Study shows no link between HPV vaccine and increased sexual activity

Big news on the sexual health front: a new longitudinal study was published yesterday in JAMA showing that young women who have received the HPV vaccine are no more likely to contract other STIs than unvaccinated women. While it is never a good idea to make generalizations about anything based on one study, this particular one seems well-designed and will hopefully lead to further study on this question. 'The Public Vaccinator' by Lance Calkin. Credit: Wellcome Library, London.

HPV causes cervical, vaginal, and anal cancer and has been connected to various head and neck carcinomas. The vaccine protects against four strains of the virus most often responsible for those cancers. To be clear: the HPV vaccine is a vaccine against cancer. Despite the potential benefits, many parents (and non-parents) fear that by giving their child the HPV vaccine, their child will feel free to engage in risky sexual behavior.

Because of this fear, HPV vaccine uptake has been abysmal in the United States. Only about half of young women and one-third of young men have received the first dose of the HPV, and even fewer have completed the three-dose series.

Looking at a sample group of women over 208,000 women aged 12-18, researchers found that young women recieved the HPV vaccine were no more likely to seek treatment for chlamydia, gonorrhea, herpes, HIV/AIDS, or syphilis than were unvaccinated women. That’s right, there was no evidence that getting the HPV vaccine increased the likelihood of being diagnosed with an STI.

Using pharmacy claims, researchers also determined that vaccinated women were more likely to use oral contraceptives. 17.9% of vaccinated women across age ranges received a prescription for hormonal birth control while 9.2% of unvaccinated women did. This could be due to a few factors: young women who intended to engage in any sexual activity were more likely to request the vaccine as well as contraceptives; the HPV vaccine was suggested by doctor during appointments for acquiring contraceptives; or parent perception of daughters’ likehood of being sexually active influenced their decision to vaccinate or seek contraceptives for their child.

There are, of course, some limitations to this study. The researchers were only able to access records, so by design they missed undiagnosed STIs, may have included STI screenings rather than diagnoses, and omits the use of non-prescription contraceptives like condoms. Researchers were also unable to use records from anonymous clinics. Researchers also could not acquire information about SES and motivations for receiving the vaccine. This study also does not look at young men in the same age range, which would give a more complete picture of how HPV vaccine impacts adolescent sexual activity.

The psychology of vaccine risk perception is fascinating. Beyond the concerns of “naturalness,” parents who are less inclined to vaccinate may feel more responsible for potential injury to their child if the injury is connected to a vaccine rather than to a disease that could have been prevented by that vaccine. A parent whose child has a seizure after the HPV vaccine may feel more responsible for that event than if the child contracts HPV. I wonder how the parents would feel if, after a decade, their child is diagnosed with an HPV-related cancer.

To an extent, I get it. I’m not a parent, but I do possess empathy and can imagine how frightening parenting must be. The world seems full of danger, and parents want to do everything in their power to keep their children safe. Sometimes not acting--not vaccinating--seems safer than risking the side effects of the vaccination or of the disease itself.

Fearing risky adolescent sexual activity also makes some sense to me. Most parents don’t want to see their child become a parent during their sophomore year of high school. Most parents don’t want their child to live with HIV or herpes.

But nearly everyone becomes sexually active at some point in their lives, and about 70% of people have their first sexual experience before age 19.  Half of sexually active men and women will have HPV. That means that means that when parents decide not to vaccinate their children, they allow their children to have a one-in-two chance of contracting HPV. And while most cases of HPV clear up on their own with no adverse effects, there are more than 33,000 cases of HPV-related cancer diagnosed each year in the United States.

No study can stand alone. We should not take the results of this study and make bold proclamations about young women’s behavior and sexual activity. I do believe, however, that this robust study provides some much-needed evidence that reducing young women’s risk of infection does not turn them into crazed sex machines making risky choices. I look forward to subsequent studies that can provide more evidence for parents to use to make informed choices.

Note: I know that women over age 18 don’t need parental permission in order to get the vaccine and may be more inclined to seek it out. But this study looked only at women under age 18, so I stuck to that age group as well.

Friday Five: Salmonella, abortion, bubonic plague, rabies, Tom Hanks

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Government shutdown, Foster Farms, and drug-resistant Salmonella

Foster Farms—a chicken processor who was the source of a Salmonella outbreak earlier this year—has been implicated in selling meat that has sickened at least 278 people in 17 states. Although the processor insists the problem is due to consumers insufficiently cooking their chicken, they have decided to revamp their procedures rather than be shut down by the USDA. This particular outbreak consists of seven strains of Salmonella, four of which are drug resistant—and due to the government shutdown, the CDC cannot properly investigate the problem and may be missing information that could reduce illness or save lives. This is a perfect example of a useful government program that should be funded regardless of politics…salmonella doesn’t care if you vote red or blue.

 

Abortion news

There’s lots going on this week regarding abortion. A woman who will have to leave the country to terminate her pregnancy since she is carrying twins who have anencephaly is highlighting Northern Ireland’s total ban on abortion. Ohio passed a budget that included three abortion restrictions, and the ACLU is suing the state, claiming the rules have nothing to do with the budget and are unconstitutional. The Nebraska Supreme Court upheld a ruling stating a pregnant foster child was not mature enough to elect to have an abortion, so she must deliver the baby and place it for adoption. Arsonists have tried to attach the Planned Parenthood in Joplin, Missouri twice in one week. Finally, some good news: California expanded access for abortions by allowing nurse practitioners, physician’s assistants, and certified nurse-midwives to perform abortions.

 

Bubonic plague may be an issue for Madagascar

Unless Madagascar gets its rat population under control, it’s likely to face a bubonic plague epidemic starting this month. That’s right, the Black Death is endemic in the island nation. Rats abound in the main prison, and the concern is that if the bacteria is introduced to those rats, the fleas they carry will be able to spread bubonic plague to inmates, employees, and visitors. And you can’t just kill rats—you have to kill the fleas, too. No word on what’s being done to avert this potential disaster.

 

Rabies vaccines are way too pricey

Fewer than 10 people have been documented as surviving full-blown rabies, but if a person who has been bitten receives the rabies vaccine before serious symptoms develop, they are likely to survive. Rabies kills about 24,000 people, mostly children, annually across Africa (approximately 26,000 die in Asia). Rabies experts at a conference this week in Dakar, Senegal suggested the best preventive measure is to tie up dogs since the post-bite treatment is cost prohibitive to most people who are bitten in Africa. The treatment requires four or five injections that cost about $13 each. Seems to me that rabies vaccine manufacturers Sanofi Pasteur and Novartis should be striking a deal with someone to lower these costs and save a huge number of lives.

 

Tom Hanks has Type 2 diabetes

During an interview with Dave Letterman, America’s favorite actor Tom Hanks announced he has Type 2 diabetes due to years of uncontrolled high blood sugar. Hanks doesn’t blame his weight fluctuations for movie roles, but says, “I think it goes back to the lifestyle I’ve been leading since I was probably seven, not 36.”  He joins the ranks of Paula Deen, Randy Jackson, Billie Jean King, Patti LaBelle, Larry King, and 25.8 million Americans. Can you imagine if Paula Deen, Larry King, and Tom Hanks did a diabetes prevention campaign? That’d be TV ratings gold.

http://www.youtube.com/watch?v=wBhZoTN2bvM

 

Friday Five: withdrawal, Amanda Bynes, gluten-free labels, vaccine rates, urgentrx

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Pulling out is surprisingly popular

A study that will be published in the September issue of Obstetrics & Gynecology shows that 31% of women aged 15-24 used withdrawal as the primary form of contraceptive at least once. The study also found that 21% of those women became pregnant, compared to 13% of women who used other methods. I was pretty outraged to learn that so many young women rely on their partners to pull out, so I consulted the Kinsey Institute site Kinsey Confidential to compare different forms of contraceptives:

Method Typical Effectiveness Theoretical Effectiveness
Withdrawal 81% 94%
Male condoms 85% 98%
Oral contraceptives 92% 99.9%
Intrauterine Device (IUD) 99% 99%
Implant 99.01% 99.01%

Whelp, turns out the much-touted condoms don’t fare much better in preventing pregnancy than withdrawal, but IUDs and implants are far better. Advocating for more extensive use of IUDs and implants would help more women learn about their effectiveness and safety, and could play a major role in reducing the number of unplanned pregnancies. (FYI: condoms protect against some STIs, so keep using them, okay?)

Now we know what’s ailing Amanda Bynes

After publicly unraveling, actress Amanda Bynes has been placed on psychiatric hold and reportedly diagnosed with schizophrenia. Schizophrenia is a debilitating yet treatable disease that can lead to delusions, hallucinations (including hearing voices and smelling odors that don’t exist), and cognitive issues, among other symptoms. I sincerely hope that her family and doctors help her find the right treatment so she can find relief from her suffering. This story is playing out all over the gossip mills, and we can learn from this: erratic behavior requires intervention. In an open letter, her former co-star Nick Cannon also taught us an important lesson about how provide compassion:

So I say to my sister Amanda Bynes you’re not alone. I’m here for you. I understand. I care and I appreciate you, because that’s what family does and that’s what family is for. I also extend this to anyone else in my life, past or present that may find themselves in hard times. I’m here! Call me! Because I truly believe, the hand you’re helping up today may be the one you’re reaching for tomorrow.

Side note: take a look at this fantastic Atlantic article with Dr. Christine Montross titled “How well do we really understand mental illness?” for more insight into the hows and whys of treating severe mental illness.

Gluten-free labels, now with accuracy!

People with celiac disease, those with gluten sensitivity/intolerance, and dieters can all rejoice because this week, the FDA standardized the label “gluten-free.” The limit is 20 ppm, the lowest amount of gluten detectable in a food product. Foods such as fresh fruit and eggs can carry the label “gluten free” because they naturally contain no gluten. Regulations like this help consumers make informed choices. Considering more than two million Americans cannot digest gluten, having consistent, effective labels is the right thing to do for their health.

State-by-state vaccine rates tell us about exemptions

Each year, the CDC analyzes vaccine rates among the 50 states, Washington DC, five cities, and eight other US jurisdictions that receive federal funding for immunizations. This year, Mississippi topped the list, with 99.9% of kindergarteners receiving full doses of MMR, DTaP, and varicella (chicken pox). Overall, median exemption rate for the country was 1.8%; Oregon had the highest, with 6.5% of kindergarteners not meeting the vaccine standards. Interestingly, Mississippi does not allow religious or philosophical exemptions for immunizations. Removing religious and philosophical exemptions altogether wouldn’t be appropriate, but perhaps the success Mississippi has with getting children vaccinated will spark a conversation about strengthening the requirements for getting an exemption.

UrgentRx: alleviating upset stomachs, potentially saving lives

Forbes just published its list of what it deems the 25 most innovative consumer and retail brands of the year. An over-the-counter medication company, UrgentRx, made the cut. The company produces powders of common treatments for headaches, allergies, and digestive issues, along with plain aspirin intended for use during a heart attack. UrgentRx powders can be taken without water, meaning that you can give yourself a hit of heartburn medicines whenever you need it. The implication for potentially life-saving doses of aspirin are immense: a study in the American Journal of Cardiology, as reported by Harvard Medical School, showed that chewed aspirin worked faster against heart attacks than swallowing it whole or taking a liquid version. For a person with heart disease, carrying around a powdered dose eliminates the need to chew and provides the benefits of aspirin as quickly as possible.

Friday Five: heat, Bloomberg, Texas, heroin, ACA

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Let’s all do the heat wave! Just in case you’ve ignored the Facebook status updates, tweets, and complaints from co-workers, I want to inform you that it is Very Hot Outside. Growing up in Florida gives a person a skewed sense of the appropriate level of summertime heat and humidity, but this week has been tough even for me. In all seriousness, the heat is severe and dangerous, especially because so many people in the affected areas (map) don’t have air conditioning. So follow the heat advisory instructions: stay inside, run that AC (if you have it), drink water, and check in on seniors—they’re especially susceptible to high temperatures. And remember, we’ll all look back fondly this week while we wait for snow plows in January.

Bloomberg’s at it again But this time, he just wants New Yorkers to bypass the elevator and take the stairs instead. Mayor Bloomberg signed an executive order on Wednesday that requires all government building to be laid out using “Active Design” principles in order to promote physical activity like taking the stairs. We often talk in public health about making the healthy choice the easy choice and changing the built environment to encourage physical fitness. Bloomberg’s latest move may spark an interest in healthier buildings. Could Active Design be the new LEED certification?

You haven’t heard the whole story about Texas This was a big week for abortion controversy in Texas, and there’s already extensive coverage of what happened, so here’s some news you may have missed:

  •  You can now purchase Rick Perry voodoo dolls (cultural appropriation isn’t just for Miley Cyrus)
  • Texas Democrat Rep. Harold Dutton introduced a bill that would ban all abortion legislation until the state abolishes the death penalty.
  • The pink running shoes Wendy Davis wore during her filibuster have over 280 positive reviews on Amazon, and not all of them extol the arch support.

What did I miss?

Heroin’s popularity is growing in Northern New England In New Hampshire, the number of fatal heroin overdoses jumped from just seven in 2003 to a surprising 40 in 2012. The increase has also been observed in Vermont, with a 40% increase in heroin addiction treatment, and Maine, which had three times the heroin overdoses in 2012 as in 2011. There are a few factors that may contribute to this growing problem: increased control over prescription painkillers, the relative cheapness of heroin compared to painkillers, and because heroin can be sold at a higher price in rural areas than in urban centers, distributors are incentivized to sell more. Heroin is now taking up most of drug enforcement agents’ time in the area. Controlling infectious diseases like HIV and Hepatitis C will be the next challenge for the area’s public health community.

Curious about what’s happening next with the ACA? Kaiser Family Foundation released a new ACA video starring its charming YouToons. This one, a follow up to 2010’s “Health Reform Meets Main Street,” explains how to “Get Ready for Obamacare.” (Interesting, the change in terminology over three years!) This easy to understand breakdown of the complicated law is accessible to all audiences. Anyone talking to the public should be emulating this kind of clear communication. http://www.youtube.com/watch?v=JZkk6ueZt-U

Friday Five: sterilization, pain robot, brains, surgeons, Sharknado

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Rural women are more likely to be sterilized

Tubal ligation, also known as sterilization or “getting your tubes tied,” is far more common among rural women as compared to urban women. Of rural women, 23% said they had been sterilized; urban women, 13%. There is only speculation about why this difference exists. Some of the theories floating around are: less access to other forms of birth control; piggybacking tubal ligation onto post-partum Medicaid coverage; lower educational level. Importantly, 39% of those rural women regret their decision. We should be asking why they didn’t choose a long-term, reversible birth control such as an IUD or an implant (like Implanon) instead.

Somewhat cute robot helps reduce kids’ pain and suffering during injections

As a needle phobic myself, I was very excited to learn that there’s an innovation in helping kids’ distress during shots. The robot not only talks to the child in order to distract him or her from the scary needle, but encourages exhalation during the injection to help with muscle relaxation (video here). There are two reasons why reducing pain and anxiety for children receiving immunizations is important: excessive worry can make other parts of the exam difficult, and in the future, an adult who had a bad medical experience as a child may be more likely to avoid care. These both have significant health implications. If this robot can help, I say let’s get one in every pediatrician’s office—and maybe in internist’s offices too, for ‘fraidy cats like me.

Brain pathways involved with learning and changing behavior charted

This week the NIH published a study identifying neural pathways associated with learning and changing behavior in mice. The nerves associated with the switch from moderate to compulsive drinking were found to also have a role in learning and decision making. Researchers hope that their insights will be helpful in understanding alcoholism and addiction. Learning more about why some people can use substances in moderation while others become addicted is crucial to improving mental and physical health. Hopefully, these findings will also apply for humans.

Surgery residents operate less often under new rules

Medical residents (doctors who are done with medical school and are completing their practical training) work notoriously long shifts and even longer workweeks. Restrictions created in 2011 limited shifts to 16 hours for first-year residents and 28 hours for the more advanced doctors and everyone’s week is limited to 80 hours. Surgical residents have in turn participated in fewer hours of surgery because of the limits on working hours. Many doctors are concerned that this will put the budding surgeons at risk for not gaining enough experience. There has to be a balance between allowing doctors to get enough rest while also learning enough to practice on one’s own—the question is, how

Kathleen Sebelius may in fact have a sense of humor

Twitter blew up last night with references to Sharknado, a horribly wonderful movie about a tornado that blew sharks into a city. (I don’t know how that works, I didn’t watch it!) Buzzfeed immediately wrote an article claiming “There is no Obamacare coverage for pre-existing Sharknado injuries.” Kathleen Sebelius replied: https://twitter.com/Sebelius/status/355766513334108160 Hey, an ACA joke!

I leave you this weekend with an excellent infographic explaining pretty much everything you need to know about gender, sexual orientation, and the like…The Genderbread Person!

Genderbread-Person

Friday Five: Sarah Murnaghan, Plan B, Arizona, wildfires, mindfulness

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. The triumph of Sarah Murnaghan

Follow up from two weeks ago: Sarah Murnaghan got new lungs! After a judge ruled that she must be added to the top of the adult transplant list, Sarah was matched with organs within days. The Murnaghan family will now step out of the public eye and, as Sarah’s mother says, they will be “focusing all of [their] attention on Sarah” as she recovers from surgery. Sarah is not the only one to benefit from her family’s perseverance—11 year old Javier Acosta was also added to the list. This judicial intervention will certainly inspire ethical debate about who can get which organs, and hopefully children’s lives will be valued as much as adults’.

 

Judge Korman: New hero of reproductive rights?

After the Obama administration finally dropped its appeal of Judge Edward Korman’s ruling that all products containing levonorgestrel be made available over the counter, the administration decided to make available only Plan B One Step (containing just one pill rather than two). Korman is not happy about this. Plan B One Step is manufactured by Teva, and if it is the only emergency contraceptive authorized to be sold over the counter, Teva will be able to set its price and have no competition. Korman argues this unduly burdens low-income women and that “it is the plaintiffs, rather than Teva, who are responsible for the outcome of this case, and it is they, and the women who benefited from their efforts, who deserve to be rewarded.” Korman also makes it clear that if the FDA or Teva drag their feet on getting Plan B One Step to the drugstore shelves, they should expect to be sued again.

 

Arizona finally decides to expand Medicaid

Despite her deep opposition to the Affordable Care Act, Governor Jan Brewer now accepts that the ACA is here to stay and that Arizona should get in on the billions of dollars available to the state. Her website even touts the Medicaid expansion as “the conservative choice for Arizona.” Imagine that: after realizing that “uninsured Arizonans get sick just like the rest of us” (because uninsured people are markedly different from the insured, of course) providing them with Medicaid would help reduce the rates paid by the insured! Brewer even denies the state is participating in “ObamaCare” by crediting former (Republican) Governor Fife Symington with coming up with the idea of the expansion in the 1990s. I’m pleased that 57,000 additional Arizonans will have access to Medicaid, but Brewer can obviously see the advantages of the expansion and yet spent months rabidly fighting the ACA…what a hypocrite.

 

Wildfires? Denver Post has us covered

Multiple wildfires in Colorado are causing serious problems for the state, and the Denver Post is taking care of business when it comes to covering the fires. It’s providing maps of the perimeters of each fire, the properties damaged, and a map of all fires across the country. There are chilling before-and-after photos of neighborhoods turned to ashes. The Denver Post is doing an excellent job of keeping people informed, spotlighting the firefighters, and reminding residents of preparedness procedures without being alarmist. With two people killed and hundreds of homes burned down, the fires are a significant natural disaster, and the Denver Post will keep us all informed.

 

Mindfulness classes in high school

Central Bucks High School East will add a new subject to its curriculum: mindfulness. Using techniques from Learning to BREATHE, the school hopes to teach students to regulate their emotions, manage stress, and strengthen their ability to focus. Central Bucks East hopes the mindfulness training will help high-achieving students feel less stressed about AP classes, applying for college, and taking the SAT while the training will also be taught in a program designed for students to learn how to live independently. Acknowledging that stress hurts students (whether they are in classes about healthy interpersonal relationships or European History) shows that Central Bucks East is trying to see its students as whole people. I’m eager to see this program evaluated—will mindfulness change test scores or graduation rates?

 

Start the weekend off right with the evolution of Daft Punk and Pharrell's new song Get Lucky as it would have sounded if it was made in the past.

http://www.youtube.com/watch?v=3r3BOZ6QQtU

 

Friday Five: Transplant ethics, Planned Parenthood, Hepatitis C, immigrants, Google

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Child in dire need of lung transplants starts a debate on ethics

Ten year old Sarah Murnaghan has been waiting for lung transplants for 18 months due to her cystic fibrosis and related lung failure. Doctors say she is not likely to live past the weekend without a transplant, so the severity of her illness placed her at the top of the pediatric list. However, Sarah is on very bottom of the adult list, meaning that any adults in need of lungs will be offered the organs before her, regardless of whether or not their need is as pressing as hers. Since 2005, organs are supposed to be distributed based on need, but that rule applies only to patients over age 12. Sarah’s parents have petitioned Kathleen Sebelius to change the rules to allow pediatric transplants of adult organs based not on age but on medical necessity. Hopefully, Sarah’s dire situation will ignite a conversation on organ donation and the ethics of treating children as if they are adults. (Okay, so this is six sentences but I think it’s worth it.)

Planned Parenthood case will not be heard by the Supreme Court

Indiana tried—and failed—to refuse Medicaid funding to Planned Parenthood. The Supreme Court refused to consider an appeal on behalf of the state to allow Indiana to withhold money from Planned Parenthood because it offers abortion services, even though federal law prohibits Medicaid dollars from being spent on abortion. Hopefully, this development will stall other attacks on low-income women’s right to choose their health care providers. However, the wily anti-choice movement is probably cooking up other ways to deny services to women—Indiana already has a law in place requiring facilities that offer non-surgical abortions to meet the same standards as facilities that perform surgical abortions. The Supreme Court’s choice not to hear the appeal is important, but as usual, fighting against restrictions on this legal medical procedure is a constant battle.

Is the “war on drugs” to blame for millions of Hepatitis C cases?

The Global Commission on Drug Policy called for an end on “the war on drugs,” in part because criminalization of injection drugs has lead to a quiet epidemic of Hepatitis C. The Commission estimates that of the 16 million injecting drug users (IDUs), 10 million are living with Hepatitis C; China, the Russian Federation, and the USA have the highest rates of Hepatitis C among IDUs. Arguing that harsh drug laws dissuade IDUs away from public health efforts such as needle exchanges, the Commission recommends reforming existing drug laws and focusing on health rather than incarceration and forced treatment. While I doubt many countries will decriminalize heroin and other injectable drugs, I’m pleased the Commission is drawing attention to the broader health concerns of IDUs. Regardless of drug use or dependence, a person has a right to access public health initiatives without fearing arrest and imprisonment.

Immigrants subsidize Medicare

A study published in June’s Health Affairs showed that in 2009 naturalized and non-citizen immigrants contributed $33 billion to the Medicare trust fund and received $19 billion in expenditures, creating a surplus of $14 billion. American-born citizens, on the other hand, contributed $192 billion and used $223 billion, creating a deficit of $31 billion. There are a few reasons why immigrants’ contributions lead to surplus: there are 6.5 working immigrants for every one retired immigrant and the cost of care for immigrants is less than the cost of care for the American-born. In a time when immigration and a path to citizenship are pressing issues, focusing on the positive contributions of new residents and citizens can only help decision makers to make choices to encourage new immigration. This study reminds us that immigration is crucial to the success and longevity of the United States, and treating all immigrants with respect and dignity is non-negotiable.

Google nutrition facts and get a clear answer

This coming week, Google is launching a new search feature: type a question about nutrition facts, and it provide you with a precise answer. The screen shots look much like the results when Googling conversions from cups to liters or the definition of a word. The feature is rolling out in the United States over the next ten days, but it shown up yet in Philadelphia so I haven’t been able to give it a try myself. Having the ability to ask direct questions about the nutrient content of food helps demystify some of the complicated information about healthy eating. This is health communication done right!

If you're looking to change up your workout routine this weekend, may I suggest Prancercise?

http://www.youtube.com/watch?v=o-50GjySwew