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Poor Science Communication endangers public health

I have a pretty impressive stack of ‘Science’ and ‘Journal of Immunology’ journals stacked on my study desk. Well, they would be impressive if they were not in the ‘To Be Read’ pile.

I had an opportunity to make some headway into this pile today and started reading the 4 October 2013 issue of Science featuring a number of articles about science communication. So far, everything I’ve read has been good, but I just put down a fantastic article by Dan Kahan entitled “A Risky Communication Environment for Vaccines.”

Several aspects of this article make it one of the best I’ve read in some time.

1. Simple, clear writingImage

2. A clear mission of improving public health by insisting on the scientific community to do a better job of talking about its work with the public

3. A novel, data-supported argument exposing how misinformation among scientists leads to misinformation in the public

4. A level-headed explanation of how key decisions should be made in order to obtain the most desirable results (again, increased public health)

It’s widely recognized that Merck made a severe mistake in the marketing and legislative lobbying done to promote mandatory adoption of its HPV vaccine , Gardasil. However, Kahan goes further to illustrate how a very similar vaccine (against Hepatitis B) was previously introduced without a lobbying effort and resulted in widespread adoption of the vaccine without significant resistance from the public. Kahan writes:

Had the HPV vaccine taken this path, it would have followed the uneventful course that marked introduction of the hepatitis B virus (HBV) vaccine into the U.S. public health system. Hepatitis B, like HPV, is sexually transmitted and causes cancer (6). The CDC endorsed universal childhood HBV vaccination—for boys and girls, a much less jarring proposal—in the 1990s. There was no political controversy. Rather, states steadily added the HBV vaccine to mandatory vaccination schedules through the customary mechanism—not high-profile legislative enactments, but guidelines routinely promulgated by public health administrators operating outside the political realm (7).”

Also check out the Podcast Interview with the author, Dan Kahan at ScienceMag.com.

He then goes on to warn against aggressive promotion of vaccines as this can often backfire psychologically and provide fuel for the fire of an anti-vaccine movement. This is exactly what James Colgrove predicted in his Perspective article in the 2006 New England Journal of Medicine when he warned that, “Moves to make the vaccine compulsory are sure to ignite a new round of polarizing debates.” Yet, he goes on to reiterate the importance of (near) universal vaccination in protecting out most vulnerable:

Laws making vaccination compulsory raise unique ethical and policy issues. High levels of herd immunity protect all members of the community, including those who cannot receive vaccines because of medical contraindications. This protection provides a justification for compulsion. The availability of religious or philosophical exemptions mitigates concern about governmental intrusion on individual decision making. Opinions vary, however, about the permissible scope of exemptions. Data show that schools with exemption rates as low as 2 to 4% are at increased risk for disease outbreaks and that children who have been exempted from vaccine requirements have a much greater risk of acquiring infectious diseases than their vaccinated peers.1 Minors have a right to be protected against vaccine-preventable illness, and society has an interest in safeguarding the welfare of children who may be harmed by the choices of their parents or guardians.”

Luckily, these great articles about scientific communication are freely available on the website links above.

It’s embarrassing that a (admittedly fantastic) comic like Calvin and Hobbes can communicate more in one page that many scientists can over the course of their entire careers. Bill Waterson asks, “Is it sometimes valuable to give up just a little freedom if all society can work better because of it? …”

Ethicshobb

 
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Posted by on November 9, 2013 in Uncategorized

 

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HPV Vaccine Success in Australia

The April 18, 2013 edition of the British Medical Journal contained the results of Australia’s new campaign to vaccinate young women against the Human Papillomavirus (HPV), associated with genital warts and an increased incidence of cervical cancer. This news was brought to my attention by a Slate article by Phil Plait discussing the politics of vaccination and how they get particularly how when the vaccine in question is against a STD. I suggest you read that article if you have any interest in exploring that hot-button topic and how it goes head-to-head-against an abstinence-only policy.

Although those questions intrigue me, I simply want to point out the data behind HPV and how the new vaccines are dramatically effective. First, I think it’s important to examine just who has HPV.

ImageAccording to the CDC’s report on HPV, approximately 79,000,000+ people in the USA have HPV. That’s a pretty high number given that the Jul 2011 US census reported that the US population is only 311,591,917 – and about 70 million of those people are under 17, the average age the Kinsey Institute reports that kids lose their virginity. Let’s call it half of Americans who have had sex, also have HPV – this estimate agrees with the CDC’s data on HPV.

ImageThere are a number of different HPV viruses and some of them are more dangerous than others. Of the ~40 strains of HPV, two of them (6 and 11) are responsible for most genital warts, but are not associated with cancer, whereas two different strains (16 and 18) are linked to the majority of cervical cancer cases. Gardasil, a quadrivalent vaccine made by Merck, protects against all four of these strains, while Cervarix is a bivalent vaccine made by GlaxoSmithKline and protects against strains 16 and 18.

In 2007, Australia began offering free vaccinations against HPV for girls 12-13 years old. Fortunately, the vaccine being offered was the Merck vaccine, so the efficacy of the vaccine could be readily tracked by using genital warts as an indicator rather than having to wait to measure cervical cancer rates at a much later time point. The caveat is that this trial assumes that the reduction in genital warts accurately models an expected reduction in cervical cancer, despite the two conditions resulting from different strains of the virus. I’m comfortable with this assumption, but I do think that caveat needs to be kept in mind.

So, what are the results? It’s been five years. According to estimates from the US population, these girls should be starting to have sex now. Are they getting genital warts?

“In the vaccination period, the proportion declined dramatically by 92.6%, to 0.85% in 2011”

Image Further, not only are fewer vaccinated girls developing genital warts, but it looks like the vaccination campaign in also benefiting unvaccinated girls as well (although this is an assumption about causality on my part). 

Image

Remember, not ALL genital warts are caused by the four strains in the vaccine – and, these vaccines will only work on people who have not caught HPV already.

   Altogether, this looks to be a whoppingly successful campaign – one that the US should strongly consider mimicking.

 

 

 

 
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Posted by on May 3, 2013 in Uncategorized

 

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