Garasil Is NOT The Answer
Merck’s continued looting of state and federal public health budgets for a dangerous and unnecessary vaccine is unsustainable and has to stop.
There are better, safer, more sustainable ways to prevent and treat cervical cancer both at home and in developing countries. Safety, and ethical issues aside, as a country, we simply cannot afford the Merck solution. There are too many other critical demands for public and private health dollars.
In early 2006, when I first started writing about Gardasil, I questioned the necessity of a very expensive, possibility unsafe vaccine for a disease that was easily detected through the use of regular PAP screens and was the most treatable and curable of all cancers. According to the American Cancer Society, fewer than 4,000 lives are lost annually to cervical cancer in America. These women, precious mothers, sisters, daughters, all, could have been saved with affordable access to PAP tests. The logical answer to me was finding a way to get low income and new immigrant populations into neighborhood clinics… problem solved, women and girls did not need Gardasil.
The “500,000-Cervical Cancer Deaths” Merck touted in their marketing blitzkrieg as their HPV vaccine’s justification, referred to women in developing countries who died due to inadequate access to existing medical solutions.
Convinced that Merck’s HPV vaccine, the $400 per series Gardasil, was simply not appropriate technology for the existing threat, I also reported on the Alliance for Cervical Cancer Prevention (ACCP) work with ‘Visual Inspection with Acetic Acid (VIA) as a low cost, easily deployable, alternative to the PAP Smear.
For middle-aged women in the developing world, cervical cancer is one of the leading causes of death. Cervical cancer is almost completely preventable, if precancerous lesions are identified and treated in a timely manner. Cervical cancer screening based on cytological examination is largely unavailable in developing countries or, made available to a small, select group of women in private facilities, maternal child health sites, or family-planning clinics, missing the age groups at highest risk for precancerous lesions.
Visual inspection with acetic acid (VIA) can be used to screen women. It can be done by nurses or midwives with appropriate training. Research results show that VIA is simple, accurate, cost-effective, and acceptable to most women. Visual inspection with acetic acid (VIA) can be done with the naked eye (also called cervicoscopy or direct visual inspection [DVI]), or with low magnification (also called gynoscopy, aided VI, or VIAM). VILI, another variation of the visual inspection, known as Schiller’s test, uses Lugol’s iodine.
Various world health organizations and charities have been actively deploying VIA solutions in Latin America, Africa and India since the late 1990’s. By 2002 and 2003 promising results had been reported. For a very, low cost, (under $20) cervical cancer was being detected and treated successfully. When the BIG FOOT of Merck can crashing down, it lobbied for funds previously committed to more sustainable technologies.
Could the millions Merck wheedled from the Bill and Melissa Gates Foundation for doses of over-priced, possibly unsafe, vaccines be more effectively allocated? In my opinion — Yes!
As healthcare dollars become scarcer, all of us are going to ask, “What is sustainable? What solution will help the greatest number of people, affordably? What is the least invasive solution, with least opportunity for harmful side effects?”
When public health officials and medical practitioners start asking those hard questions, Merck’s HPV vaccine, Gardasil will not be the objective answer.
ACCP partner organizations in ongoing VIA research are: EngenderHealth ; International Agency for Research on Cancer (IARC); JHPIEGO; Pan American Health Organization (PAHO); Program for Appropriate Technology in Health (PATH)
Sources: Evaluation of visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America : this report refers to partial results from the LAMS (Latin American Screening) study
http://repositorium.sdum.uminho.pt/handle/1822/4033
Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol’s iodine (VILI) in cervical cancer screening in Kerala, India.
Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, Chithrathara K, Parkin DM, Nair MK.
International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France. sankar@iarc.fr
http://www.ncbi.nlm.nih.gov/pubmed/12845681
Cervical cancer screening in low resource settings using visual inspection with acetic acid. Carr KC, Sellors JW. Seattle University, College of Nursing, Seattle, WA 98122, USA. Kcarr@seattleu.edu
PMID: 15236713 [PubMed – indexed for MEDLINE
