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HPV questions

"Fundamentalists fight mandatory HPV vaccine" (Exile on Jones Street, Kirk Ross, Feb. 7) follows familiar logic: If "fundamentalists" oppose mandatory HPV vaccination, then mandatory HPV vaccination must be a good thing. If only it were that simple. On the same day I read about the mandatory HPV vaccination debate in The New York Times, I came across an article in Business Week highlighting the profit potential of vaccines. Due to a sluggish blockbuster drug pipeline, vaccines—once the poor relation of drug development—are now the favored child. Whereas pharmaceutical sales are growing only 5 percent to 6 percent a year, vaccine sales are increasing nearly 20 percent annually. The number of vaccines in development has tripled over the last decade, partly thanks to tort reform and legislation reducing liability risks for drugmakers.

So is Big Pharma's shifting focus from drugs to vaccines good news for public health? More specifically, should parents of young girls reflexively embrace Gardisil, Merck's HPV vaccine? Hard to say. In a 2004 report to Congress, the director of the Centers for Disease Control noted that 70 percent of new HPV infections clear up on their own within one year, around 91 percent clear within two years and "most women with persistent HPV infection do not develop low-grade cervical cell abnormalities, cervical cancer precursors or cervical cancer." Are those numbers good enough for parents to confidently question Merck's heavy lobbying for mandatory vaccination policies, which, by the way, critics are calling a "help pay for Vioxx litigation" campaign? I don't envy parents facing this decision on behalf of their young daughters—it's far from a no-brainer.

Kathy Jo Wetter
Durham

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