Wednesday, January 31, 2007

Do Christians really want women to die?

ArchPundit reads WorldNetDaily so I don't have to. Today, he linked to a column written by nutjob Jill Stanek, who in turn wrote about how horrible the HPV vaccine is. I'm almost starting to think that conservative Christians want there to be horrible consequences for sex, because it makes it dangerous. Stanek says:

Aside from the fact Winokur has no business telling other people's children about "precautions" to avoid pitfalls of promiscuous sex, her advice stinks. Let's not address the real cause. Let's try to avoid the ramifications of the cause.

Winokur or People magazine are fueling the exploitation and health demise of women by refusing to acknowledge the only full-proof [sic] way to avoid HPV or cervical cancer: abstinence.

Let's ignore the fact that she calls any sex before marriage "promiscuous." No, Jill, actually, that's not the only full-proof way to avoid HPV. Twenty percent of women are forced to have sex before they reach their twenties. So I guess you have to add "not getting raped" to that list of "full-proof" (dumbass) ways to avoid HPV.

Fig has pointed out that HPV can live on surfaces for a short while. It's possible to infect yourself by touching an HPV-laden surface, and then touching yourself. So we also have to add "not touching things" to the list of foolproof ways to avoid HPV.

Then Stanek gets into full-self-righteous mode and gets all judgmental on the slutties:

There is only one good reason a virtuous young woman should consider getting the HPV vaccination. That is if the man she plans to marry has had sex with other women, meaning he could be infected with HPV or an array of other STDs. I don't know why a virtuous young woman would want to marry such a man, but there you go.

Seriously, Stanek has absolutely no idea why a woman would want to marry a man who has had sex? "I love you and want to spend the rest of my life with you. What, you're not a virgin? Get lost, tramp!" Is this really what goes through the mind of conservative Christians? Fewer than 10% of Americans are virgins when they get married. So when a woman meets a guy, she has a roughly 90% chance of picking one that has had sex at some point in his life. Those really aren't such great odds when we're talking about a disease that's (a) incredibly common, (b) easy to catch, (c) easy to prevent, and (d) can kill you.

UPDATE: Stanek shows up in the comments and largely apologizes for her attitude towards non-virgins at the end. What she doesn't mention is that many thousands of women are exposed to this virus, even though they do everything "right." This is a simple way to protect a woman from a virus that she is very likely to be exposed to during her life, possibly even against her will. Remember, even, that the adultery rate in American marriage is roughly 40%.

Sunday, January 28, 2007

Doughnuts and people-watching

(This was originally written while I was away for Christmas. I'm only now getting around to posting it. Yes, I really am that lazy.)

I have a couple of hours here in Chicago's Union Station. So I'm killing time sitting in the food court with a cup of coffee and my first-ever Krispy Kreme doughnut. (Not bad, but over-hyped.)

There's a restaurant right next to my seat with an older Asian man and a younger Asian woman hawking their food in broken English. "Yummy, yummy, right here" is his line and he's been repeating it every thirty seconds for the past hour. "You try sample" is her cry to the passers-by, along with a proffered toothpick topped with some sort of meat.

I just watched a guy walk up and order an egg roll and something else that I don't know what it is because he only pointed to it. The name of the restaurant? Kelly's Cajun Grill. Now that's fusion cuisine.

Monday, January 22, 2007

Aren't you tired of all this HPV talk by now?

(This was written while I was traveling recently. I'm only now posting it.)

Matt brings up the issue of the HPV vaccine. (As always, the good discussions happen while I'm out of town.) There seems to be a sentiment among many of the commenters there that the vaccine should not be required to attend school, and I'm not sure I disagree. I am, however, confused about why any parent would not want their daughter to have this vaccine. So I'm trying to think of likely reasons.

  1. Cost. The virus costs approximately $350. As a potentially life-saving measure, it's cheap at the price. I suppose for those genuinely just squeaking by, the cost might be prohibitive. For any middle-class family, the cost shouldn't be a significant issue.
  2. Anti-vaccination hysteria. As Orac has long pointed out, there is a small, but very vocal, contingent of people crowing about how dangerous vaccines are. Usually, it is that the MMR vaccine causes autism. First it was mercury, and when that was shown not to be true, the cause is unnamed "toxins" in the vaccine. So there are probably a number of people averse to one of "Big Pharma's" treatments. Unfortunately, it's irrational behavior like this that has caused a recent surge in dangerous, yet preventable, diseases like measles.
  3. A desire to avoid a perceived risk. I guess this is the reason I can understand the best. The vaccine is new, and that makes people uncomfortable. As I understand it, the vaccine is extremely safe -- to the point where no serious reactions were reported in the clinical trials for Gardasil.
  4. Treating an STD. This is what I think is behind pretty much all the controversy about this vaccine, and it is the reason that distresses me the most. HPV is largely a sexually transmitted disease, and it seems that conservative Christians are opposed to it because it will remove one of the Lord's punishments for slutty women. This was abundantly clear when they were proclaiming how HIV/AIDS was God's punishment for gay men and His cure for homosexuality. As Michelle Goldberg pointed out in her book, Kingdom Coming: The Rise of Christian Nationalism, some abstinence-only proponents have made it clear that preventing unwanted pregnancy and STD's are not the goal of their movement, but rather their goal is preventing people from sinning by having premarital sex. I really do think that if this vaccine treated eyeball cancer rather than a cancer of the naughty parts, it wouldn't be even slightly controversial.

So let me point out that HPV:

  • causes cervical cancer, the second most common cancer among women, worldwide (cervical cancer used to be the leading cause of death for women in the United States)
  • causes anal cancer (while that may make you snigger, it is important for gay men to know; a man who has sex with men is five times more likely to get anal cancer than a woman is to get cervical cancer)
  • causes penile cancer (fortunately rare)
  • causes genital warts
  • can be spread by sexual contact (by the time they reach college, one in five women have been forced to have sex)
  • can even be spread by casual contact

In a private email to me (and I hope she will forgive me for sharing this here), Fig wrote:

I think Merck made a HUGE marketing error. What they should have said was:

Hey, guys - did you know that this year alone 1500 men will get penis cancer? It looks like this [horrible yucky picture]. And the only cure? Surgery. Penis and testicle off and scraped down to the bone. You will pee sitting down for the rest of your life. You'll never have sex again. People in locker rooms will sneak looks at your deformed body and missing maleness and be horrified.

But there is hope! If this vaccine is administered to all boys and girls, penile cancer rates will be slashed by 90%.

If I ever get off my lazy ass and see a doctor, I may have to get this vaccine myself.

UPDATE: This post was picked up by Buzzfeed, so welcome everyone coming from there. This was one in a series of posts I did on the HPV vaccine. (I don't normally harp on about things like this.) If you were interested in this, you may also wish to read:

  1. School Boards and Vaccinations -- the post over at It's Matt's World that started it all
  2. Vaccinations, Revisited -- the discussion continues
  3. More vaccine talk -- where I jumped on the bandwagon (Long, but worth the read.)
  4. Do Christians really want women to die? -- last in the series, about a local conservative who refuses to believe there's any reason a woman should get this vaccine unless she's a slut.

Sunday, January 21, 2007

Local troublemakers

This is weird. While I was away for the holidays, John Bambenek's page was resurrected from it's deleted status at Wikipedia, then quickly put through the deletion process again. Weirdly, there were three sockpuppet accounts created during the process: JohnBambenek, ChrisPerardi, and Narciblog. Mr. Bambenek used to edit at Wikipedia under the userid Jbamb, but appears to have left early last year, so he does not appear to be the person behind the JohnBambenek account. The ChrisPerardi account was blocked because it was a sockpuppet of JohnBambenek. The Narciblog account was blocked for being a troll, though I suspect it was a similar sockpuppet.

I just wanted to state for the record that the Narciblog account at Wikipedia was not me.

Friday, January 19, 2007

Why Obama will not win

Obama has recently started to explore a run for the Presidency in 2008. I've always said that he seems like a smart guy and it's good to have him the Senate, but there is not a chance in hell he could ever win the Presidency. Here's an excellent example of why:

This morning, Fox News featured a segment highlighting a right-wing report that Sen. Barack Obama (D-IL) attended an Islamic "madrassa" school as a 6-year-old child.

Fox & Friends host Steve Doocy pointed out that madrassas are "financed by Saudis" and "teach this Wahhabism which pretty much hates us," then declared, "The big question is: was that on the curriculum back then?" Later, a caller to the show questioned whether Obama’s schooling means that "maybe he doesn’t consider terrorists the enemy." Fox anchor Brian Kilmeade responded, "Well, we’ll see about that."

The Fox hosts failed to correct the false claim that Obama is Muslim. One caller, referring to Obama, said, "I think a Muslim would be fine in the presidency, better than Hillary. At least you know what the Muslims are up to." Anchor Gretchen Carlson responded, "We want to be clear, too, that this isn’t all Muslims, of course, we would only be concerned about the kind that want to blow us up."

Well, that's nice of Carlson. I'm sure she's not "concerned" about all black men, either, just the ones that want to break into her house.

Raise your hand if you're surprised this aired on FOX News.

Tuesday, January 16, 2007

More vaccine talk

I'm back from traveling again. I didn't have reliable Internet access, but I do have some blog posts I'll put up soon. There is one the recent discussion over at It's Matt's World on the HPV vaccine, but Fig wrote this and asked me to post it here. As it's in better shape than what I've got, I'm putting this up forthwith. (The last time she asked me to post something here, it wound up getting published in a newspaper. Sure, the local community college newspaper, but at least someone is paying attention.)

I realize that I'm chiming in several days too late, I felt that as an MD with an MPH [Master of Public Health -N] who has been a sex educator I should clarify a couple of things and chip in my $0.02.

First let me say Mr Bambenek is correct. It is an HPV vaccine, not a cervical cancer vaccine. Merck markets the drug as "against cervical cancer" because of smart marketing strategy. They could market it "against genital warts" or "against penile cancer" (nearly 100% of penile cancer is caused by HPV). For a variety of reasons, including the fact that most people haven't heard of HPV, women die of cervical cancer, warts are yucky, and most men don't want to think about the fact that the treatment of choice of penile cancer is surgical removal, Merck made the decision to push the drug as "against cervical cancer." I would take strong objection, however, to his statement that "the medical community refuses to describe this vaccine by what it actually does." The medical community calls it the HPV vaccine and we discuss it with our patients as "a vaccine that offers protection from certain strains of the virus responsible for cervical cancer." We don't call it a cervical cancer vaccine. We also don't usually discuss "the stomach flu," "spinal meningitis," or "head colds" or any of the other odd names the lay press uses. Please do not assume that the medical community uses the same terminology as you see in the newspaper or in drug ads or that the medical community goes hand in hand with drug companies.

Cervical cancer is not to be taken lightly. In 2007 it will cause nearly 10,000 cases of cancer and more than 3,500 deaths. This comes at a considerable cost to the economy. There are approximately 3.5 million abnormal Pap results experienced by American women each year, most of which are caused by HPV infections. These abnormal Pap results require women to seek follow-up care which ranges from additional Pap tests (moving from once every 3 years to once every 3 months) to more invasive procedures such as colposcopies and biopsies. This additional care costs an estimated $6 billion in annual health care expenditures. We pay for that. We pay for it through higher insurance costs, higher hospital charges and higher taxes to pay for those without insurance, and loss of productive time at work for these women. One of the compelling reasons to consider getting this vaccine, based on cost effectiveness analyses covered in public health journals in the last year, is that even at $360 per person for a full course and even though it only is against four strains of HPV (two of which cause 70% of all cancers, two of which cause 90% of all warts) so it offers protection -not immunity- from cervical cancer, a significant decrease of the disease burden in the community would be cost saving within the foreseeable future.

While I understand Mr. Bambenek's point that abstinence would be effective in preventing HPV, so far abstinence programs have not be shown to be effective. If he has a great idea of a cost effective way to ensure that all children that are covered by the Unit 4 school board were not going to have sex at all I and all other public health professionals would be interested in hearing it. However, even if tomorrow we could enact a program that would ensure that all people were abstinent until marriage (leaving aside the issue of whether this is a good thing), there would still be an infectious pool of HPV. With the large reservoir of HPV in the population, even if a young woman was abstinent until marriage she still could contact HPV from her partner.

I met my close friend L in medical school. L strongly believes that there should be no sex before marriage. She abstained. She married a very religious man who had gone through a "troubled time" in his adolescence and then, as he described it, had "seen the light and been saved." At her next routine pap, L found that she had cervical dysplasia. 2 years later, at the age of 26, she had a hysterectomy to stop the spread of her invasive cancer. Here is a woman who did everything "right" by Mr. Bambenek's standards and she still suffered the results of HPV infection. L now has an adopted son and daughter - she is raising them with the belief that one should be abstinent until marriage...and getting them both vaccinated against HPV as soon as they are age eligible. Given her experience, she feels that the vaccine should be mandatory to save other people from what happened to her. I realize that anecdote is not data, but I find that to be a compelling story. Further more, as I'm sure Mr. Bambenek is aware, not all sex is consensual sex. A girl could be as pure as driven snow, but if she is raped she can contact a sexually transmitted disease. Some of these diseases can be treated with antibiotics, some of these diseases are fatal. Wouldn't it be nice to be able to assure the woman who was raped that, due to her immunized status, she has a far lower risk of contacting one of those diseases?

Obviously requiring HPV vaccinations in public schools raises questions about the scope of parental autonomy and the role of political advocacy in determining how preventive health measures are implemented. All 50 states allow parents to opt out of vaccinating their children for medical reasons, 48 states allow opting out for religious reasons, 20 states (including Michigan, where I currently live, but not Illinois) allow opt out for philosophical reasons. Unlike what Mr. Bambenek states in his article, however, mandatory vaccines are to prevent easily communicable diseases or even to protect against the disease itself. Mandatory school vaccines further society's interest in ensuring that people are protected from disease throughout their lives; they are a highly efficient means of eradicating disease in the larger community. Tetanus has been mentioned several times earlier in these comments and is an excellent point. It is non communicable, we require the vaccine. Why? Because it is cheaper to vaccinate everyone than to pay for the health care costs associated with tetanus infection. Why do we mandate it (and have the state pick up the cost for those who can't pay) as opposed to just encouraging people to get it? Mandatory vaccination address the issue of income disparities - the people who are least likely to get the vaccine are also the people who are least likely to be able to afford to pay for their intensive medical care. Nobody objects to the MMR vaccine. What's it for? Measles. That makes sense, they can cause a horrible encephalitis and kill you. Mumps. Also makes sense - mumps can leave men sterile. Rubella. Also known as 3 day measles - a time limited mild viral infection that gives you a rash, conjunctivitis, swollen glands, and a low grade fever. Not fatal, not even particularly debilitating. So why do we immunize against rubella? Because if a pregnant woman becomes infected the fetus is at huge risk for growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems. Again, it's a cost effectiveness issue. Much cheaper to jab all kids with an immunization than to have society providing life long care for terribly damaged individuals. Chicken pox is vaccinated against for similar reasons. 47 states, including Illinois, require Hepatitis B vaccination. Hep B isn't spread by casual contact, only sexually and by injectable drug use/needle sharing. But there is no cure and a new liver is an expensive and rare commodity. So, again, it's cheaper to immunize everyone to prevent the spread of the disease and for cost saving in the future.

I'm a little unclear as to why Mr. Bambenek feels that the HPV vaccine requirement is a more burdensome invasion of privacy than any other vaccine or, for that matter, required school sports physicals. More lives are at stake here *each year* than all the lives lost on 9/11. We have suffered ridiculous and far reaching invasions of privacy due to that. Why is asking parents to be aware that a vaccine exists so onerous? I could be wrong but I doubt that anyone other than the school nurse knows who has been vaccinated and who has not. In Ann Arbor there are many parents who choose not to immunize their children. Their children are not ostracized, the teachers and other parents have no idea which children are vaccinated and which aren't, there is no secret registry of un-immunized children As I understand it, Jakobsson's bill would require the parents of girls entering 6th grade to present an immunization form or a form that stated had been informed about the connection between HPV and cervical cancer and still declined to have their child vaccinated. You don't have to get your kid immunized, you just need to prove that you are aware that the vaccine exists and you don't want it. From reading the language of the bill, it doesn't change your medical decision making capacity, it just forces parents to be aware. There is a case to be made that asking to know if a child has been immunized at all to anything is an untenable breach of medical privacy but I'm not sure why someone would care. If your daughter is immunized it doesn't mean she's sexually active and it doesn't mean she's *not* carrying the virus; if she isn't immunized it doesn't mean she is either a horrible pit of disease or abstinent. It means that she received the vaccine or not. Why is this inappropriate for schools to know? Why do parents care if schools know it?

There is the argument that if girls receive the HPV vaccine they will promptly feel that they are free to have sex with anyone, anytime, anywhere. This seems specious. I think - prior to the advertising blitz by Merck - awareness of HPV was so low that fear of contracting HPV did not stop anyone from engaging in sexual activity. Most children have no idea what they are immunized against. Most girls/women are far more worried about contacting HIV or getting pregnant than anything else. And if finding out that they are somewhat protected against a virus that may or may not cause them cancer many years down the road undoes all their teaching that they should only have sex with the person they are married to/someone they love/someone who can prove they are disease free (or whatever else they have been taught at home, at school, or at their religious institution) it seems that the teaching wasn't very effective in the first place.

Wednesday, January 03, 2007

This would be the "anti-harlot" platform

Back from vacation. Leaving again soon. No time to blog, but I'll make some.

Thanks to Archpundit, I've found out that John Bambenek is running for school board. This is the same John Bambenek that recently published an anti-feminist screed in the Daily Illini. When asked to produce evidence for some of the ridiculous claims he made, he quoted a conservative think tank's unscientific "study," then distorted the research of nine actual scientists.

Bambenek complained in the DI earlier this year that UIUC doesn't teach creationism in its science classes. That's not particularly surprising; crystal healing isn't taught at medical schools, either. To be fair, he has said that creationism will not be part of his platform, which he hasn't decided on yet. On the other hand, if he pushes his religious ideology into the schools, I don't care if it was part of the platform he ran on or not.

Not surprisingly, Bambenek is against any sex ed other than demanding celibacy. In an absolutely stunning display of boneheadedness, he also seems to be against the HPV/cervical cancer vaccine. How someone can be against something that can have such horrifying consequences yet is so easy to prevent (or at least protect against) is simply beyond me.

Couldn't we just put lead in the water? It would be so much more efficient.

UPDATE I: Run! The feminists are invading. Err, um, that is I mean to say: Greetings, Feministingers!

UPDATE II: OK, to be fair, Mr. Bambenek comments that he isn't against the HPV/cervical cancer vaccine, just against calling it a "cervical cancer vaccine." Frankly, I think it's a distinction without a difference, since no one really cares much about HPV infection itself, but rather about the fact that it causes cancer. I bet if you asked random people on the street if they would get an "HPV vaccine," they'd give you a blank look. If you asked them if they would get a "cervical cancer vaccine," they'd answer in the affirmative. "Vaccine against the virus that causes cervical cancer" is a bit of a mouthful, anyway.