was an ad for Merck's new Gardasil vaccine, which protects against the human papilloma virus, the microorganism that causes cervical cancer. The theme of the ad was "One Less Life Affected by Cervical Cancer."

I didn't see anything false or misleading in the ad, yet I was struck, as I always am by pharmaceutical industry direct-to-consumer advertising, what a ridiculous and essentially wasteful endeavor this is.

The Food and Drug Administration approved Gardasil this past summer, and it looks like a good vaccine. Cervical cancer kills 4,000 American women each year and hundreds of thousands more overseas. The vaccine only guards against four of the dozens of types of papillomavirus, so it won't prevent all cervical cancers, but it could have a big impact. That said, women will still have to get pap smears even if they are vaccinated with Gardasil, because, as noted, it doesn't protect against all strains of the virus. The vaccine advisory committees of the Centers for Disease Control, the American Academy of Pediatrics and of Family Medicine have each recommended that the vaccine be given to girls ages 9 and up. The vaccine could have a major public health benefit. That's because it's easier to reach poor, uneducated, and uninsured women (who generally do not get regular pelvic exams later in their lives and make up the bulk of cervical cancer patients) while they are still children (especially if the vaccine is required to enter school, as it is starting to be in some states.) And, if enough women (and eventually, men) get the vaccine, it will reduce the number of doctors' visits and lab work needed to evaluate cervical lesions that turn up in pelvic exams (there would be fewer such lesions; ergo, less need for followup). So eventually, it could also save money, although in the first instance it will increase medical costs overall.

But this is all hideously complex. The only news that parents really need is, "give your daughters the vaccine." If the vaccine had been made available 20 years ago, it's probably the only information they would have gotten. In 1993, the medical authorities began vaccinating babies against hepatitis B, which like HPV is generally a "sin" virus in that it is spread predominantly, in the U.S. anyway, through sex and shared hypodermic needles. (Mothers can also transfer it to their babies, and when babies get the disease they often get if for life, whereas people in their 20s can easily shed the virus following an acute infection... another complex story)

In 1993, as evidenced by the newspapers and medical journals, there was not so much resistance from parents to the introduction of the hepatitis B vaccine--although there has come to be some grumbling in recent years.

But now, because of the not entirely unmerited mistrust of the pharmaceutical industry, the quick spread of information, good and bad, over the Internet, and our puritanical

Beruehrungsangst

over sex, we have to get the whole complex story of HPV before we commit to the vaccine. In fact the story is so complicated that I imagine many people watching the Merck advertisement feel the same way they do watching any of these direct-to-consumer ads: skeptical and jaded. Why is all this necessary? A lot of Christian conservatives are said to want to withhold the vaccine from their daughters because they feel it sends a message that encourages sexual experimentation. However, it wouldn't send that message if they or their daughters didn't know what it was for and just did what their doctors told them to do. After all, this is a vaccine to prevent a disease, not encourage sex. Ironically, most of the Christian right organizations that initially feared the vaccine now say they think it's a good product.

I know, I know, this is all wishful thinking. Informed consumers want choices, informed consent, this is the information age, etc. ad nauseum. I guess this is just a longwinded way of saying that I think this is a good vaccine.

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