Mailbag: Immune System Edition
Dr. J.’s vaccine post struck a nerve or two (Nerve, Artery, Vein, NOT Vein, Artery, Nerve, got it).
Our Myrmidon Wrangler DT writes in:
Hey Doc,
Great post, and it inspired me to post a big “Eff Jenny McCarthy” post on Facebook. One question, though: you write, “Ones that you don’t get (Hepatitis A, Meningococcus) are because they don’t last very long and only really work during an epidemic or walking into an endemic area.”
Why is that? How come some vaccines last for a long frikkin’ time, but others are good for only a short period? Does the immune system have the long-term memory of the Czar after a month-long 燒酒bender?
Dear DT,
That’s a great question. If we knew the answer, we’d have a vaccine against Malaria, HIV, perhaps a cancer or two, and perhaps better ones against the flu, Hep A and Meningococcus. The way a vaccine works is that a weakened virus, bacteria, or a protein or lipopolysaccharide from a virus or bacteria is introduced into the body. The body recognizes it as foreign and creates antibodies and such against it so that the next time it’s introduced, the body kills it dead.
Unfortunately, thats how it’s supposed to work on paper. For some reasons some infections lend themselves better to this strategy than others. We keep plugging away against these pathogens, and hopefully, one day, we will hit paydirt.
Operative SM writes in as well:
Some things that you haven’t mentioned that might also be important to know for the reader.
1) the vaccine was approved by the FDA based on female subjects from 16-23 and the doctors conducting the study said at the earliest the drug could be safe for 14 year olds, but this needed to be studied. Why is this a big deal, look at the age typically targeted by states to start the program (in Maine it was at 10). This only exacerbates the next issue…
2) the vaccine is for the strains of HPV that are STD’s. That is why it is right that Dr. J classifies this similarly to Hep B. But this raises the issue why do 10 year olds, whom the drug hasn’t been deemed safe for clinically, need a vaccine for something that is an STD? But, let’s say states only mandated it at 16, this still touches on the issue of the state wanting to get in on the game of sexual morality which obviously many of your readers, me included, have a big problem with. I agree that kids do stupid things as Dr. J notes, but in the game of sexual morality it should be up to the parents to decide if they want to encourage or discourage inoculation against an STD.
3) Perry apologized, but it is a rather stark example of crony capitalism and given some of his other moves that look more like plays out of Obama’s book, it should give us pause. What other moves? Medically related, it was under his watch that the DNA of all children born in Texas were catalogued without consent or knowledge to build a crime database for future rapists and criminals, all done holding hands with the federal government. Also, his use of eminent domain to build the trans Texas corridor is another. In other words, Michelle Malkin’s constant reminder of Perry’s shortfalls are worth our time (more from her site on the gardisil/crony capitalism/eminent domain issues, here, and here.
4) finally, no one is doubting Dr. J’s expertise in medicine and the claims of both Gardisil’s effectiveness and safety (the latter given the caveat from 1), but being an expert in medicine does not make one an expert in bioethics and political philosophy and because this involves the ethics of sexuality and role of the state, we have to understand it’s not about the drugs effectiveness. We must be weary of those scientists in their little pince-nez who forsake value for the sake of “progress” or “our own good.” Now, dr. j is the moral police for his little med student, but not for the rest of us, and neither is the state nor a panel of doctors and merck workers making recommendations to the state. As Jacobson puts it over at Legal Insurrection, http://legalinsurrection.com/2011/09/its-not-about-the-gardasil/.
Feel free to amend one since I haven’t looked if there have been any safety studies done since the initial FDA study that was published by the national cancer institute.
Also, one of my former students was actually in the first TV commercial that ran.
Best,
SM
Dear SM,
Thanks for writing in. Taking this point by point:
1) The FDA has approved Gardasil for females aged 9-26 for the prevention of a number of diseases associated with HPV 6, 11, 16 and 18. It is also approved for males of the same age range for similar reasons. The safety and immunogenicity of the vaccine was studied in this age range, and indeed in women up to the age of 45. The initial Phase III studies that lead to initial FDA approval was in women aged 16-23 and only to prevent cervical dysplasia/cancer. Tens of thousands of doses later more data has broadened the indications for younger individuals.
3) There were clear conflicts of interest with regard to Perry, his advisor and Merck. Texas is a big state, and if something is mandated, someone stands to make a lot of money. Dr. J.’s college Dante professor translated a book of Italian poetry. The Texas state Board of Education saw fit to include it on the reading list for high school Italian III, and Dr. J.’s teacher got a check from Texas for $250,000 in royalties every year while it was on the reading list. So your point is clear there.
2&4) These points go together. Dr. J. agrees with you regarding the mandate. This is not a necessary vaccination. Neither is Hepatitis B, by extension (though there are other ways of getting Hep B, like a transfusion, needlestick, or tattoo). These vaccinations should be at the discretion of the parents, not the state. Parental rights and rights of conscience are critical in Dr. J.’s opinion. That being said, Dr. J. has no objections to guidelines recommending them, nor does he have issue with the state offering them as part of medicaid care to those who cannot afford them for themselves. As Dr. J. said in his prior post, these vaccines should not be a deal breaker for attending public school in a given state. That would be unethical.
Dr. J. hopes this clarifies some dangling modifiers…
