February 10, 2007

"What kind of people supply schoolgirls to a pharmaceutical company...?"

Readers object to a NYT editorial supporting vaccinating girls against the virus (HPV) that causes cervical cancer. The letters worry about as-yet unknown side effects, loss of individual autonomy, the power of lobbying by the vaccine manufacturer (Merck), the burden on girls and not boys, and the misallocation of health care funding.

The editorial was more focused on the way socially conservative parents might stand in the way of girls getting an effective treatment:
Many parents are appalled at the notion of vaccinating such young girls against a sexually transmitted disease. But the medical reality is that the vaccine will generally not work after a woman has been infected, so it is best for girls to be vaccinated well before they become sexually active.
Before they become sexually active. The assumption is they will have multiple male sex partners, but many will not. Should they all have the vaccine? Of course, I can see why you can't expect parents to have an accurate idea of whether their daughters will expose themselves to sexually transmitted diseases -- or to spend their money protecting them from a danger they want them to avoid altogether.
None of these objections seem strong enough to forgo the protection against a devastating disease. The United States records some 10,000 new cases of cervical cancer each year, and 3,700 cervical cancer deaths. Gov. Rick Perry of Texas, a conservative Republican, has taken an “opt out” approach, in which vaccination is required but parents can seek an exemption for reasons of conscience or religious beliefs.
So the fact conservative Republican is doing it bolsters the argument? What happened to the usual suspicion that such characters are out to benefit big corporations?

ADDED: I should acknowledge that a woman who only has one male sexual partner could get the virus from him if he has at least one other partner. And I should have been clear that I don't think all (or even most) parents want their daughters to have only one male sexual partner and for that man to have had no other sexual partner in his life. And I'm not a medical expert, so I don't know what the odds of exposure are for persons with very few sexual contacts. I do think there are women who never have sex with anyone or never have sex with males and that it would be good for our culture to notice their existence when we think about what good policy is.

111 comments:

The Drill SGT said...

My position is well reflected by one of the NYT's letters:

As desirable a thing as it may be to protect people from cervical cancer, a noncommunicable disease, it is a usurpation of government authority to dictate medical decisions that only individuals may make.

Schools may rightfully require that children undergo immunizations that will protect schoolwide populations from acquiring communicable diseases, but cervical cancer does not fall into this category.

However benevolent the intent, this is not a matter for Big Brother.


I was struck by the tone of the NYT article. Though I'm not a social conservative, nor religious, I always read a vibe in NYT's prose that seems to look down on those ignorant Red Staters.

David said...

In an era of Bratz dolls dressed to look like hookers and Girl's Gone Wild on spring break cameras this is a predictable response.
It appears that Texas is shining a light on the problem of unrestrained sexual behavior. This light will show the costs of mutliple sexual partners. The demise of Texas-born Anna Nicole Smith is a wakeup call to self-absorbed females who believe they can be sexually active without suffering consequences. Aruba comes quickly to mind also.

I believe the feministas in our culture are barking up the tree of "Keep your laws off my body" when true empowerment comes from teaching our children responsibility about the costs of undisciplined behavior. Of course this will force some baby boomers to admit that their lifestyle choices were based on a false premise.

True power comes from females who command respect from males by just saying "NO" and males respecting themselves and their female friends by not pressuring for sex in the first place.

Pogo said...

1. I find inexcusable the increasing use of state coercion to meet the ideals of an idealistic few. Smoking, trans fats, now a vaccine for a noncommunicable disease.

2. Unlike mammograms and colonoscopies which cost a few thousand dollars for every life saved, this vaccine at $350 a pop will cost more than $300,000 per life saved, an extraordinarily high figure in public health spending for a cancer that's easily screened for and treated already. (And people in government have the nerve to ask why health care spending is so inflationary?)

3. It's the same message every day now: "We know what's best for you. Comply."

Joseph Hovsep said...

Before they become sexually active. The assumption is they will have multiple male sex partners, but many will not. Should they all have the vaccine?

I'm sympathetic to the concerns that we might be unleashing this vaccine on the public before we know much about its failure rate, side effects, etc., but I think its a mistake to sexualize the vaccine or to oppose it on the basis that it justifies/assumes sexual promiscuity.

If someone is making an assumption that the typical girl will grow up to have multiple male sex partners in her lifetime, that's a pretty solid assumption, but that's not a necessary assumption to make. Some girls will only have one sex partner in their entire lives, but that fact doesn't necessarily protect her from HPV if the sex partner she chooses has himself had other sex partners that she may or may not know about. A significant minority of those girls may also end up having nonconsensual sex with sex partners not of their choosing. So, the assumption being made is that girls will be sexually active, not that they will be hooking up with lots of guys. A very small minority of girls will be abstinent their entire lives, but I don't think we should be making public health policy on the basis of those exceptional cases.

Drill Sgt: Would your concern about government power to demand vaccination be satisfied if parents have the right to opt out of the vaccine?

Ghlade said...

Ann Althouse: "The assumption is they will have multiple male sex partners, but many will not."

No, the assumption is that most girls will have sexual intercourse with at least one male partner, which puts them at a surprisingly high risk for contracting at least one strain of HPV.

David said: "The demise of Texas-born Anna Nicole Smith is a wakeup call to self-absorbed females who believe they can be sexually active without suffering consequences."

Come again?

StephenB said...

...the burden on girls and not boys...

Now I'm no authority on the human anatomy, but I'm fairly certain that females are the only members of the human race that are susceptible to cervical cancer since, um, they're the only ones with cervices.

What about prostate cancer? As a male, I don't feel hard done by because females aren't susceptible to prostate cancer.

I'd say we're hard-pressed for feminist issues if this is the sort of argument we're resorting to.

The Drill SGT said...

Drill Sgt: Would your concern about government power to demand vaccination be satisfied if parents have the right to opt out of the vaccine?

I have absolutely no problem with the government running a campaign like "flu shots" for example. clinics in public places including schools, free shots etc.

I think I would prefer an Opt In rather than an Opt OUT like Texas seems to have where a parent needs a religious/moral reason to be excused.

I was also struck by the lack of confidence expressed by Texas in the safety of the vaccine when they refused to add this sentence into the law:

G. The Commonwealth waives immunity from tortuous liability if a female who is inoculated with the HPV vaccine becomes incapable of naturally conceiving a healthy child carried to live birth or experiences impaired fertility as a result of the HPV vaccine.

George said...

test

Irene Done said...

It's strange to ignore the circumstances of Perry's action -- he bypassed the legislative process to award millions of dollars in business to his former staffer's new employer. It's the executive order that angers me. Seems like executive orders should be limited to truly urgent matters. I don't think this qualifies.

By the way, Perry is the same man who during his re-election campaign signed an abortion limits bill IN A CHURCH--so desperate was he to court the conservative Christian vote.

reality check said...

Politics make strange bedfellows.

Amanda "get the government off our bodies" Marcotte and many other self-proclaimed feminists are for this vaccine and ignore the civil liberty issues. They ignore the actual evidence of the trial showing the control was contaminated, the effects short term, and the vaccine's efficacy was only inferred in girls of that age, not proven.

The letters to the editor (which are certainly not random) appear to come from women, Jews, and doctors.

Yet Amanda and others like her claim that anyone opposed to this is just a religious nutcase.

Amanda Marcotte has never been a member of the reality based community.

Have at her. Consider this a freebie from a member of the reality based community that really does think we should keep the government off our bodies.

Joseph Hovsep said...

The American Cancer Society has published the following information (bold mine):

How common is HPV? Who gets it?

HPV is a very common virus. Some doctors think it is almost as common as the common cold virus. In the United States, over 6 million people get an HPV infection every year. Almost half of the infections are in those between 15 and 25 years of age. About half to three-fourths of the people who have ever had sex will have HPV at some time in their life.


Given the link between cervical cancer and HPV, I think these facts essentially make it a communicable disease.

David said...

ghlade;

If you fail to see the link between the image portrayed by ANS, Bratz dolls, GGW, Spears/Hilton/Lohan, a conflicted and permissive society, then nothing I can say will change your mind.

Talking about vaccines for HPV and AIDS is a cover-up for a deeper problem pervasive in our increasingly secular society. The vaccines represent a get-out-of-jail-free card that spreads a thin sheen of respectability to otherwise irresponsible behaviors that carry serious consequences.

These types of vaccines, while they may admirably save some lives, are a plea-bargain down from the oft-times fatal results that come from questionable behavior.

Pogo said...

Re; "...these facts essentially make it a communicable disease."

Interesting take. In public health matters, "communicable disease" used to refer exclusively to infections that posed an immediate and usually fatal threat to the public at large. HPV is not that. It is a communicable disease, to be sure, but not a public health threat that rises to the degree of severity warranting such a big hammer as mandatory vaccination.

The vaccine would prevent about 70% of cervial cancers, which generally takes decades to appear. Although those figures claim that 50-75% of the adult population "will have HPV at some time in their life"

Most HPV infections are of very short duration and do not result in any symptoms at all. Very few infections transform into cervical cancer. The CDC states "Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with "high-risk" types of HPV is the main risk factor for cervical cancer."

Moreover, due to current screening methods, deaths from cervical cancer dropped by nearly 3/4ths between 1955 and 1992, and have continued to decline about 4% a year. In the US, cervical cancer occurs in 8/100,000 patients. For 2004, about 10,520 women will develop invasive cervical cancer and about 3,900 women will die.

So where's the public health threat? There isn't one. I'm for the vaccine, but against its being mandatory

The Drill SGT said...

reality check said...
Politics make strange bedfellows.

Amanda "get the government off our bodies" Marcotte and many other self-proclaimed feminists are for this vaccine and ignore the civil liberty issues.


Exactly! I see this as a "Choice" issue.

Note: was the politics comment referring to Amanda and the Feminists, or you agreeing with Pogo and me?

reality check said...

It's strange to ignore the circumstances of Perry's action -- he bypassed the legislative process to award millions of dollars in business to his former staffer's new employer. It's the executive order that angers me. Seems like executive orders should be limited to truly urgent matters. I don't think this qualifies.

This is a result of powers the many states have given to the executive after the anthrax attacks (that were never solved.)

Model State Emergency Health Powers Act ...Critics said, however, that it did so in such sweeping language that it "could turn governors into dictators" as the Association of American Physicians and Surgeons..."

The very definition of a "public health emergency," which triggered the law's provisions, critics said, was so broad that an influenza outbreak could qualify as an "emergency". The LAMBDA Legal Defense and Education Fund feared it could lead to imprisonment of those with AIDS.

...

George J. Annas, a lawyer at the Boston University School of Public Health and the MSEHPA's leading critic, said: "The Model Act seems to have been drafted for a different age; it is more appropriate for the United States of the 19th century than for the United States of the 21st century." Annas said the law was unconstitutional.


HPV is a communicable disease, but we don't vaccinate school age kids for all communicable diseases, only those that present either such a disastrous outcome or those to which the schools present a unique distribution site. Since the ACS link given above states that cervical cancer is mainly a problem to women that don't get regular pap smears, the win win solution all around is to encourage women to get regular pap smears and to wait until this vaccine, or its competitor, or medical science has a bit more time.

(The bedfellows comment refers to all of the above....)

downtownlad said...

The assumption is they will have multiple male sex partners, but many will not. Should they all have the vaccine? - Ann

That's completely irrelevant. Even if the woman is a virgin on her wedding day and is faithful to her husband for her entire life, this vaccine can still protect her, because her HUSBAND may have had more than one sexual contact prior to the marriage. Or the husband can cheat on her, etc.

It's similar to AIDS in Africa. Many of the women are catching AIDS from their husbands, who may have been with prostitutes, etc.

I call it this way. Make it mandatory, with an opt-out if the parents insist. But then if the parents opt-out and the woman ends up getting cervical cancer later in life, she should be allowed to sue her parents.

Bissage said...

There are fixed costs to manufacturing the vaccine and that is why the government should make it available to all young women. You know, cost spreading and all that. It’s not so much about cervical cancer. I have no cervix. And it’s not so much about other people’s children, who compete with my own children for scarce resources.

No, it’s all about the genital warts. You see, genital warts are unattractive and greatly devalue the marketability of a “sexually active” woman. My wife and I have invested a princely sum of money in our daughter’s personal attractiveness and education in sexual technique so that she can begin shopping herself around as soon as she turns the age of consent. We’re hoping that ultimately she will be good enough for a European nobleman but a wealthy American football player would suffice, so long as his assets are placed in trust and sufficiently managed.

Let’s be reasonable, here. Parents should have the right to opt out of the vaccination program. Their money will nevertheless be available to subsidize the vaccination program and their daughters’ sexual marketability will be jeopardized. Our daughter will have more sex and this will promote a greater return on our investment. That’s a good thing.

Freder Frederson said...

The vaccines represent a get-out-of-jail-free card that spreads a thin sheen of respectability to otherwise irresponsible behaviors that carry serious consequences.

So, cervical cancer is God's punishment for a misspent youth. You are one sick puppy. On that theory, any disease, illness or trauma is a punishment from God and seeking medical care is defying God's will.

reality check said...

The same economic logic states that the flu vaccine should be mandatory as well.

The CDC says that 36,000 Americans die of flu (and flu related pneumonia) each year. There are, I believe, only 4,000 cervical cancer deaths a year.

We don't accept opt-out for flu shots, for spam lists, or for telemarketers, why would should we accept opt-out for an unproven vaccine?

If there is an economics issue, the answer should be the same as that proposed for the flu vaccine. Have the government agree to purchase X amounts of vaccine each year, but don't mandate its use. In the case of the flu that is to assure there is a supply for the rare occurrence of a pandemic.

If we want to make sure that insurance companies cover this, pass a law that says that insurance companies must cover this. But don't make it mandatory.

Better yet, move to universal health care which will make sure that pap smears are covered, and relieve businesses of an enormous competitive disadvantage.

downtownlad said...

Pap Smears?

I see - it's better to find out a woman has cancer AFTER the fact, rather than prevent it from happening in the first place.

???????

vbspurs said...

Pogo wrote:

Interesting take. In public health matters, "communicable disease" used to refer exclusively to infections that posed an immediate and usually fatal threat to the public at large.

Yes. I wonder if in the STD-rampant 1800s, had we had penicillin, if the US gov't would've made syphillis-vaccination mandatory?

HPV is not that. It is a communicable disease, to be sure, but not a public health threat that rises to the degree of severity warranting such a big hammer as mandatory vaccination.

Agree. Never mind though.

Further reason for parents to opt out of the public school system, to private schools, and homeschooling.

Cheers,
Victoria

downtownlad said...

And 14,000 women get cervical cancer each year.

Go ask the other 10,000 who get and live - if they would have preferred to have had the vaccine.

Go ask women if they'd prefer to have one vaccine when they're 11 or instead have to get a yearly pap smear.

While we're at it - let's stop giving kids vaccines for polio, measles, etc. I mean it's a choice right?

It's been proven time and time again that vaccines are most effective when they're mandatory, The more people in society that are immune, the less likely it is that someone will become infected in the first place - even if they didn't have the vaccine.

There are 6000 deaths from Hepatitis B in the United States every year as well. Entirely preventable if people were smart enough to get vaccinated.

Ann Althouse said...

Why did DTL miss the gay rights issue I raised? Because it's only about lesbians?

downtownlad said...

It's going to be fun looking at the cervical cancer rates in 30 years.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh."

The Drill SGT said...

I call it this way. Make it mandatory, with an opt-out if the parents insist. But then if the parents opt-out and the woman ends up getting cervical cancer later in life, she should be allowed to sue her parents.

Lad,

Note that the state of Texas was either not confident about the safety of the mandated vaccine or less than confident in the Ambulance Chasing Bar when they refused to accept a similiar burden to the one you proposed for themselves:

G. The Commonwealth waives immunity from tortuous liability if a female who is inoculated with the HPV vaccine becomes incapable of naturally conceiving a healthy child carried to live birth or experiences impaired fertility as a result of the HPV vaccine.

reality check said...

I am no expert on Pap tests, but according to the ACS link, Pap tests detect pre-cancer cells. Pre-cancer cells are not cancer.

I do not know what the treatment is after a pap smear detects pre-cancer cells.

reality check said...

Go ask women if they'd prefer to have one vaccine when they're 11 or instead have to get a yearly pap smear.

According to the ACS link above,

Will girls/women who have been vaccinated still need Pap tests?

Because the vaccine will NOT provide protection against all of the types of HPV that can cause cervical cancer, women will still need Pap tests.

reality check said...

It's going to be fun looking at the cervical cancer rates in 30 years.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh.


Ah, it's so nice to offer a cancer victim a condescending tone of superiority. Beats having to favor universal health care.

reality check said...

Why did DTL miss the gay rights issue I raised? Because it's only about lesbians?

Went over my head too. What are you talking about?

chuck b. said...

Maybe they should give the vaccine to boys instead. Would that reduce the noise levels...30%? Merck's vaccine has not been approved for use in males, but I believe GlaxoSmithKline's is expected to be.

reality check said...

From the same hoopy froods that brought you vioxx, thalidomide, des, premarin, sulfanilamide, Baycol, Depo-Provera, now comes Gardasil, fast-tracked, no long term longitudinal studies, never proven effective in the targeted age range, and just so happens to be the most expensive vaccine ever produced.

PatCA said...

"The vaccines represent a get-out-of-jail-free card that spreads a thin sheen of respectability to otherwise irresponsible behaviors that carry serious consequences."

The feminists are for this mandatory vaccination because it's a tenet of their dogma that choice (impulse) trumps...well, everything and that morality is just godbag oppression. Just take the shot, grrll, and you can do whatever you "choose" to do!

10,000 women per year out of a population of how many hundred million warrants a mass inoculation campaign like that against polio?! Let's see a breakdown of who contracts this disease and counsel them before we start shooting untried drugs into children.

bearbee said...

I am not anti-vaccine but I wonder, does anyone really understand the cumulative effect all these drugs have? What unknown side effect might the polio vaccine produce by itself; in combination with, e,g,, hepatitis, tetanus, flu or other common vaccines, or with drugs used for diabetes, asthma, or with antibiotics? Now we add into this mix, a new drug in which no one can anticipate its long-term side effects.

It is troubling.

reader_iam said...

I do not know what the treatment is after a pap smear detects pre-cancer cells.

In my case, it was crysosurgery. (See here.

With regard to the vaccine:

I find it quite alarming, even despicable, how quickly this debate (I don't mean here; I mean more generally) has become a symbolically political one on the part of both sides. Thus I see a fair amount of dishonesty and obfuscation being spread around in support of each particular "position."

MadisonMan said...

The vaccine in question is effective against four different strains of HPV. Two of those four lead to about 70% of all Cervical Cancers. Even if you do vaccinate (and my daughter likely will), stopping a yearly pap smear is a ridiculous notion.

PatCA said...

Here is a medical opinion from the letters which suggests who all these elite white feminists, journalists and politicians are saving...er, targeting:

"The vaccine has not been proved to reduce cervical cancer. It is moderately effective at preventing certain pre-cancerous changes. There is no long-term safety or effectiveness data.

Most deaths from cervical cancer in this country are in women who are not adequately screened (with a simple Pap smear). In Texas, underscreening in African-American and Hispanic women probably accounts for their disproportionately high rates of cervical cancer.

These adult women need access and coverage for screening. Unfortunately, there is no lobby for the Pap smear.

Deborah Kamali, M.D.
San Francisco, Feb. 6, 2007
The writer is an associate professor of obstetrics, gynecology and reproductive sciences at the University of California at San Francisco."

reader_iam said...

It's going to be fun looking at the cervical cancer rates in 30 years.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh."


My God, you're a jerk. So...then... I guess it'd be just a-ok if someone say now, to a current cervical cancer patient, "your parents must have raised you wrong since obviously you must have turned out to be a slut if you got that virus that led to this."

Please don't pretend to be so stupid that you can't get the point I just made.

You disgust me.

Ghlade said...

reality check, I think the professor's "many will not" remark refers in part to lesbians, who may never have sex with men. As the one woman who I know for a fact has HPV acquired it from rape, I am unpersuaded on that count.

David, I can understand why you think ANS' "image" contributes to a more sexually permissive society, I fail to see why her as yet unexplained death should be a "wake up" call to sexually active women. We don't know why she died, and I very much doubt her death had anything at all to do with sex.

More generally, the idea that we should tolerate life-threatening STDs in order to scare women away from choices that we don't approve of is, for lack of a better word, evil.

reader_iam said...

Obviously, it would be more a more complex undertaking because of the nature of the procedure and the literal amount and type of physical space that would be required, but it would be immensely beneficial and helpful if accessible free, or low-charge pap-smear clinics could be held in the community, much as flu shot clinics, blood pressure & cholesterol diagnostic clinics, and etc. are.

Bruce Hayden said...

Notice how quickly they jump from the fact that a lot of cervical cell abnormalities (and presumably ultimately cancers) come from HPV, and that this helps prevent some HPVs. But it apparently is only effective against 4 or so of 30 or so HPVs. And, so far, most HPVs haven't been tied to cervical cell abnormalities. So, it isn't a cure all for all types of genital warts, and may not be totally effective in preventing this type of cervical cancer.

Oh, and that also ignores that not all cervical cancer is caused by HPV. Notice how everyone seems to be jumping from the fact that some HPVs can cause cervical cell abnormalities, which in turn can be precursors to cervical cancer, to the implication that the vacine will eliminate cervical cancer. But that doesn't logically follow: what about cervical cancer from other sources? We just don't know. HPV is often undetectable after a couple of years, so did a woman get cervical cancer from a HPV that she no longer has? Or for some other reason? We just don't know.

Given the number of lives that might be saved, the cost, that this is all fairly unclear at this point, and that we don't know yet of any long term danges of the vaccine, I think that opt-out is not appropriate. Rather, opt-in is the better way to go.

reader_iam said...

This is not an argument against the vaccine, but I think it is legitimate to be concerned that some young women may mistakenly feel that because they receive the vaccination, they can be more casual about getting regular pap smears performed. This prospect truly alarms me--as I'd like to think it would even if I were not a woman who has undergone cryosurgery more than once. This treatment has been successful because the problem was detected promptly and early due to regular pap smears.

Again, I want to emphasize: this is not an argument against the vaccine.

reader_iam said...

I suppose I should say that I have not been diagnosed with HPV.

B said...

It is impossible to find a government control restricting parents decision-making rights over their children that the New York Times will not endorse. The Times, without exception, has always endorsed the concept of state-nations owning complete rights over the upbringing of children. Every right of the parents is subservient in the Times view.

In the real world, where the Times parental control efforts have been on display, such as China, Cuba, and the former Soviet Union, there's a name for it. It's called Communism. Germany under Hitler also had such state ownership of parental rights.

There has been a quiet inside joke among many church folk for quite awhile: if you want to know what Satan is up to, read the editorial page of the New York Times.

chickenlittle said...

Who's concerned about Merck's example of inventing a useful remedy;
patenting it;
lobbying a government to mandate it;
setting an arbitrary cost for providing it which does not correlate with the cost of producing it;
convincing a public that it is their best interest to go along with it.


Sounds like a sure fire method to bolster a failing drug industry to me.

Kirk Parker said...

Whoa! Now 'reality check' is channeling Cedarford? Please help me find the looking glass so I can step back through it...

Joseph Hovsep said...

I find it quite alarming, even despicable, how quickly this debate (I don't mean here; I mean more generally) has become a symbolically political one on the part of both sides.

I agree with this statement quoted above by reader_iam. This is really a health issue that should be evaluated on the basis of need, cost efficiency, safety, individuals' rights, etc., but I found myself reflexively responding to what is or I anticipate will be the illogical social conservative position on any issue remotely related to sex, as exemplified above by commenters pat_ca and david ("The vaccines represent a get-out-of-jail-free card that spreads a thin sheen of respectability to otherwise irresponsible behaviors that carry serious consequences.")

I think many liberal/feminist types would be very open to considering the costs of this vaccine and the way it is administered on issues they care about like personal autonomy and governmental paternalism on issues of women's sexual health and issues that everyone cares about like efficiency and safety, but they/we feel the need to combat offensive and absurd notions put forth in opposition to the vaccine that women shouldn't be protected against HPV/cervical cancer because then they'll feel free to be promiscuous.

Pogo and Drill Sgt raised some interesting points in opposition to the Texas plan that I hadn't thought of. They they framed it as an issue of public health/personal freedom rather than a debate about the sexual revolution, which I think we all should do.

downtownlad said...

So reader_iam thinks a woman who is a virgin when she gets married, but is infected by her husband, he thinks that woman is a "slut".

Nice one. What a jerk.

Kirk Parker said...

"setting an arbitrary cost for providing it which does not correlate with the cost of producing it"

Sounds like chickenlittle needs to re-take Econ 101 perhaps.

In addition to the basic, nay remedial-level, error about economics here, it also glosses over that minor issue of drug development costs.

Joseph Hovsep said...

I don't really see a gay rights issue here and its not because it affects lesbians rather than gay men. Presumably the gay rights issue is that little girls who grow up to be lesbians would be vaccinated even if they never have sex with a man. But little girls who grow up to be lesbians often have sex with a man along the way, whether before they come to terms with their sexuality or experimentally or nonconsenually. And even if they don't, the vaccine is preventative. People aren't vaccinated against X or Y disease because they are 100% sure to be exposed to it later in life. They are vaccinated because there is a chance they might be exposed to it or, even if there's a low chance of exposure, the consequences of exposure would be dire. Lesbians can argue about whether there's a good chance of exposure or whether the consequences are sufficiently dire or whether we should be spending our money on other things or whether the vaccine works well, but I don't see a cognizable objection from the lesbian community to making the vaccine available as it is in Texas on account of their sexuality.

reality check said...

Kirk, you should consider taking econ 102, 103, ....

The drug development costs are sunk and the drug should be priced at marginal cost to maximize profit. That maximum profit either will or will not cover the drug development costs but that is irrelevant to the pricing to obtain maximum profit. Pricing to include the development costs will assure the drug does not achieve max profits.

downtownlad said...

It's really no different than the movement underway with many parents to not innoculate their children against other diseases. They really are laying the groundwork for future breakouts of things like polio, measles, etc. - diseases we should really be trying to make extinct.

And yes - when those unvaccinated children come down with measles and polio in the future, something that in reality was entirely preventable, you betcha I will say "heh" to myself. Of course that will be directed towards the parents, not the children. It's not the children's fault for having stupid parents.

Just as I do with Christian Scientists who refuse standard treatment in favor of prayer instead - and then prompty die.

I'm the one who favors a vaccine instead of getting cancer. The religious folk on here think cancer is better than the vaccine.

Who's really the sicko here?

Tim said...

"So reader_iam thinks a woman who is a virgin when she gets married, but is infected by her husband, he thinks that woman is a "slut".

Nice one. What a jerk."


Indeed. The incidents of HPV infection leading to anal (as anal receptive males are at risk too) and cervical cancer based upon exposure to one HPV carrier are vanishingly low; the science indicates conclusively the risk of exposure increases as one's exposure to sexual partners increase, i.e., the more promiscuous the person, the more likely one is to contract HPV leading to anal or cervical cancer.

It isn't at all clear reader_iam called such a one-partner person a "slut;" it is exceedingly clear reader_iam's point is scientifically more sound than the jerk willfully misrepresenting reader_iam's point.

reality check said...

So reader_iam thinks a woman who is a virgin when she gets married, but is infected by her husband, he thinks that woman is a "slut".

Nice one. What a jerk.


There is no reason to read reader_iam's statement that way, except to avoid acknowledging your own stupid statements.

downtownlad said...

Let's see Tim. You want women to get cancer, because they're sluts.

I say - let's prevent as many of these cancers as we can, by giving them a vaccine when they're 11 years-old.

Utterly disgusting.

How many women have you slept with Tim? Before you start judging them, I think its fair to know whether or not you're holding yourself to the same standard. If the vaccine affected testicular cancer, i.e. something that affects men, I really wonder if you'd prevent your son from getting the vaccine, because you want him to be "moral".

Remember - these women got the HPV virus from other men. Why do we demand that the woman be the ones who refrain from sex and not demand the same of our sons?

There is a sexist tone in this entire thread.

downtownlad said...

And what stupid statement would that be reality_check? All I'm saying is that if people want to allow their daughters to have an increased risk of cancer - all in the name of "religion" and "morality" - then sorry - I'm going to laugh at them when their kids get a cancer, a cancer that could have been avoided if they weren't so obtuse.

I'm supposed to sympathize with them? Why? It's their fault that some of their kids are going to get cancer and die, not mine.

Perhaps we should make these women future recipients of the Darwin award.

reality check said...

As I pointed out, your statements about pap tests were stupid.

I would say incorrect or ignorant, but most of your posts in this post have been woefully misguided to the point of sheer stupidity.

reader_iam said...

Oh, come off it. I wasn't commenting on the woman--the hypothetical patient--either way. (I don't think women with HPV, however come by, are sluts. In fact, I don't generally use that term nor make that judgment, period. NEVER have, IRL or otherwise.) Here I did so only to make a specific point.

I was saying that it's as ridiculous and callous and disgusting to say--while having fun--to a cervical patient "heh! your parents must have been religious nutcases" as it would be for an analogous thing to be said from the so-called conservative point of view.

I knew you'd pretend you were too stupid to get my point.

Also, my comment wasn't about the science of anything. And no, I was not calling women with HPV, or any other sort of STD, sluts. That's just ignorant nonsense.

Anyone reading my original comment that way is being willfully obtuse. I find this ESPECIALLY amusing from anyone who has ever, ever, ever drawn and played the "irony" card.

Puh-leeze, people.

downtownlad said...

Actually - my post on pap tests was correct. Almost all in-depth articles I've read on this subject have predicted that the frequency of pap tests required in the future will be LOWER because of this vaccine.

Unless the women have stupid, ignorant, religious parents - who prefer cancer over sex.

Based on NHIS 2000 and NHIS 2005, 66 million (95% CI, 65-68) and 65 million (95% CI, 64-67) Pap tests were performed in the US, respectively. Had HPV testing been performed in women older than 30 years who had both negative HPV and negative 3-year Pap tests, then 30% (95% CI, 29-32%) of Pap tests would not have been performed.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17262799&query_hl=6&itool=pubmed_docsum

So - again - you're wrong. Or should I say "incorrect and ignorant" as you prefer.

downtownlad said...

Puhleeze read_iam.

I don't WANT these women to get cancer. I'm trying to PREVENT these women from getting cancer.

My friend's mother died of cervical cancer last year. My cousin is suffering from it. So I find that comments that "only" 4000 people die from it a year, rather shallow.

So we now we have a wonderful cure. And people are avoiding this cure in the name of religion. Well - frankly - that's dumb.

It's equivalent to the gay person who has sex without condoms and then wants me to feel bad for him when he gets HIV. Um - nope.

reader_iam said...

I'm going to laugh at them when their kids get a cancer,

Damnit, DTL, I am NOT going to let you get with that--with rephrasing what you originally said and to whom you were directing it. This is your typical approach when you get caught out at doing something you suposedly despise.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh."

Which, by the way, is stupid anyway--given that you'll have NO WAY of knowing whether that woman had the vaccination or not. Or whether she did have it but got cervical cancer anyway.

You said something stupid and offensive in order to make yet another swipe at religion. It's that simple.

And you bet I'm passionate about this one. Cervical cancer is no joke. Hell, even recurrent bouts with pre-cancerous cells is no joke. How and why those come by to be are beside the point, and the parents of the victim, in the event, are beside the point.

This is a serious issue, the vaccination offers serious help, but like all things medical, we don't know everything about it yet. This is an issue of women's health. Having an issue of women's health once again become political fodder by people more interested in taking political potshots or converting a serious discussion into a symbolic one is an outrage.

So knock it off, you fool.

reality check said...

First you cut off your own cite before it got a chance to establish your point. What you do cite just is for HPV testing, not for HPV vaccine.

Second, regardless, the ACS says that due to other diseases, women still need pap tests.

Third, what you actually stated was not that pap tests would be reduced, but that they would not be needed at all:

Go ask women if they'd prefer to have one vaccine when they're 11 or instead have to get a yearly pap smear.

Fourth you were wrong about the very nature of pap tests:

Pap Smears?

I see - it's better to find out a woman has cancer AFTER the fact, rather than prevent it from happening in the first place.


As I pointed out from the ACS link, pap tests find pre-cancer cells, that the ACS says, "pre-cancer cells are not cancer."

Fifth, you still come up with the lie that the only people who question this are religious nutcases, though as this discussion shows, that is patently not true.

Sixth, having failed to prove five, you shift gears, now people that dislike this hate women, placing you squarely in Amanda Marcotte's camp.

Seventh, you clearly need to apologize to reader_iam

Care to continue?

Tim said...

"Let's see Tim. You want women to get cancer, because they're sluts."

Hey Asshole, wrong. Again.

I never said that.

I called you on your willful misrepresentation of reader_iam's point - address that point, if you could instead of willfully distorting my argument.

It is clear that it isn't remotely possible for you to discuss ANYTHING without willfully misrepresenting different arguments. You're a human black-hole, diminishing the rest of us.

Downtown Lad, the automatic distortion machine. What a pustulent prick.

downtownlad said...

Scientists have been quite clear that this vaccine is a good thing. The only people making political fodder of it are the religious nutcases.

And you're the one misinterpreting me. My "heh" was directed at the parents.

And you obviously have zero sense of sarcasm. I'm advocating for the eradication of this type of cancer (i.e. - caught through the HPV virus). I am speechless at the thought that people want to allow this type of cancer to continue. And I'm giving the theoretical of what's going to happen:

That in the future the only women catching cervical cancer from HPV will be women whose parents were religious nutcases.

I'm trying to prevent that. You favor it. And I should be allowed to call people to task for that.

downtownlad said...

Tim and reader-Iam and reality_check favor a policy that will have more women getting cancer.

I oppose it.

It's as simple as that. But somehow arguing against cancer makes me a "jerk".

Tell that to the women whose deaths you're going to cause by stopping this vaccine from being implemented.

Cedarford said...

The elephants in the room are HIV and "herd immmunity".

Vaccines do not automatically confer individual immunity on all innoculated. The way disease works though, is when you get a high enough percentage of any "herd" innoculated, and that includes human, the disease cannot take root in enough of the people to spread and persist. It dies out. When enough people "opt-out", you have a host population that can spread disease to those whose vaccine only conferred resistance and to those with medical reasons why they could not get innoculated. Polio, measles, and whooping cough outbreaks have occurred in religious populations here, in Europe, and Africa (vaccine opposing Muslim tribes) and killed or paralyzed others in the "herd". The consequences do not end with "the individual whose family made their choice.

So the goal is the elimination of cervical cancer. Globally, it is the 2nd greatest cancer killer of women - And I doubt the "cured" survivors that had their cervix fully or partially surgically removed found the experience much fun, and of little consequence.

The other argument is the HIV elephant. If, hopefully when, a HIV vaccine is developed, we still face the fact that the religious and libertarian arguments against vaccination will be identical as for HPV. (1)It's not really contagious, just communicable if "bad behaviors" are tolerated in our morally lax society. (2)Getting a HIV vaccine is bad because it would only encourage my child into promiscuity, illegal drug use. (3)Or, no dang gummint will tell my family to get nothin' done.

HPV sets precedence for HIV vaccination impediments society accepts or does not sanction.

Efforts towards ending HIV and AIDs, hypothetically, if a vaccine was developed - would trigger the identical public reaction HPV vaccine is getting. Though, with AIDs, the enormous costs to society from AIDs may be enough in and of itself to make HIV vaccination absolutely mandatory, no "opt out" (And past the hypothetical..in reality...a vaccine against AIDs is an exceptionally difficult task because the virus mutates so quickly...)

*******************
The true effectiveness of vaccines are based not on individual, but on a "herd immunity" if enough are immunized. Polio and other diseases persist because reservoir populations of people who don't have access to vaccine or who do but are refusniks are not immunized. As long as reservoir populations harbor disease, we face outbreaks that include a percentage of immunized people.

I take the perspective that if we can wipe out killer scourges like HPV and HIV, we should.

chickenlittle said...

Kirk Parker said:

"In addition to the basic, nay remedial-level, error about economics here, it also glosses over that minor issue of drug development costs."

We're not dealing with a free market situation here: treatment is mandated; monopoly supply of the drug is enforced by law; the price is already set...which part of Econ 101 would you like to discuss?

downtownlad said...

I still say let the girls who get cervical cancer in the future sue their parents.

People who get Hep B should do the same.

The Drill SGT said...

Lad,

As usual, you are taking a hyperbolic approach to this.

Almost everybody posting on this topic thinks that if this HPV vaccine proves out, it is a good thing for society. The concerns come in a variety of areas, among them:

a. is the vaccine safe and effective in the long term? Nobody knows that. Nobody

b. HPV is not in the same class of communicable diseases that polio or measles are. They are transmitted by anonymous contact. HPV is transmitted by very low incidence intimate contact. Given that the long term safety is unknown, and there are other prophylactics available to acquiring the disease, there is resistance in some quarters about a MANDATORY program this early Not everybody wants to be an early adopter here.

c. some folks are concerned that even if effective, lack of education on the subject will lead some no zero number of folks to conclude that the vaccine protects them from things that it does not, like other STD's or ALL cervical cancers, which it does not. This ultimately could cause more deaths than the current practice.

d. some folks are not convinced of the cost benefit ratio of this, given the low incidence of the cancers, of which only some portion will be prevented, and where the possible costs of the downside are completely unknown at this point.

e. some folks want to wait and get more data

f. some folks don't like government mandated monopoly corporate welfare.

We all would like to improve the health of the population.

this isn't really a LEFT-RIGHT issue as demonstrated by the fact that Reality Check has demonstrated that in his Lefty little red heart beats a bit of libertarian skeptic.

Old Dad said...

I think the relion angle is a red herring. While there may be some parents who would choose to opt out for religious reasons, most, I religious parents would not. While I may encourage my child to be abstinent, to avoid sin, etc., I wouldn't bet her life on it.

Assuming the safety and medical efficacy of the vaccine, I'd be likely to vaccinate my daughter, but I don't think the case has been made for mandatory vaccination.

The Drill SGT said...
This comment has been removed by the author.
The Drill SGT said...

Cedarford,
both good points, but this vaccine has no long term track record. Wouldn't a bit of data from voluntary immunizations before you mandate what will ultimately impact 200 million women in the US make sense? I have no idea of the science basis on the vaccine and whether it is live or dead, but what percentage of adverse results would you accept in a mandatory nationwide program for a virus whose impacts can be and will continue to be treated in other fashions?

downtownlad said...

Leftists are anti-science. What do you expect.

Every study I've read has laid out the cost-benefit analysis for this vaccine. And the FDA, a notoriously SLOW agency, has even approved it.

As for cost/benefit, how many Americans have died from terrorism in the last 30 years? Yet somehow, we think it's worthwhile to spend $150 billion a year on a war to prevent about 100 terrorist deaths a year (if you even buy the argument that the war will cut terrorism - I don't).

Surely this vaccine has a greater cost/benefit basis for saving lives than the war.

reality check said...

Yes, leftists are anti-science, FDA approval proves it's safe, and the logic of going into Iraq means it is okay to mandate this for kids.

downtownlad said...

They're mandating with an "opt-out", so nobody's freedom is being curtailed.

But don't come crying to me when your daughter gets Ovarian cancer, because you believed the anti-science loonies.

My parents may have been jerks. But thank god they were smart enough to vaccinate me.

Lots of parents aren't vaccinating their kids for Hep B, because only fags and druggies get that disease. And unfortunately there are still 6000 deaths a year from that disease, and about 200,000 people catch it. But new rates have been plummetting due to vaccination recommendations in many states.

Unfortunately, an alliance of anti-science leftists and religious right wingnuts is threatening to reverse that trend.

But you know - it's just the fags and druggies who will die (and maybe some hemopheliacs) so who cares . . .

Yup - let's ignore all actual EVIDENCE that has proven that the vaccination regime is cost-effective and saves tens of thousands of lives.

reader_iam said...

I defy anyone here to go back through these comments and find where I said I favor a policy that will have more women having cancer.

In fact, I defy anyone here to find where I argued for OR against the policy in question, specifically.

Go do it. I dare you. Cite chapter and verse.

DTL: You're now a liar and a smearer.

downtownlad said...

"your parents must have raised you wrong since obviously you must have turned out to be a slut if you got that virus that led to this." - reader_iam

downtownlad said...

Reader_iam - All you have been doing this thread is slamming me when I claim that the failure to vaccinate women will lead to more deaths.

So it's quite obvious you are against the vaccine, otherwise why slame me . . . .

reader_iam said...

Out of context AGAIN, DTL.

Your original, COMPLETE comment:

It's going to be fun looking at the cervical cancer rates in 30 years.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh."


My original, COMPLETE comment:

t's going to be fun looking at the cervical cancer rates in 30 years.

I'll look at those women, and say "Ah - your parents must have been a religious nutcase. Heh."

My God, you're a jerk. So...then... I guess it'd be just a-ok if someone say now, to a current cervical cancer patient, "your parents must have raised you wrong since obviously you must have turned out to be a slut if you got that virus that led to this."

Please don't pretend to be so stupid that you can't get the point I just made.

You disgust me.


The way you just presented what I said, in a non-answer to my challenge that you demonstrate where I addressed the policy itself (again, I offer your COMPLETE comment):

"your parents must have raised you wrong since obviously you must have turned out to be a slut if you got that virus that led to this."
-reader_iam


Again: Liar. Smearer.

And now--COWARD!

reader_iam said...

See 1:25 comment if you're still confused.

downtownlad said...

There's nothing out of context about what I said.

You have stated quite clearly - that women who have cervical cancer now are sluts. It's there in black and white.

All I said, in a sarcastic tone, is that if parents oppose this vaccine, it is THEIR daughters who are going to die - and isn't that ironic. With the OBVIOUS intent of that if you don't want your daughters to die of cervical cancer, then maybe you should think again and get the vaccine for your children.

How that is equivalent to women today being sluts just because they have ovarian cancer is beyond me.

downtownlad said...

And this is a black and white issue. You are either against cancer (pro-vaccine) or for cancer (anti-vaccine).

I think silence (reader_iam) is the equivalent of being for the status quo, i.e. pro-cancer.

reader_iam said...

Sorry, folks, but I am sick to death of DTL, who jumps in, almost without fail, to be offensive, willfully misstates other people's positions and then smears them. He's being doing it for months. No matter what the issue is, he never cares to be thoughtful. He cares only to score personal points, nothing more.

DTL, I trust your motives with regard to public health policy and the health of individual women about as much as the farthest religious-right fanatic I can think of. Neither of you truly gives a rat's ass against whose body you grind your personal axes.

And I am under no obligation to stand idly by and watch you do it.

downtownlad said...

Reader_Iam,

So I use a sarcastic tone to advance my arguments. So freaking what.

You then come on with your attacks of how I "disgust you".

Well don't expect me to just sit there and take it.

This is a serious matter. Women are dying of ovarian cancer every day. And religious loonies are advancing bogus arguments to stop that. And women will continue to die if they succeed.

Sorry - I won't be silent in that matter.

How it is "offensive" of me to be pro-vaccine is mind-boggling. Why don't you go back and read this thread carefully. You started with the mud-slinging.

reality check said...

It is a black and white issue, and I have to admit that I am objectively pro-cancer. It's a fair cop.

reader_iam said...

1) Where did I say I was anti-vaccine? You are jumping to conclusions. I'm not anti-vaccine.

2) For the last time, I wasn't saying women are sluts. I was saying that if you think it's OK for you to say what you did, then it must be OK for others to ... .

I don't think EITHER thing is OK. Get it?

downtownlad said...

And please read my first five posts "in context" before you start slamming me.

ploopusgirl said...

Pogo: This is off topic, for certain, but I'm pretty sure I recall your saying you work in the medical field at some point or another on this blog. Now, call me crazy, but how do you purport to work in the healthcare field and sit in your house whining on the althouse blog about how only an "idealistic few" would suggest cessation of smoking and consumption of trans fats? Now, legislation dictating against the sale of foods containing trans fats or dictating when and where a person can light up a cigarette may be taking the power of the law a bit too far and crossing over the line of our freedoms (though I can't say I mind the smoking in public places bans; alleged "smoking section" or not, I don't want your damn smoke wafting through my lungs), but to not recognize the importance of speaking out against smoking and trans fats? To decry this as an inexcusable overstepping of government and media bounds that only an idealistic few would support? Interesting medical school you must have attended...

On a more relevant note, I sincerely hope all you people whining about this vaccine in this thread have no daughters or sisters who ever develop cervical cancer. The goal of medicine with regard to infectious diseases is to discover a vaccine that could potentially eliminate the infectious agent once and for all. Though this vaccine is not that magic potion, I would think that a 70% reduction in the chance of obtaining a virus that has been linked to cervical cancer would be a damn good start and a chance I'd be glad to take. Furthermore, $350 for a one time dose that may prevent cancer is hardly a costly investment, in my mind. Though, I suppose shelling out $350 every time a new IPOD mini or whatever-the-fuck comes out is a much more sound investment for you apparently poor denizens of the althouse blog.

downtownlad said...

Reader_iam,

Actually I'm not sure what you actually think on this topic. All I know is that I "disgusted you" and I got rather perturbed with you after that.

Again - read my first five posts, and the sarcastic tone of the post that "disgusted" you should have been pretty clear.

Yes - I was taking your quote out of context, but you did the same with mine.

downtownlad said...

And Reader_iam, I apologize if mispresented you.

My gut reaction when personally attacked, is to personally attack back. I'm used to being attacked for who I am - and I have learned to attack back as a self-defense mehcanism.

PatCA said...

DTL,
You are willfully ignoring that the question here is not whether the vaccine is good or bad but whether all parents should be forced to vaccinate their daughters.

As the Ob-Gyn wrote to the NYT, only certain populations, about 10K per year, those who do not get Pap smears, are diagnosed with cervical cancer. So, yes, public policy should be directed at those "reservoir populations" who avoid screening or have no access to it before we force every girl to be a guinea pig for Merck. Or should we also then by the same token require every sexually active gay man to take AZT?

And I say that as a stockholder in Merck. Earn your money the honest way: without bribing government to do it for you.

downtownlad said...

PatCa - I have said quite clearly that I'm in favor of an opt-out. But don't come crying to me when your daughter gets cervical cancer from HPV if you chooses to opt out.

downtownlad said...

Or should we also then by the same token require every sexually active gay man to take AZT?

AZT prevents HIV???? Since when.

But a valid example is the vaccine for Hepatitis B. Conservatives oppose this vaccine, because typically gays, people who have anal sex, and drug addicts get Hep B. And since conservatives have no gay kids, or have disowned them, they actually prefer that Hep B continue to kill people than their straight, wholesome kids getting the vaccine.

Unfortunately, some of those straight whole kids of theirs who are unvaccinated actually turn out to be gay, some of whom go on to get Hep B, some of whom go on to die.

Do I think that everyone should be vaccinated against Hep B, in order to eliminate this disease predominantly affects gays, homopheliacs, and drug addicts?

Well yes I do favor that.

storkdoc said...

I am an OB/GYN. I am fairly conservative. I am a practicing Catholic. I don't do electice abortions. I have a 6 year old daughter.

The vaccine is for 4 types of HPV.

It is useful against types 6 and 11 which account for 90% of genital warts. I have seen many many cases of genital warts in the last 17 years. I don't want my daughter to get them.

It is useful against types 16 and 18 which are associated with 70% of cervical cancer.

My daughter will get this vaccine because I can not protect her against everything in life, but I can protect her against this.

It doesn't need to be mandatory, but you should really think about having your daughters vaccinated.

When it is approved for men, I will give it to my currently 11 year old son, so that he can not spread it others

downtownlad said...

Bingo storkdoc.

Take a look at this graph for Hep B incidence:

http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5251a3.htm#fig

Notice how the rates amongst youngsters is going towards zero, as 42 states pretty much mandate this vaccine. But lots of people want to go back to 1990, because they assume their kids won't be gay, etc.

Well - statistically they are correct. Chances are their kids don't need this vaccine. Only about 10% really will.

And they really couldn't give a crap if that 10% of the population is ravaged by this disease. As if a gay kid at 18 who starts having sex is going to think "Hey - I should get vaccinated for Hep B first". Yeah right. Even today, only 39% of gay men are vaccinated against Hep B. Because doctors don't even recommend this. I had to DEMAND to my doctor that I get the shots. Dumbass. Thank goodness mandatory vaccination routines are now in place for young people and they won't have to deal with this disease. Unfortunately, adults are still dying of it.

Kirk Parker said...

Chicken,

Don't know how well it works to try and have a conversation with all this shouting going on around here, but let's try...

Please notice that my original complaint was limited to only one of your phrases. I defy you to find a single word from me here, or anywhere else, of support for that notion that the HPV vaccine should be mandated.

But your jab about "setting an arbitrary cost for providing it which does not correlate with the cost of producing it" is completely objectionable in its own right. What else do you (or any of my other naysayers out there) think is supposed to happen during the limited-time monopoly that a patent provides???

PatCA said...

I think you're on one of your tirades, DTL, but one last try: opting out means that the default position is mandatory vaccination.

As storkdoc said, and as you agreed, it doesn't need to be mandatory.

I never stated what I would do as to my daughter, but throwing mud is your substitute for argument when you're in your mood. And you know what I'm talking about with HIV/AIDS.

downtownlad said...

Actually I have ZERO idea what you're talking about with HIV.

If they find a vaccine, you can damn well bet that I'll be in favor of a mandatory "default" position in favor of vaccination for everyone, with the option for stupid people to opt out if they so choose.

There's a big movement in this country to stop kids from getting any kinds of vaccinations. Dumb. And the kids should be able to sue their parents if they get sick. It's sheer negligence on the parents part.

reality check said...

DTL, I am not sure Libertarian means what you think it means.

chickenlittle said...

Kirk Parker asked:

"What else do you (or any of my other naysayers out there) think is supposed to happen during the limited-time monopoly that a patent provides???"

I guess lots of voluntary purchase driven by long felt need, thereby rewarding the inventor, assignee, or licensor etc. in exchange for putting that product in the public domain. The whole thing encourages innovation. That much at least is supported by title 35 in the constitution. It's the part about mandated purchase which bothers me.
I realize that many people take many patent medicines because their doctors prescribe them- with little volition involved. Still the purchase is not mandated- I guess that's the bright line here.

Look, I have no moral qualms about the particular drug here. I just object to the business model and precedent as highly suspect. It's on par with defense contracting. Just because some here think $350 is "reasonable" doesn't mean that every parent in Texas will or even should. Also, suppose the "cost" was $3,500 per person- would anybody here balk at that? What forces exist to drive this down?

I'll give another example: the state of California (where I live) just mandated dental exams for every school age child (I found out about this from my hygenist who has been approached to provide pro bono exams for children/parents unable to afford it). This, I believe is the correct way to go about these things- why not expect it from a company like Merck?

reality check said...

Having a patent (a limited monopoly) is its own economic reward. It is not supposed to be further abused by having a legally mandated demand for your product. You are still supposed to operate in a free market of informed consumers.

And again, I think the economists would still say that patent or not, you should still be pricing at marginal cost in order to maximize profit.

The only reason they can price at $350 is not because they have a monopoly, but because they have a legally mandated demand.

If it was a free market of informed consumers with elastic demand than they would not be able to price at $350 -- it would drive demand to zero regardless of their patent.

If you have a legally mandated demand creating an inelastic demand AND a monopoly then you should definitely not be engaging in price gouging. That is just an abuse of the public.

reality check said...

Let me refine that.

They have gotten the government to grant them:

a) monopoly with no competitors
b) taxpayer/stockholder/company subsidies of their product
c) inelastic market and forced demand by making the vaccine mandatory

This is what lets them charge $350 for the vaccine.

The phrase for this is not "health program" but "government corruption, fraud, and abuse."

ploopusgirl said...

Oh, reality check, how in check with reality you are. You think that demand for this vaccine would drop to zero without a mandate? Despite your stubborn argument that not everyone would find $350 an acceptable cost for potentially preventing cervical cancer (which, good luck developing that, you know how much chemo costs? and I think you may have to purchase yourself more than three doses of that), pretty sure there are just as many parents that would scrape up a few extra dollars to invest in such a vaccine for their daughter. What's most laughable, however, is how little you understand the way drug development and patenting works, and how much you seem to think you're an expert on the matter. Are you in any way aware of how much it costs to create a drug? How many trials have to be conducted to gain FDA approval? $350/dose is nothing, especially for something that (except for in the Althouse blog) would be a relatively popular purchase (if they wanted to gouge, they could charge $1000/dose because alot of people would still find that a worthy investment). Angiomax, an anticoagulant used pretty much in special situations only when people are allergic to heparin (that is to say, rarely), costs $2500/dose.. without mandated use, just to put your out-there view on what is and isn't expensive into perspective. Of course, should the vaccine become mandated, it would likely become formulary on most insurances, allowing you to pay a $40 copay, which I'm sure you'd find ridiculously expensive as well.

Also, I'm unsure how the government granting approval of this vaccine is equivalent to government handing them a monopoly without competition. Merck happens to be the first drug company to come along and develop an HPV vaccine; I'm not sure how this is the government's fault? Should they wait until Glaxo comes out with their $1200/dose HPV vaccine before granting approval to either?

I repeat, I hope your daughter doesn't grow up, contract HPV and develop cervical cancer; it'd suck to have to be the one to tell her her daddy put a [pretty fucking cheap] price tag on reducing her risk for that in the name of standing up against the evil Merck empire.

reality check said...

ploopusgirl, the question I was addressing was over how an economist might view it.

So when I wrote demand would drop to zero, I didn't mean literally to absolute zero.

But if you had informed consumers that knew the background of the vaccine, and its alternatives, and were told they might wait until the Glaxo vaccine came out, and/or maybe do nothing apart from recommending to their kids they get annual pap smears, than yeah, my guess is demand at $350 would drop way off.

The government monopoly comes from the "patent" clause in our constitution, Article 1, Clause 8, " To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;"

I am sorry you don't like me ploopusgirl, sorry too that an ability to argue the facts that have been presented here and not the emotion eludes you. (authoritarian ignorant dingbat.)

ploopusgirl said...

Reality check.. wtf?

First off, I understand the concept of a patent, believe me. This is why drug companies are able to make any money off of their expensive drugs, because they're given a window of about 7 or 8 years before generic warehouses are able to make a generic version of the SAME drug for a lot less money because the generic companies only have to copy the original companies' recipe; the generic company does NOT have to put in the millions of dollars in clinical trials and evaluations to prove efficacy to the FDA like the original company does. A drug patent ensures a window in which no one besides the original developer of the particular chemical in question cannot be replicated exactly; a drug patent does NOT, however, ensure that another company can't come along 10 days later with a newer, cheaper drug (different chemical) that is in the same chemical class and does the exact same damn thing (and maybe better). Once again you've demonstrated that you do not understand the process.

Annual pap smears would also cost money, and in your world of non-existant health insurance, the yearly pap smear alone would probably be at least $350 dollars. That is before you go to your 10th annual pap smear only to be informed that you do in fact have HPV, and it's developed into cervical cancer. At this point, you've done what? Found out that you have a disease? Found out that now you're in real deep shit because between the office visits and chemo (along with the anti-emetic therapy [that'll be $4000/month for your Zofran) and antidepressant [$100/month for your Zoloft] you'll need to deal with this emotional trauma) you're going to be spending well over the $1050 dollars total you could have spent to avoid this whole thing? The point in mandating it is that it's a vaccine, and as such it doesn't work once you've contracted the damn virus. Fifteen year old girls (and as much as I hate to agree with DTL, but he did say this earlier) are not going to stop and think about how they should go out and get an HPV vaccine before they start having sex for the most part. The only way to ensure that the full efficacy of the vaccine is employed is to regulate its use.

I'm sorry you don't like me either (also, I apologize for being an ignorant dingbat apparently), but I don't understand your complete and utter disregard for a potentially life-saving and ultimately cost-effective idea.

downtownlad said...

I am small L Libertarian. The government should only get involved in things where it makes sense - and where the free market will just not work.

Anti-trust laws fall into that category. So does the military. So does the police and fire department. And so do vaccination programs. Their cost/benefit analysis has been clearly marked out by economists.

Considering the fact that 50% of health care costs in this country are picked up by the government - damned right if I'm going to use the power of the government to try to mandate that people get vaccinated (with opt-out of course). Because it will lower the amount of money that the government spends.

And the main goal of being a libertarian is to lower my tax bill. And more freedom of course.

I fail to see how childhood vaccinations infringe on my liberty. Either the government is going to force a kid to get a shot or the parents will. The kid (whose liberty we're really talking about) gets zero choice either way.

chickenlittle said...

Though you directed you ire to Reality Check, you’ve managed to piss me off too.

Once upon a time, big Pharma did discover all their new stuff in house. But then two things happened: direct advertising to consumers and combinatorial chemistry.
I’ll leave the former topic to others-suffice it to say that it is a voracious money sucker. No wucking funder that Pfizers’s latest round of layoffs hit marketing the hardest (there’s hope yet)
CombiChem, which hit the scene in the 1990s, was such a marvelous temptation (imagine getting rich without really having to think) that companies invested billions (collectively trillions) in its promise. Well, after more than decade, the promise came up well short. We needn’t argue that. Here’s a link that’s a few years old. The situation is even worse now: http://pubs.acs.org/cen/employment/8218/8218employment.html

Nowadays, companies like Merck try to buy their next blockbusters (Zithromax anyone?) The new business model involves small independent start ups,who lack Superbowl advertising budgets, but who are willing to bust their asses to invent something (or die trying). Their biggest hope is to be bought. They might skimp on their IP by hiring a patent agent instead of an attorney to draft their claims (I hope that doesn’t hit you personally).

You see two can play your game.

ploopusgirl said...

Um.. chickenlittle, is that directed at me? ..because if so, once again, wtf? I was unaware that knowing what a patent is was playing a game; some childhood you must've had if that's your idea of a game. Frankly, I have no idea what your neverending post even means. Some drug companies are big and are mean to the little companies? Yes, that's true sometimes.. What's your point? That doesn't change the fact that a $350 drug nowadays is nowhere near as "gouging" as reality check thinks it is, and in the scheme of things (considering all the money you save indirectly by, you know, not developing cervical cancer), a pretty damn good investment.

I'm not sure what part of my explaining how a drug patent works angered you so much, unless of course you've discovered a drug for a small drug company only to have it sold to Merck? If this is the small company's dream then what the hell is the problem?

I'm not sure why you think combinatorial chemistry is leaps and bounds cheaper than "true" drug development either; combinatorial or not, the company has to pay for the chemicals to "combine" and play with, and the personnel to do this, and the lab to do it in. They still have to pay for hundreds of clinical trials to have the drug approved by the FDA.

I'm totally confused as to what the hell you mean about marketing. Drug companies are unfair because they have to spend money to market their products so that prescribers will know about them and write prescriptions for them? How else would anyone know about the product? Since when do doctor's agree to write any old prescription for a patient because the patient really wants it because they saw it on TV? ("Hi I piss a lot, I know I don't have prostatic enlargement, but give me Flomax anyways" - "oh okay").

Lastly, Zithromax wasn't purchased by Merck. So I'm not sure where that comes from. It was purchased by Pfizer from another company that discovered it (not sure which one), but I again don't see the problem? Pfizer still had to pay to run the American clinical trials proving its safety and efficacy to gain approval, regardless of whether they physically discovered it or not. I do hope that you refuse to get your Zithromax filled the next time you're sick and your doctor writes you a presription for it, though, because you'd be an enormous fucking hypocrite if you put money into the big money company you hate so much for.. purchasing a drug with its own money..?

Bruce Hayden said...

One problem with a mandatory government program is that the government would essentially be committing assault on these girls - except arguably for the presence of the opt-out provision.

As to patents, technically a patent does nothing for the patent owner directly. It doesn't let you legally produce the patented article, but rather is a negative grant: it can be used to prevent others from making, using, selling, or importing the invention. And that is what the drug companies do with patents: they use patents to prevent potential competitors from making, using, selling, or importing.

My complaint is that Merck has talked Texas into forcing most of the school aged girls there to have the vaccine, at taxpayer expense.

And lest you think that this is a Texas problem, the company is trying to do the same in other states across the nation. Indeed, I read today about the CO legislature being pushed into something very similar - and the State House is now controlled by the Democrats (so it isn't a part issue).

ploopusgirl said...

Bruce Hayden, thank you for your expert patent incite (see www.softpats.com for more!); I already explained how a drug patent works though, so I'm not sure why your (less informative) comment is necessary.

How in hell is requiring a vaccine equate assault? Could you please explain that completely overblown statement to me (in like 4 words or less, if possible)? So we're committing assault on our children when we.. incubate them if they're primis? when we... vaccinate them for polio, rubella, measles, tetanus..? I don't think I've ever read anything more asinine in my life. Also, I do apologize that trying to prevent cervical cancer will take your cherished Aspen ski getaway money from your paycheck in taxes, but it seems like a worthy enough cause. I suppose taxing you to support the president's vacations home in Texas is a more appropriate use of your hard earned tax dollars.

Finally, would it kill you to type out the word Colorado?

Pogo said...

ploopusgirl, you missed my point about the "idealistic few".

It is the use of force, by state coercion, that the ideals of a few become an evil done in the name of good.

The desire to control other people's lives is a common one among the left. I think it's evil, that's all. The health issues aren't the debate, but rather the use of force to compel one side of the debate. You seem to think mandatory vaccinations for a rare disease are "a worthy enough cause". But I find that argument rather weak, and remain pro-choice.

RogerA said...

Sorry I am late to the party. One question for the group: Can't parents opt out because of religious objections to any vaccination? Yes, there are consequences such as being excluded from public schools for not having the state approved vaccinations, but parents, as I understand it can still opt out. True?