Monday, October 31, 2005

Debate rages on use of cervical cancer vaccine / While almost 100% effective, some contend use condones teen sex :: sfgate

People respond to incentives

Welcome Slate readers. Note, though, that I'm not exactly "socially conservative." More of an economic libertarian. See here and here.


Officials of both companies noted that research indicates the best age to vaccinate would be just before puberty to make sure children are protected before they become sexually active.
. . .
11 percent of the doctors said they thought vaccinating against a sexually transmitted disease "may encourage risky sexual behavior in my adolescent patients."

Conservative groups say they welcome the vaccine as an important public health tool but oppose making it mandatory.
. . .
Alan Kaye, executive director of the National Cervical Cancer Coalition, likened the vaccine to wearing a seat belt.

"Just because you wear a seat belt doesn't mean you're seeking out an accident," Kaye said.
Mandating seat belts has resulted in riskier driving behavior. Mandating the vaccine can be expected to result in riskier sexual behavior. No where in the article are the dots connected between this unintended consequence of the vaccine mandate: more sex without condoms resulting in more deaths due to AIDS.

For a related discussion see: Private Choices and Public Health : The AIDS Epidemic in an Economic Perspective by Tomas Philipson and Richard A. Posner.

UPDATE: Alex Tabarrok points to work linking access to abortion and risky sex.


Scott of Hybla said...

I've often heard that seatbelts save more lives every year than number of soldiers killed in the Vietnam war. So if you view seat belt use or nonuse as an aspect of driving behavior - as I do - then you would reach the opposite result: less risky driving behavior.

I'm not ready to make conjectures about the vaccine part of yuor analogy, but I'm not going to have the seatbelts removed.

Ursula said...

Condoms don't prevent the spread of HPV anyway- that's one of the best arguments abstinence activists had against condoms, until the vaccine came along. The administration of the vaccine would presumably be accompanied by information regarding the continued necessity of prophylactics for safe sex, the same information that clinics such as Planned Parenthood are required by law to give to anyone who gets tested for STDs with them.
The solution here, as with other public health issues, is to make sure that patients are informed as to exactly what the vaccine can and can't do- not to rule out the vaccine entirely.

Jane said...

Argh- this makes me so angry.

An HPV vaccine has no rational relationship to encouraging abstinence or discouraging risky sexual behavior. Unless you are of the opinion that the more untreatable STD's out there can only help the abstinence cause.

What about non-risky sexual behavior? The CDC estimates about 80% of women have an HPV strain by the time they are fifty. Surely some of that was caught "responsibly"- say, with their husband while trying to get pregnant? Hard to do with a condom.

Men don't know they carry it and women don't get tested for it unless they have visible symptoms or an abnormal pap. The CDC even notes that most don't even know they carry it.

I got a high risk, cancerous strain from my husband- presumably non-risky sexual behavior. I didn't do anything wrong. A lot of married women get this. Why, because we don't practice "safe" sex when trying to get pregnant.

Now, I'm on my third round of biopsy's. The likelihood that I can carry a child to term lessens with each month the virus doesn't go into remission. And, I've yet to have any children so I may not get the chance now. I'm looking down the barrel of a hysterectomy far too soon.

That's because I was lucky and kept to the feminine health regime and caught it in time. If I didn't get a yearly check up, I would have the invasive killing cancer within a couple of years.

Doncha think that infertility, miscarriages from failure to carry to term, the pain of a biopsy, a hysterectomy, and/or invasive cervical cancer are sufficient reasons to protect our daughters, sisters, nieces, etc.?

John B. Chilton said...

The commenters and I share a common concern: reduction in the spread of STDs and the human suffering that accompanies them. Would mandating the vaccine do that? There's no easy answer.

Part of what we need to know is the behavioral response of those who received the vaccine whether by choice or by mandate. I suspect the number who become sexually active as a result of the vaccine would be quite small - contrary to the concerns of religious conservatives.

But what of changes in behavior amongst those who are sexually active, such as the number of sex partners?

Making the vaccine universally required may wipe out one sexually transmitted disease, but this benefit cannot be considered in isolation from the spread of other STDs.