Skepticism

What Came First? The Chicken or the Gardasil?

A lot of crap has been thrown around about the new HPV vaccine named Gardasil. As a concerned teenage girl I felt the need to separate the myths and truths behind the new immunization. So let’s take a look at HPV and Gardasil.

“Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI). The virus infects the skin and mucous membranes. There are more than 40 HPV types that can infect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), and anus, and the linings of the vagina, cervix, and rectum.”

Here’s the description of the vaccine from the Merck website:

“GARDASIL the only cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. GARDASIL is for girls and young women ages 9 to 26.”

So now we know a little bit about both HPV and the vaccine, let’s look at some of the silliness concerning this inoculation.

My favorite quote is “Parents of girls in many states lobbied against a mandate for this vaccine because of the implication of sexual promiscuity.”  Yeah, we need cancer to scare us into remaining responsible. Unwanted pregnancies and other STDs just aren’t enough!

There are also other claims of disastrous side effects that include paralysis, and even death. (As if we needed more fear about vaccines.)

First of all when sixteen million doses of a new vaccine are given out, stuff is bound to happen. When you have this many people doing anything, some folks are going to coincidentally have bad stuff happen and think it was caused by the vaccine. Bad stuff happens. (As Dr. Tyson says, “The universe is trying to kill us.”) It is just a matter of probability people!

Researchers at Center for Disease Control (CDC) are currently looking into potential side effects but say that these side effects are minor and do not even require a warning label. A recent report on July 22, confirmed their position that the vaccine is safe and effective.

I just recently got shot up with my third and final helping of the egg-based substance. I don’t know about anyone else but it did not make me any hornier nor did it kill me, or paralyze me. I did get a sore arm though. 🙁

But it’s all good! I got a Bugs Bunny band-aid.😆

I talked to my doctor about the concerns and anxieties that some people have about the vaccine.  He said that right now there is really nothing to worry about. He did say that if I had a history of blood clots in my family or a compromised immune system and was very young, then he would tell me to wait until further research was completed to assess the blood clot claims that have been made. When I mentioned concerns about “sexual promiscuity” among the teens who received the vaccine, he told me that this idea was ridiculous. He also said that medicine is never absolute. His final words to me were “never say ‘never’ and never say ‘always.’” Good skeptical advice. Yea, my doctor is cool.

For all of you teens out there, talk to your parents and doctor about your medical history and then please get vaccinated. Parents! Get your girls vaccinated, HPV is no joke.

Previous post

Charles Darwin Is on the Back of the £10 Note?

Next post

'Lil Skeptics

Cassie

Cassie

45 Comments

  1. August 7, 2008 at 10:21 pm —

    Vaccines really scares me because of the needles, but I think it is much better than dying or getting sick unnecessarily. As for the antivax excuses, jeez, they never seem to end. When mercury is gone, it is some crap about aluminum.

  2. jerry
    August 7, 2008 at 10:49 pm —

    Hi Teen Skepchick. You’ll have to take my word that I am not a Christian or Catholic, I am liberal, agnostic, I have two daughters and that I’ve had Guillain Barre.

    I think you’re wrong. Well meaning, but wrong.

    I think the FAQs at evilslutopia tell a bit more of the story. When the woman, m.d. in charge of testing the vaccine says it’s a mistake to give this vaccine to prepubescent kids, I think that’s significant.

    The various truths are:
    The vaccine was never tested for long term side effects. Given the history of the FDA, especially in the Bush Administration, that should be alarming.

    The vaccine certainly looks effective in young kids, but you can’t give young kids HPV, and so we don’t know if it is effective.

    We don’t know how long the vaccine will remain effective.

    Now, I’ve had Guillain Barre, and it’s no picnic. It’s life threatening. It’s pretty callous for you to say, “you give out millions of doses and stuff happens.”

    Jenny Tetlock, 13, from Berkeley California, hardly a right wing christian bastian is suffering paralysis and more and it may be that Gardasil has been implicated. Google her up.

    Putting names to “stuff happens” takes a lot of that joy Away.

    But here’s the real puzzler for me.

    Cervical cancer strikes most victims in their 30s and 40s, about 15 – 20 – 30 years AFTER the injections. What will cancer treatment look like 15 – 20 – 30 years from now? What did cancer treatment look like 15 – 20 -30 years ago?

    My suspicion is that Gardasil may be effective, may be very risky and absolutely no one can tell you, and will almost certainly be totally obsolete in about 5 – 10 years.

    I hope you’re right. And I hope you understand plenty of people, including scientists, liberals, ph.ds, and doctors, are concerned about gardasil and it has NOTHING to do with “promiscuity.”

  3. jerry
    August 7, 2008 at 11:28 pm —

    By the way, you may wish to check your wordpress and dashboard settings that show up when you first register.

    I saw information regarding the numbers of posts, and comments, and comments in the queue — I had to look and make sure it hadn’t logged me in as you.

    At the moment, it won’t let me change this farkakte password wordpress gave me. It’s not clear why that is, but oh well.

  4. Cerus
    August 7, 2008 at 11:41 pm —

    The religious claims of moral decline and increased promiscuity always interest me. Though they claim to be concerned with these “problems” more often then not it comes down to being in control.

    The anti-vaxxers are a new phenomenon to me that I am just experiencing. I came from a small community where everything was done to make the best life for the youth as a whole. The anti-vaxxers seem to be more concerned with their child(ren), and their “right” to be outraged, than on what is good for the general public. This is evidenced by the constant changing of the “toxin” that is hurting children.

  5. jerry
    August 8, 2008 at 1:09 pm —

    Hi, sorry to belabor the point. I’d like to think that if there were blogs 30 years ago, and I had the energy you had, I’d be Science Boy or Skeptic Kid or something like that.

    Anyway, early 70s, a bunch of scientists and doctors decided to treat “shortness”. Turns out I was short and my MD told my mom about this, and my mom, wise as she was, totally left it up to me. Shortness isn’t as bad a disease in almost any measurement as Cervical Cancer, but I think the lessons are still meaningful. I declined.

    Turns out many of the participants got Creutzfeldt-Jakob disease about 10 – 20 years later. (And presumably died with swiss cheese brains.) The upside was a very nice Nobel prize to Stanley B. Prusiner for research into prions. Lesson: treat clams from the FDA and even MDs and scientists with huge skepticism, especially when big big big dollars are involved, because money, career promotions, and politics corrupt and the FDA doesn’t have a wonderful record at all times. (And an additional lesson for us all into ensure the FDA allows ample testing of meat and making sure that dairy animals are fed only parve or milchig (sorry small joke.))

    I’m proudly liberal — up to the point where I worry about people without my principles and my notion of what adequate testing advocating injecting me and the people I care about with relatively untested drugs. At that point, I’m very skeptical about their claims and look at the promises very conservatively and with huge discount rate.

    My concern about Gardasil falls into those lines. Inject people now, “Help Pay for Vioxx”, and find out later you either definitely hurt people, or that a 5-10 year wait resulted in a much safer and more effective treatment.

    (I can understand perfectly well why a teenaged woman would at this particular point in her life decide differently than I would choose at this time for my several year younger daughters.)

    Best wishes, I’ll try not to annoy you more on this, but since my neurologists have told me to minimize vaccinations from now on, well, it’s a pet peeve of mine.

  6. August 8, 2008 at 2:14 pm —

    Jerry, first of all, Gardasil is not a vaccination for cervical cancer, but HPV, a leading cause of cervical cancer. The reason it is recommended to vaccinate at ages 13-16 is because HPV is so prevalent that a large percentage of sexually active people have it, so it is necessary to vaccinate before you become sexually active. This is why people are advised to vaccinate in their teens and twenties even though women usually get cervical cancer in their 30’s and 40’s. It is not recommended for prepubescent girls, only after puberty before sexual activity.

    I think it’s nice that you are so optimistic about the future of cancer research, but I worked for one of the lead pediatric oncologists at MD Anderson (one of the largest cancer centers in the country) and she advised me to get the shot. No one credible will tell you they are 5-10 years from curing cancer, and to advise someone to make an irreversible decision (ie, once you have HPV you at much higher risk of getting cervical cancer and you can’t go back and get the shot after you are infected) based on the fact that they might cure cancer before you get it would be extremely medically irresponsible. Anyway, genital warts are unpleasant on their own, even without risk of cancer.

    With any new medicine (or any old one, people can react in unexpected ways to generally safe things, and a surprising number of people die from aspirin poisoning each year) there are risks, but the FDA does actually behave responsibly the majority of the time. Confirmation bias makes us think they don’t, after all every drug proven dangerous is a huge story but, “no one died from a new antibiotic today” almost never is.

  7. jerry
    August 8, 2008 at 4:05 pm —

    It is not recommended for prepubescent girls, only after puberty before sexual activity.

    My main interest in this is because from what I’ve seen, there is lots of discussions towards mandating this as an OPT-OUT vaccine for 9-12 year olds, many of whom, even the 12 year olds are prepubescent.

    I’d be much more okay with it as OPT-IN since OPT-OUT requires an active step and isn’t very easy to do in many states where it can require a doctor’s order, or a priest’s letter and where “I just don’t want it” isn’t accepted, and where the doctor’s order and priest’s letter can actually be overridden by “more important” state doctors and lawyers. Ya rly. OPT-OUT is pretty difficult in many places.

    As I said, I think the vaccine is reasonable to take, now, in the post-pubescent set and I can understand why women in that cohort would take it.

    I just see an awful lot of anti-anti-gardasil posts out there that paint any sort of concern as coming from the religious, the right, or luddites.

    Also, just a nit, I was not saying they are going to cure cancer in 5-10 years. I was saying there would be better cancer treatments, including earlier cancer detection, and that there would be better vaccines against HPV.

    If folks want to take it and are informed, I think that’s fine. It’s the claim it’s a harmless, or that the benefits are so huge that the deaths are ignorable, or that people who are concerned are somehow to be dismissed as ignorant or rightwingers that I find problematic.

    By paying attention to the paralysis and the deaths, we can probably learn how to prevent them, and learn about those diseases in general.

    And for a vaccine with no long term testing data available, I find it problematic to compare deaths today with deaths 20-30 years down the road and say today’s deaths are okay. There is a very good chance those that are injured today would not be the people getting cervical cancer down the road, so I just find it very hard to trade them off. “You are collateral damage today of a disease some people may get in 20-30 years. Thank you for your participation.”

    It’s also not an irreversible decision. Right now I have to make a choice between three different technologies to treat an ailment I have. One choice, recommended by several doctors, will almost certainly require another absolutely very serious life threatening surgery in 15 years. Another choice requires a more difficult double surgery now, but will probably never require surgery again. Some in the first group of doctors say, “do the simpler operation now, and there is a good chance that in 15 years we’ll have completely new techniques that will require no surgery to repair you then.”

    So the choice of opting out now is not necessarily irreversible. A lot WILL happen to cancer treatments in 15-30 years, and a lot of that will benefit from the human genome project and from our fight against AIDS and other retroviruses.

    Apparently, the best “treatment” for cervical cancer comes from early detection, so annual pap smears are still a must. And I believe that cervical cancer fatality rates are low and getting lower in the United States.

    Sometimes waiting is the better way not to make an irreversible decision.

    If you have been vaccinated, there is no big reason to worry. But for people who haven’t been vaccinated yet and who find these posts, I just hope they’ll talk to their physician and do a little googling and make an informed decision.

  8. justin
    August 8, 2008 at 5:07 pm —

    Jerry –

    Unless I got something wrong when I was learning about vaccinations, I’m pretty sure that a vaccine against something like HPV would involve some sort of weakened or dead form of the virus to be injected to “prime” the immune system against attack. I was wondering what the long-term effects of an HPV vaccine might be, and how they would differ from something like an MMR or flu vaccine?

    I also have a hard time buying that paralysis or death would be a common or likely side effect of this vaccine. It seems to me that this is the kind of thing that researchers would notice in clinical trials, and the legal departments of pharmaceutical companies might take exception to the release of a product that is shown to kill or paralyze the patient.

    I do not mean to say that there is no risk associated with the vaccine, but here is what I would look at when considering whether to have my daughter vaccinated:

    1. Kids are going to have sex, and
    2. Sex can lead to STDs, and
    3. STDs can be a stigma and a long-term health risk, and
    4. This vaccine can prevent a common STD with proven long-term health risks, and
    5. There is little convincing evidence (that I have seen) to say that this vaccine does harm.

    I’m not even sure I would give it a second thought at this point. If there are any problems with my way of thinking, I hope someone will correct me.

  9. August 8, 2008 at 7:38 pm —

    This comment thread is great. I’ve been having quite a time telling the women and parents around me about Guardasil. In my experience, just fyi, most of the negativity about getting this vaccine DOES revolve around sexual activity. Which is just sad. We can talk our heads off about proving this works and the vaccine’s risks outweigh the probability of harm caused by the virus. But what is there to do when people can’t get past their “touchy-feelies?”

    My “sister-in-law” doesn’t want to give her daughters the vaccine because she doesn’t want to introduce the idea of sex to her. I suggested she not mention anything about sex, and she told me “well, I think it’s wrong to lie to her.”

    Okay, fine.. tell her the truth, I think, tell her “mommy is selfish and uneducated and squirms when sex is mentioned. I would much rather you be at risk for something unpleasant, potentially threatening and deadly.”

    Obviously debate about the efficiacy of this vaccine never has a chance to be brought up once she loses herself in the emotional aspects.

  10. jerry
    August 8, 2008 at 7:39 pm —

    justin,

    I am not a doctor and my knowledge of biology is several college courses taken quite a while ago.

    Guillain Barre however, is positively linked with vaccinations.

    The stuff of a vaccination is not just the dead-virus, but all sorts of other stuff ranging from preservatives to well, who knows what. (I mean someone does, but not me.)

    So the “bad stuff” may not be the dead virus, but maybe the other elements of the cocktail.

    And the fact is, these side effects are seen during drug testing and part of the researchers jobs is to figure out what side effects are due to the Law of Large Numbers and what are due to the vaccine.

    In the Gardasil testing in fact, the control has been criticized has having been done poorly and not being a simple saline solution for example, but being part of what went into the eventual vaccine. So if this element causes , then having it in both control and vaccine tends to statistically diminish the chances that it will be seen as the culprit behind problems. That is, the control presumably should not contain questionable elements in it.

    There is little convincing evidence (that I have seen) to say that this vaccine does harm.

    Absence of evidence is not evidence of absence. And, I have no idea what you might find convincing or not.

    I’ve given you plenty of ways to google this up, or you can start with evilslutopia’s faq.

    Where might your thinking be wrong?
    1) You are among the great unwashed that don’t understand that a vaccine is a cocktail
    2) You may be suffering from groupthink, every one you know says this thing is great stuff, so it’s hard for you to believe otherwise regardless of the strength of evidence
    3) Your research techniques may be poor. Having been told that people who dislike this vaccination are nutcases, black helicopter, religious types, you might be looking at yourself and saying, “I am not a nutcase. I don’t believe in black helicopters. I am not religious” and failing to follow up on the provided links. And then since you’ve done no research, you fall back to: I haven’t heard anything bad about this, so it must be safe.
    4) at each step in your thinking is a probability and an expected payoff. To move from one step to another you need to multiply by that probability and payoff. At the last step, you have to compare to the alternative expected value.

    Amongst the alternatives are:
    1) Take gardasil now
    a) never get hpv
    b) get Guillain Barre or other side effect and/or die

    2) Wait and take the successor to Gardasil

    3) Take nothing
    a) live happy life
    b) get cancer, detect it early do well
    c) get cancer, detect it late, die

    4) Teach your kids to use condoms and not use gardasil

    It’s just as simple as your 1, 2, 3, 4, 5.

    Remeber: this is the same FDA that approved:
    thalidomide
    phen phen
    iuds
    tampons
    sponge
    celebrex
    bextra
    vioxx
    guidant pacemakers

    and a probably a lot of other dangerous products.

    SkepticTeen, and SkepChik, et. al., I haven’t subscribed for years, but before the age of blogs, a truly wonderful resource and entertaining conversation was the ACM’s RISKS Digest
    “Forum On Risks To The Public In Computers And Related Systems” (originally comp.risks)

    A lot of world renowned computer scientists and technology journalists got their start contributing and sending things in to Peter Neumann.

    “It is a moderated forum concerned with the security and safety of computers, software, and technological systems. Security, and risk, here are taken broadly; RISKS is concerned not merely with so-called security holes in software, but with unintended consequences and hazards stemming from the design (or lack thereof) of automated systems. Other recurring subjects include cryptography and the effects of technically ill-considered public policies.”

    RISKS Digest used to talk about the nature of risk, the overlooked risks, and always had wonderful stories of risks that were dismissed that then came back to bite people in the butt. Especially neat were ones from the medical field, like the x-ray machines that ended up burning and killing people. Oops.

    Justin, you’ll have to do your own research and make your own decision. Please understand that RISKS Digest amply demonstrates that it’s possible to be a progressive liberal (if that’s what you may think you are), a scientist, or engineer, and still be very skeptical of drugs and devices that carry FDA Approval or frankly just look good and cool and so must be good stuff.

  11. August 8, 2008 at 7:43 pm —

    The FDA will inevitably get some stuff wrong. Nobody, and I do mean nobody, ever gets everything right all the time. But, the fact that they approved it shows that there is evidence that it works and brings health benefits.

    As far as I know there is no evidence that shows that it does cause adverse health effects.

    That doesn’t mean it’s impossible but there is such a thing as being too careful and there is such a thing as being too skeptical to the point of paranoia.

  12. justin
    August 8, 2008 at 8:53 pm —

    In all honesty, given the current administration, I would be surprised to find out that every attempt wasn’t made to keep this vaccine from reaching the public.

    I couldn’t help but notice that you referred to me as one of the “unwashed” that doesn’t know that vaccines are cocktails. This would almost lead me to believe that you are anti vaccine, not opposed to this vaccine specifically.

    I honestly have no idea how anyone could be anti-vaccine. Vaccines eliminated small-pox, and polio just doesn’t happen in the US any more. I have never known a single US-born person that has had measles, mumps, or rubella. There have been a rash of measles outbreaks, though, thanks in no small part to people who didn’t get vaccinated. We have a vaccination against chicken pox, and I am about to go and get a meningococcal meningitis vaccination so that I can go to school worry-free.

    Vaccines save lives.

  13. justin
    August 8, 2008 at 8:58 pm —

    Also, I went to the Evil Slutopia website that you suggested, and all of the side-effects that were “later reported” were anecdotal in nature and cannot be counted as reliable. I would be willing to bet that 20 years from now, women will still be taking this vaccine along with all the others that keep our nation healthy.

  14. August 9, 2008 at 1:03 am —

    Okay, one more point. HPV is not very effectively prevented with condom use. The vast majority of STD’s are, so I’m certainly not saying, don’t bother with condoms, but HPV is not. That’s why it’s so common.
    Alright, I’m leaving this one to the professionals now : http://www.scarleteen.com/article/infection/the_hpv_vaccine_faq
    http://www.ourbodiesourblog.org/blog/2008/07/gardasil-and-fear-mongering

  15. August 9, 2008 at 2:12 am —

    Okay, one more thing and then I’m done. The think about requiring a vaccine on an opt-out basis is that it requires all insurance companies to cover it, and for anyone without insurance to get a voucher for the cost. This is not necessarily true of opt-in vaccines, depends on the state. With a new, and therefore expensive (all those trials for safety are expensive you know) vaccine like Gardasil that is the difference between getting it or not for a lot of girls. It’s well and good to say, “I don’t want it the government shouldn’t tell me I have to get it”, but for low-income people if the government doesn’t require it they have no choice. They can’t afford it. Whereas anyone who doesn’t want it can opt-out. Yes there’s some paperwork, well tough noogies.

  16. vreify
    August 9, 2008 at 9:54 am —

    @ Jerry
    From what I understand, Guillian-Barre Syndrome is rare and is only occasionally triggered by vaccines. That makes it an even more negligible side effect.
    And the control used contained aluminum. It has been shown not to affect vaccine effectiveness, and if anything, causes minor swelling and skin inflammation. No reason to think it is dangerous.

    It’s also hard to tell whether you do have HPV or not, since it often has no symptoms. You may continue to spread the virus unknowingly.

    I don’t think you are being truly “skeptical.” You are cynical about what the FDA has to offer, without really examining the evidence in a fair and objective manner (which is what a skeptic does). Is there evidence of its harm? How harmful is it? My varied googling tells me, “not very harmful.” It seems to carry the risks that any vaccine would carry.

    I think when you compare the risks and the benefits, the benefits clearly win. Preventing a cancer is worth the small risk three shots may pose.

  17. jerry
    August 9, 2008 at 2:08 pm —

    Zambiglione, first of all, you are one of my favorite deserts.

    From what I understand, Guillian-Barre Syndrome is rare and is only occasionally triggered by vaccines. That makes it an even more negligible side effect.

    It’s called a syndrome, because no one knows WHAT causes it. It is linked to vaccinations, but I am not aware (I am not aware of many things so no surprise here), I am not aware that it is linked to vaccines only rarely. It’s always nice though to have people decide YOUR life threatening illness is neglible, but THEIR life threatening illness is all important.

    In many ways, the opt-out vs. opt-in I think gets to the crux of the matter. But I think it’s a loser in terms of its civil rights implications as well when you examine what it takes in so many states to opt-out.

    The simple answer is that if you, governor, want the insurance companies to pay for it, you walk down the hall to the insurance commissioner for your state and he/she will mandate that insurance companies pay for it. You don’t need to mandate it as OPT-OUT.

    Amongst the problems with opt-out that I mentioned above, another problem is that in many places, opting out of one vaccination means you have to opt out of all vaccinations.

    More on the legal problems, and the due process, equal protection problems of OPT-OUT as incorporated in most states:
    http://www.nvic.org/state-site/legal-exemptions.htm

    OPT-OUT goes against the grain of informed consent. It also goes against the grain of “keep the government off our bodies (and out of our bedrooms.)

    Of all the rights you have that should be inviolable, control over your body should be number one, and only violated in extreme cases of imminent public health and public safety issues.

    (legally we’ve decided that opt-out is not good enough for spam removal, it’s amazing how it became good enough for this vaccine.)

    I understand that many people think it is a low risk vaccination, and I agree it would be good if those people had it available for free. My suggestion is a) vote Obama and work towards universal health care, and b) lobby the legislature and governor to force your state’s insurance companies to cover it.

    But I think it should be very rare that we agree to allow government to force injections into our body. MMR. Pertussis. Polio. Childhood diseases or diseases that affect pregnant women. Stuff like that. Not a poorly tested vaccine that may result in a cancer 30 years down the line that has alternatives in detection and treatment.

    Other vaccinations should be encouraged and educational and outreach programs put in place to inform people of their choices. But not made mandatory opt-out.

    My wife and I, in combination with our daughters’ physician (a woman if that’s important) discussed every vaccination, and we definitely had them vaccinated for some, and had them skip others.

    Informed consent.

    Though you are my favorite desert, I do take exception with this:

    You are cynical about what the FDA has to offer, without really examining the evidence in a fair and objective manner (which is what a skeptic does). Is there evidence of its harm? How harmful is it? My varied googling tells me, “not very harmful.” It seems to carry the risks that any vaccine would carry.

    I just finished several longish posts in which I describe how this is different from other vaccinations: the physician in charge of testing says it shouldn’t be used in prepubescent kids, there has been exactly ZERO long term tests, we have no idea of how effective the vaccine is in the kids, OR how long the vaccination will last. The control was contaminated. It has been linked even in the testing to illnesses and deaths. I take exception to your then telling me, that I’m just cynical, or worse, tell me I haven’t demonstrated its harm, or how risky it is.

    As I’ve said repeatedly, I don’t know how risky it is, there has been no long term testing. No one knows how risky it is. In the short term testing it has been linked to deaths and serious illnesses.

    It’s a bizarre tactic many people have, but I don’t think it’s a particularly logical, scientific or skeptical argument, to listen to people and then tell them: you haven’t looked at all the evidence, or you haven’t looked at it as well as I have.

    I’ve provided a few links, and I haven’t insulted you by telling you you’re a moron. So please, after I’ve clearly shown I’ve examined this, don’t tell me I’m a moron who hasn’t examined this, or examined it as nicely or as well as you have. I suspect that would be your take on anyone who disagrees with your conclusion.

    Actually, in a scientific and skeptical world, reasonable people can reasonably disagree in many instances, and in no way does it show that one person hasn’t examined all the evidence, or examined it as well as other people have.

    We’re not talking Copernicus vs. Kepler, or evolution vs. creationism, we’re talking assessments of risks and benefits in a probabilistic domain. That’s often a personal judgment, (and usually requires knowledge of total costs including, in this case, the results of the non-existent long term testing.)

    Also, I’m not objective? How objective is anyone in this? Skepchick is a young woman entering a very wonderful and sexual part of her life. To quote the X-Files, “She wants to believe.” How is she any more objective than I, the parent of two young girls trying to figure out what is in their best interests medically? We all have our opinions and agendas, and frankly, when I was getting my degrees in physics, and engineering, one of the lessons we learned was that in any experiment, no one is objective. It’s why we demand double blind studies. Why we are so grateful to Heisenberg. And why we don’t believe journalists who claim to report objectively. (Or politicians, or lawyers, or people who google and report.)

    It’s hard to reconcile my objectivity with your objectivity since your knowledge of this seems to be limited by your various googling, depending on the search words you uses, how PageRank as well as your own choices in what links you clicked on, and how you interpreted what you read.

    My varied googling tells me, “not very harmful.”

    I’d be careful or skeptical or cautious in your varied googling, and how you let it inform you on how *other people* have done their research or formed their judgments.

  18. Pato2747
    August 9, 2008 at 3:44 pm —

    After so many many times that you hear and read the crackpot “hardcore” conspiracy theories, you start to look with a very harsh look the back of the coca-cola bottle, looking for the word “Aspartame”. And with all that information bombing I actually started to lose trust on the vaccines. >_>

  19. Pato2747
    August 9, 2008 at 4:00 pm —

    Hmm, didn’t read this whole ‘thread’ so far. Mind you, when I meant ‘that information bombing’ I did not mean any of the stuff posted by ‘jerry’.

  20. Pato2747
    August 9, 2008 at 4:24 pm —

    Let’s see the slutopia’s faq for a moment:

    “1.- The vaccine only decreases your chances of getting cervical cancer, it doesn’t eliminate the risk.”

    Of course not. It’s not a cervical cancer vaccine, it’s an HPV vaccine. HPV is one of the causes for cervical cancer.

    “2.- Even without the vaccine, the number of cervical cancer cases is trending downward and has been for years. (This is only true in the U.S.; worldwide it is one of the top cancer killers of women because women in many other countries have limited access to Pap tests and other health services.)”

    But HPV can bring another nasty stuff, not necesarily cervical cancer. Cervical Cancer is one major thing regarding HPV, but there’s other stuff.

    3.-” Gardasil is one of the most expensive vaccines ever”

    It just came out. It is going to be a tad expensive by the first moments.

    4.-“[…] If Merck can get state governments to put Gardasil on their lists of vaccines that are required for schoolchildren, it can become a part of a federal vaccine liability program. Meaning that Merck will not be liable if Gardasil turns out to be harmful some time in the future. ”

    Only if it has been proved as effective. If not, it will be disregarded.

    5.-“There have been no long-term studies done on the effect of the vaccine after 5-10 or more years, and testing on young girls has been extremely limited.”

    It doesn’t necesarilly means that it’s going to kill you 10 years after the vaccination. Testing on young girls is limited because, you don’t start to get sexually active being only nine. Girls start becoming sexually active at 16 or so, that has been the average age of the girls that offered for testing.

    6.- ” It is unknown how long the immunity provided by Gardasil actually lasts.”

    But it’s expected to last for long. Not all vaccines last forever.

    7.- “The studies done on Gardasil were not set up to investigate whether the vaccine itself has the potential to cause cancer.”

    Yet, that doesn’t necesarilly means that it will cause cancer.

    8.-“Gardasil is one of many vaccines containing aluminum, and there is increasing evidence suggesting that aluminum-based vaccines can have harmful effects”

    It has been never confirmed.

    9.-“Gardasil is only for women.”

    It has not been tested for men as women are the ones that most suffer HPV. But nothing says that Gardasil won’t work on men.

    Anyways, over 20k women were tested with this vaccine. How many of them died or got irreversible damage? None. And they have been tracked for 5 years. If something was bound to happen, it would have happened already.

  21. Cassie
    August 10, 2008 at 4:05 pm —

    Jerry,

    I understand that medicine is not absolute and that in an extremely rare situation, the HPV vaccine could have some weird affect on me. This could be true for any medical treatment. The chances of this happening are somewhere between slim and almost none. The fact is that you take a risk in everything you do. I put my life in danger when I drive to work everyday. I am in a lot more danger driving then taking this vaccine. Does that mean I should not drive? If I follow your logic I should just go hang up my keys for good, stay in my house, and become a recluse. A geek like me could do everything on the web and never come out of my room!

    Part of critical thinking is making good judgments in relation to risk management. In risk management you want to prioritize the risks with the potential for greatest impact of loss and the greatest probability of occurring at the top of your list. For example, while the risk of an adverse reaction to a vaccine is very small, the rate of Type II diabetes, hypertension and other obesity-related ailments in children are on the rise. If your children happen to be overweight and do not exercise regularly, you may have a much greater health risk on your hands than a vaccine.

    Ellis is right. There is such a thing as being too skeptical to the point of paranoia. I think a lot about safety when I drive, because I have a reason to be careful. It is statistically the most dangerous thing I do on a regular basis. Vaccination does not even come close to making my risk management list.

  22. August 10, 2008 at 10:57 pm —

    I declined the Gardasil vaccination.

    I’m not saying that it doesn’t work. It probably does. I’m not saying that there’s a significant connection between Gardasil and Guillain-Barre. There probably isn’t.

    Now, I’m an Apple fangirl, so I’m going to put things into my kind of geek-speak. What I’m saying is that I didn’t buy the iPhone EDGE. I waited and bought the iPhone 3G, and the darned thing still lags and freezes up when it shouldn’t. Heck, when I was in the seventh grade and simply couldn’t wait to buy a new iPod mini, Apple stabbed me in the back (at least, it felt like it…) and released the iPod nano soon after, which didn’t have anywhere near as many random crashes and connectivity issues as the mini.

    My point is that I’m waiting until the second gen. I don’t think that there’s enough long-term research yet. Plus, my family sort-of, kind-of has a history of clotting.

  23. Protesilaus
    August 11, 2008 at 1:02 pm —

    Okay, I have just found this thread, but am completely confused on one point.

    Jerry said that this is the same FDA that Approved tampons…being male and have a fair understanding of the period, what the hell is wrong with Tampons? Is this related to Toxic Shock Syndrome? Is he claiming a deep dark Tampon lobby in Washington who are secretly trying to teach the public that its perfectly safe?

  24. Resfirma
    August 11, 2008 at 9:42 pm —

    Just thought I’d mention that Dr. Novella at SGU gave a nice overview of “herd immunity” a week or so ago. Here’s a link at Wikipedia:

    http://en.wikipedia.org/wiki/Herd_immunity

    I think vaccines are one of those needs of the many, needs of the few or the one Star Trek things… once the science is sound, we should do this for the “herd.”

  25. Cassie
    August 11, 2008 at 9:43 pm —

    Now this is going to sound really funny but who dugg me? 😉

    (besides Elles and Katherine)

    and no Katherine I did not digg myself, I don’t have an account. You are right digging yourself is a no no.

  26. Resfirma
    August 11, 2008 at 9:52 pm —

    Katherine,

    I was very disturbed by your comment. It seems that you don’t realize that you are endangering your health. HPV virus be damned, do your parents know you are an Apple fangirl?!?

  27. Resfirma
    August 11, 2008 at 9:54 pm —

    I just thought I’d mention that Dr. Novella over at SGU gave a nice overview of “herd immunity” a week or so ago in a discussion on vaccines. Here’s a link at Wikipedia:

    http://en.wikipedia.org/wiki/Herd_immunity

    I think vaccines are one of those needs of the many, needs of the few or the one Star Trek things… once the science is sound, we should do this for the “herd.” And Jerry, I think the science is pretty sound on this one.

  28. August 12, 2008 at 1:14 am —

    @Cassie What I was getting at is that it’s also sometimes frowned upon to submit articles from sites that you blog for, meaning that I shouldn’t submit articles from this site, you shouldn’t submit them, Elles shouldn’t submit them… you get the point. 😉 Oh, and GET AN ACCOUNT! It’s Digg, darn it. Get with the times! Haha.

  29. August 12, 2008 at 1:27 am —

    @Cassie Oops, forgot to mention one more thing! When you visit the story’s Digg page, there’s a tab that says, “Who Dugg It?” Click that, and then select “All Diggers.” As of now, that list includes SplendidElles, Skepchick, ResFirma, and myself (katie10).

  30. Evil Slutopia
    August 12, 2008 at 2:29 pm —

    First off, thank you to Jerry for reposting our original gardasil entry. (We have some follow-up information up on our blog as well if anyone cares to look).

    This response is to Pato2747:

    The points you’ve made in regards to our ’10 Things You Might Not Know About Gardasil’ are technically correct, however you seem to be misunderstanding/misinterpreting some of the actual intentions by our list. (That is, while nothing you have said is exactly false, some of it is sort of… besides the point).

    You seem to have responded to the list as if it had been a list of reasons not to get Gardasil. It is not. It is simply a list of things people might not know (but should know/probably want to know) about this vaccine.

    I won’t take the time to address all of the points you made, but this one deserves some attention:

    **
    5.-”There have been no long-term studies done on the effect of the vaccine after 5-10 or more years, and testing on young girls has been extremely limited.”

    It doesn’t necesarilly means that it’s going to kill you 10 years after the vaccination. Testing on young girls is limited because, you don’t start to get sexually active being only nine. Girls start becoming sexually active at 16 or so, that has been the average age of the girls that offered for testing.
    **

    We have not suggested in anyway that Gardasil will “kill you 10 years after vaccination”. (If anything, recent reports have suggested that adverse effects would occur much sooner). We’re simply saying that we have no idea what will happen 10-20-30 years after vaccination, because they haven’t done any studies to determine this.

    Testing on young girls has been extremely limited, however this is the age-range that they are marketing this vaccine towards. Starting as early as 9. Just because they’re not sexually active until 16 (yeah right) doesn’t mean that we shouldn’t fully test something on that age range.

    Also,

    **
    6.- ” It is unknown how long the immunity provided by Gardasil actually lasts.”

    But it’s expected to last for long. Not all vaccines last forever.
    **

    Who says it is expected to last for long? What basis do they have for these expectations if they haven’t fully tested the duration? At the time of our original article, they could confirm duration beyond 4 years. So if I follow your estimate that girls do not become sexually active until about 16 (which is questionable) then vaccinating a 9 year old may actually leave her unprotected by the time she becomes sexually active.

  31. Evil Slutopia
    August 12, 2008 at 2:32 pm —

    PS: I wanted to reaffirm the point that our ’10 Things’ about Gardasil (and follow-up ’10 More Things’) are not intended to steer people away from getting Gardasil.

    We simply don’t want people to get the vaccine solely based on misinformation, scare tactics, guilt trips, etc. It’s your health, your decision. Do your own research and weigh the pros/cons for yourself. The benefits may very well outweigh the risks for you. Or they may not. Your call.

  32. PH
    August 13, 2008 at 5:55 pm —

    >>”We’re simply saying that we have no idea what will happen 10-20-30 years after vaccination, because they haven’t done any studies to determine this.”

    How many other vaccines have caused side-effects 10-20-30 years after vaccination?

    Could any commercial company afford to do 30-year trials of a vaccine (or any other product) to cover the possibility there may be massively delayed side effects, while watching their patent rights expire?

  33. August 13, 2008 at 8:09 pm —

    You’ve taken us too literally. Obviously, they’re not going to do 30-year trials, but more than four would be nice. (The health of the subjects had only been followed for about three and a half years on average at the time that we posted our Gardasil article).

    Pato was responding to that point, by saying that it won’t kill you 10 years later. We were just trying to make a point that just because it won’t necessarily kill you years later, it’s still disconcerting they had no idea what long term side effects could be after ANY period of time.

    I’m not personally aware of any specific vaccines and their side effects, however we are all too familiar with drugs that turn out to be harmful. It’s not outrageous to wonder if a vaccine might be harmful down the line as well.

    Let’s not forget about DES. They weren’t aware of the horrible side effects until decades later. We don’t expect drug companies to do decades-long testing, but we do think that patients should realize the risks involved in trying a new drug/vaccine/procedure/etc. Again, we’re not saying you should avoid Gardasil for this reason, but it’s something that might matter to some people.

  34. PH
    August 14, 2008 at 4:36 am —

    >>”Obviously, they’re not going to do 30-year trials, but more than four would be nice.”

    How many more years than four would be likely to satisfy the kind of person who would worry about what might happen 20 or 30 years later?

    >>”It’s not outrageous to wonder if a vaccine might be harmful down the line as well.”

    Not outrageous to wonder, but possibly not massively useful unless there’s any real reason to suspect that vaccines have a significant likelihood of being harmful in the long term.

    Anyone can generate speculative future risks, the trick is to generate ones which can be meaningfully considered.
    Speculative distant and unquantifiable effects can’t easily be added to any rational calculation – all that can be added in is one person’s subjective fears, which are likely to be basically unrelated to any actual probability of harm.

    >>”Let’s not forget about DES. ”
    Let’s not forget about it, (or thalidomide, for that matter).
    The reason people weren’t aware of the side effects of DES until decades later was that those effects were due to interference with the development of the offspring of pregnant treated women.
    That’s a fairly specific mechanism which could almost be designed to give delayed effects, and wouldn’t have arisen if the drug hadn’t been prescribed for use on pregnant women (where it seemed to have an actual use in preventing miscarriage).

    For someone who isn’t pregnant, that specific avenue of potential long-delayed effects doesn’t seem to be open.

  35. PH
    August 14, 2008 at 4:44 am —

    Fundamentally, when choosing vaccines for oneself or one’s children, what often (and understandably) seems to happen is that people are more scared causing damage from action (choosing a vaccine) than damage from inaction. Even though it’s precisely as much of a choice not to have a vaccine as to have one, it may be easier to write off damage from inaction as bad luck or [deity]’s will.
    Possibly that’s one subconscious thing that some people don’t like about opt-out – that even if it’s easy to opt out, it forces them to actively choose not to have a vaccine, so if there’s a bad outcome from making that choice, it does become more their fault.

    Emotionally, it’s quite understandable that people would think “I’d never forgive myself if I chose a vaccine and something went wrong”, but realistically, they should also be thinking “I’d never forgive myself if I chose to avoid the vaccine and something went wrong”

    One other great and obvious difference between vaccines and drugs is that people don’t have to take a vaccine to potentially derive great benefit from it, as long as enough other people take it.
    Someone who reckoned to be investigating all the pros and cons to make an informed decision, but who didn’t claim to consider that as a serious factor is either a crashingly poor investigator of facts, or is being economical with the truth, to themselves or others.

    With Gardsil, that may currently be less of an issue, since in the short-medium term, there’d still be a large reservoir of people (men and older women) who’d be carrying the infection around, though presumably infection rates would be expected to slowly decline, benefiting everyone to some extent, though not as dramatically as with other infectious diseases.

  36. August 14, 2008 at 9:59 am —

    PH – you’re still missing my point. The issue I wanted to address is that some people hear that the FDA approved it so that means it is absolutely, irrefutably safe. They hear a commercial telling them to be one less woman with cervical cancer and they think “Oh my god I have to get this/give this to my daughters or they will get cancer and die!” Nothing is that simple. Not everyone realizes the process of getting something passed through clinical trials, etc. Our ’10 Things’ was simply a ‘you should know’ list for people who really didn’t know about certain aspects of the medical industry.

    I don’t think they should take Gardasil off the market, but I don’t think it should be mandatory. I don’t think every woman should avoid it, but I don’t want it for myself or my daughter. It’s about personal choice. To me, I’ve seen too many ‘safe’ things turn out to be hazardous in various ways… that I don’t want to jump and get the brand new thing the second it comes out unless I am convinced that the benefits outweigh the risks (for myself).

    Although, there IS legitimate reason to suspect that vaccines (this one specifically and others in general) have a likelihood of being harmful short term OR long term. Even where completely conclusive links haven’t yet been made, there are studies and ‘evidence’ to support the possibility. It is up to each person’s ‘subjective fears’ to decide what risks THEY are willing to take, be it the risk of action OR inaction.

    I happen to feel personally that when this vaccine first came out (and we wrote our original article) that there hadn’t been enough testing to merit blind faith in it yet. That was my personal opinion. I weighed the potential risks of the vaccine against the alleged benefits of the vaccine, as well as the actual risks of HPV/cervical cancer and the medical histories of my family, etc. I decided that for myself and for my daughter – it was not the best choice at that time. As we’ve said many times, each person should make their own informed decisions.

  37. PH
    August 14, 2008 at 11:36 am —

    >>”The issue I wanted to address is that some people hear that the FDA approved it so that means it is absolutely, irrefutably safe.”

    These days, especially with all the MMR stuff fizzing away in the background I’d have thought few people would think approval meant a guarantee of 100% safety.
    I’d go further, and suggest that the kind of person likely to think that is possibly the kind of person whose decision making is likely not to be particularly rational even if presented with a clear list of facts.

    I’m also rather curious about the point made regarding the vaccine not being currently licensed for men.
    For a man (or rather, a boy), the risks of nasty outcomes from infection to him are much less than for a woman, (especially if he’s heterosexual), and the benefit of vaccination correspondingly smaller (5x, 10x?).

    Unless there was some reason to believe that the risks of vaccination were seriously greater for women than men, then simply looking at the potential benefits to the person being vaccinated depending on their gender, it’s clear that whenever there was enough of a balance of informed (or even guessed) risk/benefit to make a thinking female carefully consider whether she should be vaccinated, a thinking male would unavoidably be much more cautious, so the fact that males weren’t being vaccinated would be both deeply predictable, and totally irrelevant to any sensible calculation for the female.
    If her risk/benefit choice was actually anywhere remotely near a 50:50 one, his would be a no-brainer to avoid the vaccine.

    If people are going to make a choice for emotional reasons, I’m not sure what the point is of making a list of information. It seems more likely to be of use in making people feel more comfortable in the decision they already made (“Here’s another unquantifiable reason why you (I) might be right“), rather than actually informing them.

  38. August 14, 2008 at 11:42 am —

    “I’d have thought few people would think approval meant a guarantee of 100% safety.”

    Maybe not 100%, but you’d be surprised how much uninformed people really do trust the medical industry to a fault.

    The point about the vaccine not being for males (yet) was just that. Something you might not know about Gardasil. HPV does cause problems in men, although not as serious as cervical cancer, and where do we think all these women are getting HPV? From men.

    “If people are going to make a choice for emotional reasons, I’m not sure what the point is of making a list of information.”

    Who said anyone was making a choice solely for emotional reasons? Having information is never pointless.

  39. PH
    August 14, 2008 at 12:33 pm —

    Maybe not 100%, but you’d be surprised how much uninformed people really do trust the medical industry to a fault”

    But presumably few, if any, of those people are likely to happen upon a list of points about Gardasil without having first happened upon other information likely to shake their faith in medicine.

    I’d suggest that quite a few people don’t necessarily trust the medical industry to a fault, but still assume that generally, most products do more harm than good, and maybe they just decide not to waste time worrying about things once they’ve decided to trust someone, even if they might only just trust them.
    Even if there’s reasonable information out from people who are simply skeptical about the medical industry, in an area like vaccines where there’s also likely to be a deal of misinformation from people fundamentally opposed to vaccines on religious or psychological grounds, I imagine a great many people could spend a lot of time looking and still not end up significantly better-informed.

    ..and where do we think all these women are getting HPV? From men.

    So what?
    Where do we think anyone gets any infectious disease from?
    From other people (or animals).

    That doesn’t make disease prevention something that other people should be expected to do on one’s own behalf.

    Suggesting a girl gets vaccinated essentially for her own future health is a rather less tenuous argument than suggesting a young teenage boy gets vaccinated even partly for the sake of some potential distant-future girlfriend (just in case she or her parents had decided she should avoid being vaccinated).

    Having information is never pointless.

    Sometimes, having information not relevant to a decision can actually be a distraction, and effectively worse than useless.

  40. August 14, 2008 at 4:38 pm —

    But presumably few, if any, of those people are likely to happen upon a list of points about Gardasil without having first happened upon other information likely to shake their faith in medicine.

    False. Most of the people who found our list, did so because they were curious about this new vaccine they’d seen commercials for so they googled it. Most of our readers are not those who have already lost their ‘faith’ in medicine.

    Suggesting a girl gets vaccinated essentially for her own future health is a rather less tenuous argument than suggesting a young teenage boy gets vaccinated

    And we haven’t suggested that a young teenage boy should get vaccinated.

    Sometimes, having information not relevant to a decision can actually be a distraction, and effectively worse than useless.

    That’s only if the information is actually irrelevant, which we do not feel it is. It’s fine that you believe in Gardasil, but you can’t make other people believe in it the same way. Just as we are not suggesting that anyone should decline the vaccination based on what we’ve written, we’re certainly not going to run out and get it based on what you have written.

    Agree to disagree.

  41. PH
    August 14, 2008 at 8:27 pm —

    Most of our readers are not those who have already lost their ‘faith’ in medicine.

    At least at the moment, it seems they’d have to do a fair bit of scrolling to hit on you from Googling ‘gardasil’, skipping over numerous sites or news stories covering all kinds of FUD, keeping their faith all the way.
    However, that may well have been different some months ago.

    And we haven’t suggested that a young teenage boy should get vaccinated.

    By including male non-vaccination in the list, you’ve effectively suggested that boys not being vaccinated is something females should somehow take into account, even though its relevance isn’t at all obvious

    Personally, were I making the Gardasil decision for someone else, I’d try and find out what the risks really were, in some quantifiable way. That’s not necessarily easy at present, what with hype on at least one, and possibly both sides, but that’s what I’d try to do, rather than make a list of things I couldn’t attach any obvious weight to.

    I wouldn’t worry too much about the price from a safety perspective. A company is likely to sell a product for what it can think it can charge, and unless it’s making a loss per sale (unlikely), it’s likely to want to sell as many products as possible, and that holds whether it’s making a few cents or hundreds of dollars a time.
    A high cost wouldn’t obviously indicate a company was less trustworthy.
    In fact, if a company *was* trying to make up for past losses, the cheaper they were selling something, the more they might feel obliged to try and shift to make the necessary gain.
    [High] cost seems to have little/no clear bearing on the vaccine safety issue.

    I wouldn’t worry about unproven long-term efficacy in stimulating immune response if the only way to get that information was to wait longer than I could realistically afford to wait before making a decision.

  42. Cassie
    August 16, 2008 at 4:49 pm —

    Well done PH! Woot woot!

  43. PH
    August 16, 2008 at 6:23 pm —

    Actually, I’d be a bit worried about seeing things as a black/white contest.

    I wasn’t really trying to go all out for any position, more looking at selected points that had been suggested as relevant and/or implicitly leading towards a particular conclusion which just didn’t seem to carry me in that direction.

  44. August 17, 2008 at 2:31 pm —

    At least at the moment, it seems they’d have to do a fair bit of scrolling to hit on you from Googling ‘gardasil’, skipping over numerous sites or news stories covering all kinds of FUD, keeping their faith all the way.
    However, that may well have been different some months ago.

    Actually, right now we’re on the first page of results when you Google Gardasil – #10 out of more than a million. We don’t search it that often but we’ve been on page one or two of results each time we’ve looked. So no, our readers don’t have to search ‘Gardasil for people with no faith in medicine’ to find our information.

    As we said before, agree to disagree. Our piece is called 10 Things You Might Not Know About Gardasil, and that’s exactly what it is. You can declare parts of it to be irrelevant or unrelated to the way that you would make a decision, but obviously some people will agree with you and many people won’t.

  45. PH
    August 17, 2008 at 7:06 pm —

    That’s interesting.
    My access is via google.co.uk, which does put a few UK sites (14 of them) early in the listings, but sticks you at #76, with the total of earlier .coms, .orgs + .govs being 47, with 6 .cas and the remaining 8 mainly being Australian.

    I’d expected that google.co.uk might bias somewhat towards local sites, and tried to allow for that, but I didn’t realise it gave greatly different ordering even within US TLDs, when compared to google.com.
    That does seem a bit strange, but it’s always good to learn things, and I stand corrected and apologise for that.

    However, when comes to the issue of relevance, for instance of boys not yet being vaccinated, the reason I mentioned it is not just that I wouldn’t find it particularly relevant were I making a decision, but that even if I try to imagine one, I don’t really see any rational argument for why anyone should see it as relevant.

    That may well just be down to the failure of my imagination, and that’s one reason I’m interested in it, to see what I might have missed.

    I didn’t declare it to be irrelevant, I explained why I thought it wasn’t relevant, which is rather different.
    I already understand that some people might think it is relevant, I’d just like to know why they think that.

    I did find your article interesting (actually, I thought the follow-up one was probably better), though in general, I’m wary of the ‘10 things‘ format (or more generally the ’10*N things’ format) – it does have rather the ring of a fashion/movie magazine to it.

    Again, that might be just me, but when I hear ’10 things’, I do tend to reflexively wonder what the odds are of there being 10 (and only 10) things worth mentioning.

    Note, I’m not saying everyone (or every female) should run out and get vaccinated right now.
    I’m not sure what I’d do if I were put in the position of a teenage girl. It would depend greatly on circumstances, but I can certainly imagine some scenarios where I may be tempted to delay making a choice, if such a delay was permitted.

Leave a reply