February 07, 2007

The Politics of Gardasil

Every now and then an issue pops up on the radar screen that scrambles what we've come to expect as the natural political order. Mandating human papillomavirus (HPV) vaccines for eleven and twelve year old girls is that type of issue.

Here's the brief backstory: HPV is the most commonly transmitted sexual disease in the United States. According to news reports by the AP and others, some 20 million people are currently infected, and some 6.2 million people contract the infection each year. Certain strains of the virus can lead to cervical cancer which killed some 3,700 women in the U.S. last year (even though it is a disease on the decline).

Last June the FDA approved the vaccine Gardasil, hailed as a breakthrough in protecting against four strains of HPV that are responsible for 70% of cervical cancer cases. In January, Gardasil was put on the 2007 "recommended immunization schedule" issued by the American Academy of Pediatrics, American Academy of Family Physicians, and the Advisory Committee on Immunization Practices of the Center for Disease Control (CDC). As a result, certain state legislatures have begun debating bills that would make Gardasil a state-mandated vaccine.

Last Friday, Rick Perry, the conservative two-term Governor of Texas, issued an executive order requiring all sixth grade girls to receive the three-shot vaccination series (which costs about $120 per shot), though the order does allow parents to "opt out" for religious or philosophical reasons, but only if they file a written affidavit.

Perry has come under fire, not only from conservatives in Texas who argue that the vaccine will increase sexual promiscuity, but also from doctors in Texas who believe it's way too early to mandate such a new vaccine.

Others, like the editorial board of the San Antonio Express-News have taken issue with Perry's order, saying that while "the health of Texas girls is paramount, you have robbed citizens of the chance to hear the issue discussed during the normal legislative process."
But even in those states currently considering legislative action on mandating HPV vaccinations there are serious concerns and objections. Yesterday, both the Chicago Tribune and the Chicago Sun-Times editorialized against the Illinois state legislature passing a mandate right now. Even Christine Gregoire, the very liberal Governor of Washington state, said she was unwilling to go as far as Perry in issuing a mandate:

"I told the medical association that I was reticent to dictate when I think there is a lot of public education that needs to go on," Gregoire said. "To go out and start just saying everybody mandatorily has to have this is a little bit troublesome for me."

Given all this, it may or may not be surprising to note that the one organization rushing to hail Perry's decision was none other than the New York Times editorial page which wrote yesterday:

Congratulations to Texas for becoming the first state to require vaccinating young schoolgirls -- ages 11 and 12 -- against a sexually transmitted virus that causes cervical cancer and genital warts. Other states would be wise to follow the same path.

On one hand, it makes sense the New York Times would find this to be a "wise" decision, since it involves the government getting behind a policy that the Times' editorial writers obviously favor. Notice, however, the Times congratulates Texas for "for becoming the first state to require vaccinating young schoolgirls" without ever making mention of the fact it was done by executive order.

Here's another twist: the Times does mention the fact that the HPV vaccination, Gardasil, is made by Merck & Co. What they don't say is that Governor Rick Perry's former chief of staff is now a lobbyist for Merck and that the company contributed $6,000 to Perry and $38,000 to Texas state legislators last year. You can bet those are two facts that would not have escaped the NY Times editorial writers had they been opposed to Perry's decision.

Furthermore, the push for state mandates for HPV vaccinations is part of an intense lobbying effort on the part of Merck, as the Baltimore Sun reported last week:

Just a few months after federal regulators approved a vaccine against a sexually transmitted virus that causes cervical cancer, more than a dozen states - including Maryland - are considering a requirement that girls entering middle school get it.

One of the primary drivers behind the legislative push: Merck & Co., the pharmaceutical giant that manufactures Gardasil, the only vaccine for human papillomavirus, or HPV, on the market.

The vaccine is expected to reach $1 billion in sales next year, and state mandates could make Gardasil a mega-blockbuster drug within five years, with sales of more than $4 billion, according to Wall Street analysts.

Again, the point here isn't about Merck's lobbying efforts or even the merits of the policy, but rather the blinding hypocrisy of the New York Times editorial page. The Times is always willing trash big pharma or to rail against executive power when it suits its needs, and it's easy to see how the Times editorial page editors would have cast the issue if had been something they didn't agree with.

Editorial pages are supposed to have a certain point of view, but they should also be consistent, intellectually honest, and persuade through argument rather than glossing over facts they're unwilling to deal with or find politically inconvenient.
For a good example of what I'm talking about, go read this editorial("Perry's power play aside, HPV vaccination is wise thing to do") from the Austin American-Statesman. The Statesman ends up in the same place as the Times but does so in a much more balanced way that gives its readers the full scope of the issue before coming to the conclusion that however the fight over Perry's executive order comes out, "parents should have their girls vaccinated to guard against cervical cancer. And the government should make those vaccinations available to families who are uninsured or can't afford it."