Monday, November 23, 2015

American Hysteria and Syrian Refugees

About 75 Syrian refugees have settled in the state of New Jersey since last January. Now, Governor Chris Christie won't admit any more--"no, not even orphans under the age of five!"
Because you know these people. They might grow up to be terrorists, and some of them won't grow up to be Christians.
I have nothing but shame for my citizenship, and incidents like this make me think hard about whether I'll keep it. 
75 refugees pose a danger? Because we're all scared of what happened in Paris? Governor Christie, the German city of Passau is taking in 75 refugees every fifteen minutes. We've got around 500 in the neighborhood I live in--30 or 40 new ones come daily--and several hundred more near the university where I work. They are cold, scared, hungry people, many of them young men who did not wish to be pawns in this Pyrrhic war that will end in annihilation. 
Why does America rush to repeat its awful isolationist past? From before the hint of a republic, with the Salem witch trials, we had periods of mass hysteria during which the blame game destroyed lives. The Japanese internment camps. The Joe McCarthy Years. The 9/11 panic that destroyed, and continues to destroy, Arab-Americans. Donald Trump. The excuse has always been national security, and the reality has always been that panicky measures produced far worse situations than the inciting incident ever did.  In all of these situations, hatred united people. Nothing is easier than to unite a group in hatred of an enemy, and politicians who succeed in doing this, the demagogues of the world, rise and fall like shooting stars. The rare politician manages to unite a group in shared love, a far more difficult task, love usually uncovering vulnerability as well as strength.
 When will we get another politician who inspires people to understand that the only thing we have to fear is fear itself? When will the Statue of Liberty lift her lamp beside the golden door again? Why is Mad Magazine still one of the most realistic commentators on the American attitude toward the refugee crisis:

Give me your tired, your poor, your huddled masses yearning to be free,
And we'll send 'em right back
We'll send 'em right back
We'll send 'em right back to you.

When panic and racism overcome optimism and pragmatism--when America loses her foundational goal of being the city on the hill, that the eyes of the world may be upon us, then there is no more American dream. President Obama protests "this is not who we are," but until he can stop the fearmongers, Americans are indeed the bad guys. When a country that fits into the State of Texas and feed, clothe, and offer education to thousands pouring in while the world superpower sucks its thumb and pleads security issues, my world ends, and any faith I still had in the United States.

Friday, November 20, 2015

Paris Is For Friends

The moment I heard about the attacks, I felt cold, and I haven't warmed up since. My sixteen-year- old son spent a day in Paris a few weeks ago.
"Mom, if it makes you feel better, we weren't anywhere near the eleventh arrondissement." 
I feel no better knowing that he was nowhere near the site of the attacks.  But I'm not going to change my life, and if I were invited to Paris tomorrow, I'd go. 
During a moment of silence  at a local school for the victims of the Paris attacks, a ten-year-old boy yelled, "Allah is greater!"
He's supposedly not a bad kid and allegedly not much of a student. He's a kid who gets into trouble and who needs support. Police arrived. Questioning took place. Piles of paperwork needed to be filled out.
These are the kids who get approached by terrorist networks. These are the kids whose vulnerability to promises of a paradise filled with gorgeous virgins makes them down cocaine or psychoactive pills that release inhibition and increase aggression--firing a gun becomes easy.
A boy who doesn't do well in school? A girl whose classmates make fun of her? A brilliant teenager who's unsure about "everything?"
What could feel more reassuring than absolute certainty, unity in hatred? 
But how to find these children and help them to know that life with all its oddities, its disappointments, its bad jokes, is the thing worth having?

I have my mantras for these times:

(1) Keep them talking

(2) Being full of fear, and making decisions because of fear, will get you nothing.

(3) The worst returns to laughter. Watch out for a humorless person. 

(4) Be brave, and never lose hope.

 Paris is for those who love her--Paris deserves her friends. Paris is not for those who want to incinerate her for her secular palaces. Paris deserves all of our support today.

Friday, November 13, 2015

Gardasil Concerns, Part Two: A Conversation with Dr. Ian Hector Frazer, Developer of the HPV Vaccine

Dear Readers, I believe in going to the very top with the tough questions, so I wrote with no hope of an answer to the physician who developed the HPV vaccine, Dr. Ian Hector Frazer, Professor of Medicine, of the University of Queensland, Australia, and Chairman of the Board of the Translational Research Institute. He wrote back right away, answering my questions thoroughly. Here is our e-conversation of November 12, 2015:

The Critical Mom:  I write as a lay person trying to assess the risks of HPV vaccine for my
eleven year old daughter. I've already read the CDC page and the Merck pages, and of course discussed the vaccine with our pediatrician, who tells me his daughter has been vaccinated, but I can't ignore the reports of adverse reactions from a number of young women, even though the CDC seems to think there's no pattern to them and that they therefore remain insignificant. I also wonder why, when only 1% of women in the developed world are affected, I'd want to assume that my daughter is at risk.

I pasted in my blog post of November 10, 2015 with the remarks of Dr. Diane Harper. 
Dr. Frazer: Most of what Dr Harper writes in response to your questions is true.  However,  unfortunately,  12,000 women continue to die of cervical cancer in the USA each year where PAP smear screening is supposedly routine. 




While only 1% of women infected with HPV will develop cervical cancer, more than half of all sexually active woman (even those in a monogamous relationship with only one partner ever) will become infected with a cancer causing HPV virus.  PAP screening is not a perfect test, (50% of precancers are missed  on any one PAP sampling) and it therefore only works to reduce the risk of cervical cancer  if a pap is done regular every 2-3 years - even then, some women have disease that progresses from undetectable to invasive cancer within 2 years.

In Australia where about 80% of girls have been vaccinated over the last 10 years there  has been a dramatic reduction in abnormal pap smears (yes we still do them,  because Gardasil 4 only prevents about 70% of cervical cancers - those due to HPV16 and HPV18 - this will be less of an issue with Gardasil 9 which covers over 90%).  
However from next year we’re  going to test for the viruses that cause cervical cancer, rather than looking for cancer cells, and testing will be done less   frequently because the virus test catches cancer causing infections earlier than the pap smear test.   

The HPV vaccines have proven safe - the US and European regulatory authorities have stated that there are no long term problems attributable to the vaccine - just sore arms for a day or two in a small number of girls and boys, and a 1 in a million chance of an allergic reaction (that's the same odds as for all the other vaccines your daughter would be likely to have had as a baby).  
See for example this recent report from Europe that two diseases that have been said to be associated with the vaccine are not.

Another incentive to vaccinate is prevention of genital warts, not lethal, but common, difficult to treat, and can be passed from mother to baby to cause a rare but distressing and sometimes lethal disease in the child. 

In Australia genital warts and abnormal pap smears in young women  are now occurring at less than 10% of the rate that was observed prior to the introduction of routine vaccination of girls in 2007 – modelling predicts that with universal vaccination the infection will eventually be eradicated from the community altogether (maybe in 50 years).
In the meantime, personal protection through vaccination is effective at reducing the risk of cancer, and safe.   

It's also worth pointing out that  the studies in Australia have shown the greatest benefit has been in girls vaccinated at age 12 – those vaccinated at age 14 or older have had significantly less reduction in disease.  The most likely reason for this is that by age 14 a significant number of girls have had contact with the papillomavirus (contact does not need to be penetrative sexual intercourse – other forms of genital contact are sufficient to spread the virus).   The median (average) age of first sexual contact for girls  in most countries in the developed world is between 14 and  15. 

The Critical Mom:  I have a pap smear every year--actually my doctor recommends every year. Why isn't a yearly pap test enough? You mentioned "every 2-3 years."


Dr. Frazer: The recommendation in Australia is that unless you have had an abnormal pap in the past you should have the test every two years.  In Australia this strategy works as Gabrielle Medley did a chase back on all women over a period of years who had developed cervical cancer in Australia, and found that each of  the women who had had cervical cancer had not had smears according to the schedule, or had had the smear but had had no treatment for an abnormal one. . I.e the women who followed the pap smear schedule and had treatment for an abnormal smear when it was found did not get cancer.  Unfortunately like the US we still have deaths from cervical cancer because only 50% of women follow the PAP smear protocol. 


The Critical Mom: If so very few women develop dangerous cancers when so many are infected, and when so many infections seem to clear by themselves, how wise can it be it to vaccinate when the person might never be in danger to begin with?



Dr. Frazer: No one has died as a result of the vaccine (with 80 million women immunised world wide), whereas 12,000 women die of cervical cancer each year in the US and 250,000 worldwide, and 70% of those deaths would be avoided by prior vaccination.   So I’d suggest that the risk without vaccination is much greater that any perceived risk with vaccination. 



The Critical Mom: The vaccination is said to be painful. Is that not in itself possibly a bad sign?



Dr. Frazer: Its a sign that your immune system is reacting to the vaccine – your immune system needs a kick start to make a new immune response, and the sore arm is the physical manifestation of the kick start that the vaccine gives. This occurs with all vaccines. However, we don’t remember the pain of a vaccine that was given when we were 2 years old (fortunately)!


If you doubt the virtues of vaccination, you might want to  look at a graveyard that was in use in the 19th century and count the number of children under 10 who died of infectious diseases that we now vaccinate against like measles, chickenpox, diphtheria, tetanus, whooping cough. 



This gives me plenty to think about. Point by point:

Girls, get your pap test! Every year! Here in Northwestern Germany, my gynecologist recommends a yearly exam and pap smear.

No one has died as a result of the vaccine (with 80 million women immunised world wide)
 
 • According to a group known as the National Vaccine Information Center--whose beliefs are generally rejected by the medical profession--deaths have occurred as a reaction to the vaccine. Wikipedia identifies the group as a "public charity" and an "anti-vaccination advocacy group."
Be aware, readers, that by quoting their opinions I'm giving equal time  to the highly respected Dr. Frazer and to a group that is considered by many physicians to be the lunatic fringe. This group disputes not just the HPV vaccine but many vaccines; some doctors associated with them are against all vaccines. Some believe in a different vaccine schedule.

I don't buy the idea that all vaccines are bad and I would not need a visit to a 19th-century graveyard to convince me that many children died of diseases now prevented by the standard childhood vaccines. 

 The website publishes the claim that the following girls and women died or were disabled after receiving an HPV vaccine: 

Even if I remain uncertain about the reality behind these stories, I'm still bothered by two things: 
(1) The rate of reported  adverse reactions to HPV vaccines seems higher than the rate of reported adverse reactions to any other vaccine.

(2) Why should there be "a pattern" to reactions in order to consider them legitimately reactions to the vaccine?  You can go on the Snopes.com discussion of the vaccine and find an explanation, the gist of which is: a man gets a vaccine, happens to hit his vaccinated arm with a hammer the same day, and complains of an adverse reaction in that arm.

If only it were that simple. Are all these reactions really something that science can measure? To say yes means to assume that there must be a pattern to a reaction. 

Doctors and concerned citizens, continue to weigh in. I'm a tough customer. Before I consider this vaccine for my daughter, I'm going to be damn sure I think she'll be helped, not hindered, by it. 

Tuesday, November 10, 2015

Guard Against Gardasil: The Critical Mom's Research

If you are the mother of a nine-to-twelve year old girl, your pediatrician is sure to recommend the Gardasil or the Cervarix shot for HPV--human papillomavirus, otherwise known as the cause of genital warts, a condition that can (but does not usually) lead to deadly cervical cancers. The only surefire way to avoid HPV, which the vast majority of the population has, or will have, is never to touch another person's genitals. 
But the alternative to these infections--there are many types of HPV, and in most cases they clear up by themselves--is the shot.  Is the shot safe?

When I Googled the virus and the vaccines, the name Diane Medved Harper appeared repeatedly, because Dr. Harper, now at the University of Louisville, was one of the physicians employed by Merck to evaluate the vaccine and to run clinical trials. You can read about her here and here.

But I decided to write to her myself, and she very kindly wrote back, and since she had no objection to my sharing our correspondence of November 5, 2015 with my pediatrician, I am also sharing it with my readers.

The Critical Mom: How wise is it to give a vaccine for a condition that may never develop? (If I am correct in assuming that only 10% of infected people develop cancer, that is).

Dr. Harper: Only 5% of infections develop CIN 3 lesions (precancer).  Of the CIN 3 lesions, only 20% become cancer within 5 years, and only 40% become cancer within 30 years -- so less than 1% of HPV infections become cancer after a very long period of time.   How wise it is is a judgement that only you can make:  it weighs the knowledge that you have a screening system in place to detect the CIN 3 precancer and then treat it. Our treatments are nearly 100% effective (LLETZ, usually).  HPV4 or HPV9 only protect against about 47% of the CIN 3 lesions regardless of HPV type;  HPV2 protects against 93% of CIN 3 lesions regardless of HPV type.  Neither prevents all CIN 3, so screening is still necessary.  HPV2 lasts at least 9.4 years.  HPV4 lasts at least 5 years.  HPV9 lasts at least 3.5 years. ​Screening has few side effects -- the worst side effect is being told you were positive for HPV 16 and going to colposcopy and having a biopsy and having the results of the biopsy be normal. You can see the Gardasil Girls videos on the internet.​

The Critical Mom: Would you give your daughter this vaccine? (Side effects reported by parents on forums do seem worse than those reported for the standard childhood vaccinations).

Dr. Harper:  I would give her the option of choosing whether she wanted it -- but I would suggest that she wait until she was at least 16 years, and maybe even 18 years if she had not yet begun any interest in any sexual activity.​

The Critical Mom:  Isn't a yearly pap test enough after my daughter becomes sexually active? My kids know all about condoms and barrier protection and seem like responsible people. 

Dr. Harper: Yes, screening is enough.  And screening has moved to every 3-5 years depending on whether your doctor uses HPV genotyping as a screen.

The Critical Mom:  Is family history important? (We have no family history of uterine cancer--that is, my mother, my aunt, my grandmother, my husband's mother, never came down with it).

Dr. Harper:  No -- this is an infection that is transmitted by skin to skin contact -- not hereditary​.

The Critical Mom: Is it important, in making a decision, to note that more side effects for Gardasil appear to be reported on the Merck website than are listed for standard vaccines like those for polio and diphtheria?

Dr. Harper: I would think that you would want to consider all possible side effects. I would also think that you should want to know whether one vaccine offered better protection and fewer side effects.  In my opinion I believe that HPV2 is superior.​

The Critical Mom: On a related subject: Ana├»s Nin, the diarist, died of cancer of the vagina. As she detailed in her writings, she had sex four times a day with four different partners for a number of months.  A Gardasil vaccine might have been good for her--but when I read around on the net, and listen to some genuinely alarmist videos, like this and this, I wonder if the vaccine is predicated on the assumption that most girls will pursue sexual activity at the same rate that Nin did.

Dr. Harper: Yes, the adolescent pediatricians promoting the vaccine see only the segment of the adolescent population who indeed are having sex at Nin's frequency.  The vaccine may not have helped her as HPV infections causing vaginal cancer are not necessarily covered by HPV4 or HPV9.​
  
I am very glad to have Dr. Harper's opinions and for the time being have decided not have my daughter vaccinated. Folks with a history of cervical cancer in their families may well feel differently.  I have watched a number of videos of young women who claim that their health has been damaged by the vaccine--Gardasil girl videos referred to by Dr. Harper above; I've also read and seen video accounts that discredit the girls, or that claim no distinct pattern has emerged explaining the girls' idiosyncratic reactions: the implication is that the girls who got sick were already sick, or that their reactions are too rare and unusual to worry about.

So far, I don't agree.  I've decided to continue questioning experts--I've sent an email to Dr. Marcia Angell, the professor of medicine at Harvard who was the first woman editor of the New England Journal of Medicine. Haven't heard from her yet, but hey--how many experts are going to get around to writing some obscure mom?

That is why I appreciate Dr. Harper's response--and, should you read this, Dr. Harper, know that I did forward your remarks to my pediatrician, who thanked me, then insisted that the vaccine offered significant protections, that his thirteen-year-old daughter had already had the first shot, that his wife is a gynecologist who approved it. When I asked him why a pap smear wasn't enough, he rolled his eyes. When I asked if he'd seen any of the Gardasil girls videos, he smiled and said, "Not yet."  He told me his daughter had been vaccinated. But that's not what I need to know. I need to know what percent of women are afflicted by cervical cancer, what kinds of screenings exist, and how to assess the side effects when the mothers and the medical authorities appear to differ. So, Moms, do your own research.  Since the manufacturer of the vaccine, Merck, lists significant side effects on its website, I will wait.  Compare that Merck page to the ones for polio and other standard childhood vaccines.
Personally, I'd wait on a vaccine about which so many side effects including death, continue to be reported.