October 2, 2006
Dobson, Seipp, and HPV Vaccination
Cathy Seipp is a smart person, so why does she her analysis of the response to an HPV vaccine stumble so badly?
First off, she claims that certain religious fanatics are attacking the new vaccine for HPV:
One of the first things I had my 17-year-old daughter do when she began college this fall was make an appointment to get the new anti-HPV (for “Human Papillomavirus”) vaccine at the university’s student health center. HPV is the sexually transmitted virus that can cause cervical cancer, and the new vaccine (which in my view should only be celebrated, as should all medical progress) has been attacked by religious fanatics almost as soon as it was introduced. ‘Why, this will only encourage young girls to have sex!’ Or so that kind of thinking goes — if you can even call it “thinking.”
OK, what is Focus on the Family's position? Oddly enough, they have a .pdf position statement on their web site:
Recognizing the worldwide detriment to individuals and families resulting from HPV, Focus on the Family supports and encourages the development of safe, effective and ethical vaccines against HPV, as well as other viruses. The use of these vaccines may prevent many cases of cervical cancer, thus saving the lives of millions of women across the globe. Therefore, Focus on the Family supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school. The decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child’s parent or guardian. As in all areas of sexual health and education, Focus on the Family upholds parents’ right to be the primary decision maker and educator for their children. The use of these vaccines should involve informed consent for parents as well as education for both parents and youth regarding the potential benefits and risks of the vaccine. In making this decision, parents should consider the following:
• No vaccine is 100% effective against disease;
• There are more than one hundred sub-types of HPV and the current vaccines being tested are effective against, at most, four of these;
• The sub-types of the virus that these vaccines protect against are the cause of most but not all cases of cervical cancer;
• The possibility of HPV infection resulting from sexual assault, including date rape;
• The possibility that young persons may marry someone previously exposed to and still carrying the virus;
• The HPV vaccines do not protect against other STIs or prevent pregnancy;
• The HPV vaccines do not, in any circumstance, negate or substitute the best health message of sexual abstinence until marriage and sexual faithfulness after marriage.
Hmm, how about Family Research Council:
The Family Research Council welcomes the news that vaccines are in development for preventing infection with certain strains of the human papillomavirus (HPV). We also welcome the reports, like those we've heard this morning, of promising clinical trials for such a vaccine. Forms of primary prevention and medical advances in this area hold potential for helping to protect the health of millions of Americans and helping to preserve the lives of thousands of American women who currently die of cervical cancer each year as a result of HPV infection. Media reports suggesting that the Family Research Council opposes all development or distribution of such vaccines are false....
We will also continue to take an interest in the activities of the pharmaceutical companies, the federal and state governments, and of the medical community, as vaccines for HPV are approved, recommendations for their use are developed, and their use is implemented. In particular, we encourage follow-up studies to determine whether use of the vaccine has any impact on sexual behavior and its correlates, such as rates of other sexually transmitted diseases or rates of pregnancy.
We are particularly concerned with insuring that medically accurate information regarding the benefits and limitations of an HPV vaccine is distributed to public health officials, physicians, patients, and the parents of minor patients. It is especially important for those parties to understand that such a vaccine:
* will not prevent transmission of HIV or other sexually transmitted diseases, of which there are many;
* will not prevent infection with other strains of HPV, of which there are also many;
* will not prevent infection with all of the strains of HPV that cause cervical cancer;
* and lastly, will not eliminate the need for regular screening.
We recognize that the most current immunological studies suggest that these vaccines would be most effective in pre-adolescents. Our primary concern is with the message that would be delivered to nine- to twelve-year-olds with the administration of the vaccines. Care must be taken not to communicate that such an intervention makes all sex "safe." We strongly encourage the health care community to clearly communicate the medically accurate fact that only abstaining from sexual contact with infected individuals can fully protect someone from the wide range of sexually transmitted diseases.
However, we also recognize that HPV infection can result from sexual abuse or assault, and that a person may marry someone still carrying the virus. These provide strong reasons why even someone practicing abstinence and fidelity may benefit from HPV vaccines.
Because parents have an inherent right to be the primary educator and decision maker regarding their children's health, we would oppose any measures to legally require vaccination or to coerce parents into authorizing it. Because the cancer-causing strains of HPV are not transmitted through casual contact, there is no justification for any vaccination mandate as a condition of public school attendance. However, we do support the widespread distribution and use of vaccines against HPV.
Vaccination at the beginning of adolescence may provide a unique opportunity for both health care providers and parents to discuss with young people the full range of issues related to sexual health. We would encourage this committee to recommend that policy-making bodies, such as the American Academy of Pediatrics, should develop and formalize clinical counseling interventions directed toward sexual risk elimination strategies for pre-adolescents. Such strategies could be incorporated into anticipatory guidance protocols. Such a strategy would also mirror the risk elimination messages presented to adolescents regarding tobacco, alcohol, and drug usage, and youth violence prevention. This risk elimination message is the best form of primary prevention youth can receive.
Both health care providers and parents should reinforce the fact that limiting sexual activity to the context of one faithful and monogamous long-term relationship is the single most effective method of preventing all sexually transmitted diseases, unplanned pregnancies, and the whole range of negative psychological and social consequences that can result from sexual activity outside marriage.
OK, how about Jerry Falwell? Silent on the issue.
National Abstinence Clearinghouse? OK, I admit I'm not a member and don't want to join so I can't actually see what's in their resource library, but here are some titles:
07.05.2006 More on HPV and Condoms…
06.29.2006 HPV Vaccine: How Much Will it Cost?
06.21.2006 HPV Vaccine: Progress, But the Battle’s Not Over Against HPV
05.24.2006 HPV Vaccine Clears FDA Hurdle
04.26.2006 Data from Eight Collected Studies Shows Enormous Risk of Cervical Cancer from HPV
04.07.2006 New Way to Encourage Someone to Test for STD
04.05.2006 Teens and STDs: A New Message for a Healthy Millennium
Call me crazy, but it strikes me that they are in line with Focus on the Family, not opposed, and I'm assuming their position is best summed up by "HPV Vaccine: Progress, But the Battle’s Not Over Against HPV".
Now perhaps these organizations have all moderated their opposition after the FDA approved it and I'm (admittedly) late to the party. But that isn't what is claimed. Now to be sure there may be some people out there actually flat out opposed to the HPV vaccine who are Christians, but I'm sure not seeing some movement by any influential organization.
But it doesn't end there. Ms. Seipp continues:
This naturally brought out all the true believers in hordes -- many of whom insisted that my comparison of vaccines that prevent disease to locked doors that prevent burglars is wrong, wrong, wrong. I don't see why. Some of these people insist the analogy is flawed because airbags and seatbelts encourage people to drive more recklessly, not less.But while it's true there are some studies that indicate improved safety features in cars do make some people feel inoculated against road hazards and so more likely to speed, what about people like me? I never speed and haven't had a traffic ticket in 26 years -- pretty much what you'd expect from a typical Volvo-driving fuddy-duddy...whose seatbelts always fastened, and whose car has airbags.
It's true my analogy about burglars and disease may be imperfect, but it's nevertheless essentially true. One person, for instance, said I should have used the example of theft insurance instead of locked doors. But I don't see why. Vaccinating against disease and locking your doors against burglars both recognize that we live in a world where bad things can happen even if we don't deserve them. Recognizing that fact no more encourages promiscuity than locked doors encourages burglary; both are simply precautions.
Now let's take up the question of whether or not reducing the risk associated with a behavior increases the incidence of said behavior. That is the what is claimed again by Ms. Seipp as the religious fanatic's objection to this vaccine.
So her analogy is that since locking your doors at night doesn't encourage burglars, making sex less risky won't encourage sex. There are two problems that make her analogy a non-sequitor. The original is about how your ability to lower the risk of your behavior to yourself encourages you to do more of that behavior. The analogy is about how your ability to (1) increase the risk of (2) someone else's behavior doesn't encourage them. Gee, when you get to stand the other person's points on their heads, you can easily refute them.
Now a reader tries to rescue her "One person, for instance, said I should have used the example of theft insurance instead of locked doors. But I don't see why." Here's why: the analogy becomes just because you have theft insurance [lower the risk] you don't stop locking your doors at night [risky behavior]. The reason you should use it is that it actually conforms to the logic of the objection. I have to admit I don't have data, but I'd say there are more people who would take less precautions with their property knowing they would be paid for a loss than there are who would take more.
But I don' have to think too hard about this, because we already have data about this very effect, and Ms. Seipp cites it - anti-lock brakes and airbags have made people feel safer, so we have engaged in riskier driving behavior to the point we are no safer, and even less safe than before. So we have valid evidence that low and behold, if you lower the risk of a certain behavior, people will do more of it.
And how does Ms. Seipp respond to actual real hard data? Anecdote. Hey I own a safe car and I don't engage in risky behavior. OK, what does that have to do with the measurement of real behavior by real people? Yep, none.
As far as Ms. Seipp's analogy, how about we ask the question, if burglars were given a "get out of jail free" card that really worked, even if only once, would they commit more or less burglary? I don't have to think too hard about that one.
But one has to ask, so what? As far as I can tell, what Focus on the Family and Family Research Council are warning against is a false sense of security - that is they don't want the message to be that because of this vaccine, sex has been rendered safe and complication free. Kind of like, just because you lock the front door everynight, don't think you can't be burglarized.
A better response would be that given all of the factors that go into becoming sexually active, the risk of HPV is pretty far down the list and is just not very significant, and that the risk that young girls would misjudge and take this vaccine as a license for risk free sex could be overcome through the proper education -- which sound a lot like the positions take by those religious fanatics at FOTF and FRC.
So what did I learn from reading Ms. Seipp in this case? Nothing about so called religious fanatics. But I did learn that even smart, reliable people goof: they don't accurately represent other people's positions, they don't reason well, they dismiss data if it disagrees with their opinion, and in general can just go off half-cocked. And yes, I'm sure if you were a glutton for punishment and went through my archives you could find similar problems from time to time.
Posted by Kevin Murphy at October 2, 2006 11:55 AM | Economics | Faith | Science
