Playing chicken with cancer

Yes­ter­day Gov Jer­ry Brown signed into law AB 499 which allows minor chil­dren age 12 or old­er to give legal con­sent for treat­ment for sex­u­al­ly trans­mit­ted dis­eases with­out parental con­sent or notice. This bill (now part of the Cal­i­for­nia Fam­i­ly Code) has gained tremen­dous noto­ri­ety because of its asso­ci­a­tion with the vac­cine Gar­dasil, the same vac­cine for which Gov Rick Per­ry of Texas has endured crit­i­cism recent­ly. Gov Per­ry signed an exec­u­tive order in 2007 which man­dat­ed that girls be vac­ci­nat­ed before enter­ing the sixth grade. Gar­dasil pre­vents Human Papil­lo­mavirus infec­tion of strains that have been shown to be the cause of cer­vi­cal cancer.

Per­ry’s deci­sion was bad for a num­ber of rea­sons. He over­reached his author­i­ty with an exec­u­tive order and doing so would have ben­e­fit­ted Mer­ck, a com­pa­ny with which Gov Per­ry had finan­cial ties. While there may not have been any impro­pri­ety, some­thing with that much appear­ance of impro­pri­ety should have gone through the leg­is­la­ture rather than get exe­cut­ed by one indi­vid­ual who will be sus­pect­ed of cor­rupt motives.

Though Gar­dasil is not men­tioned in AB 499 — in fact vac­ci­na­tion itself is not men­tioned in the bill though it is like­ly on a list of approved treat­ments else­where — HPV vac­ci­na­tion has once again become a hot top­ic. As a sec­ondary issue, my read­ing of the bill indi­cates that it does not cov­er pre­ven­ta­tive vac­cines but only treat­ments after a child has had sex­u­al con­tact. This is when Gar­dasil would be too late. But the news peo­ple are up in arms about Gar­dasil so I have to assume that spec­i­fi­ca­tions else­where in the fam­i­ly code pro­vide for vac­ci­na­tions with the mod­i­fi­ca­tion in the law.

I’m afraid I still fail to see why this is such a big deal. I under­stand the parental rights argu­ment on prin­ci­ple but I have no idea why there is this cloud of stig­ma around vac­ci­nat­ing young girls (and young men as well since HPV has now been shown to cause throat can­cers in men) against HPV. I don’t under­stand why any­one would want anonymi­ty (beyond basic med­ical record pri­va­cy) about get­ting this vaccine.

##Sex changes everything

The only rea­son I can think of (per­haps some­one can help me out with more rea­sons?) is that there is an asso­ci­a­tion with immoral behav­ior because HPV is sex­u­al­ly trans­mit­ted. And that asso­ci­a­tion makes no log­i­cal sense to me. I know par­ents think «oh she’s my lit­tle princess» or what­ev­er and can’t bear to think about their daugh­ters ever hav­ing sex, but turn the ques­tion around: do they want grand­chil­dren some­day? Most par­ents want to be grand­par­ents. Heck, I’m not a par­ent and I want to be a grand­par­ent. News flash: you can’t be a grand­par­ent unless your child has sex. (Well, OK, there is adop­tion, but lets set that aside for the moment.)

I know the ques­tion is: when will your daugh­ter start hav­ing sex? Do you count on the fact that she won’t have sex until after she’s 30 and hold off on the life­sav­ing vac­cine until she’s 29? Maybe vac­ci­nate her when she’s twen­ty and make sure to pro­vide lots of lec­tures about the virtues of vir­gin­i­ty until at least age 21? I hope you’re laugh­ing because these are ridicu­lous to me. Well, how about when she turns 18? Every­one knows that 17-year-olds nev­er have sex, right? 15? Sor­ry, yes it’s trou­bling, but I know at least a half-dozen women whose first sex­u­al expe­ri­ence was at 12 or 13. And it’s not like I go around ask­ing women about their sex lives, so that’s at least six out of not very many. If it were my daugh­ter, she’d be vac­ci­nat­ed by 12 and if she nev­er had sex before it was time for the next round of vac­ci­na­tions that would be just fine with me.

##Wait­ing for the last minute

I ride a motor­cy­cle, and once out of every cou­ple hun­dred times I ride the motor­cy­cle I’ll have a minor acci­dent of some kind, maybe hit a slip­pery patch and fall off the bike. Once in the 40,000 miles I’ve rid­den I was hit by a car. So here’s the ques­tion: when should I have start­ed to wear a hel­met? I did­n’t have my first minor acci­dent until I’d been rid­ing for five months, so should I have wait­ed four and a half months before buy­ing a helmet?

Of course not! Get­ting vac­ci­nat­ed against a virus that caus­es can­cer is not some­thing to wait until the last minute to do. It’s some­thing to do ear­ly and be safe rather than sor­ry. Yes, it’s a vac­cine against a sex­u­al­ly trans­mit­ted virus but the strains of HPV that cause can­cer can hard­ly be called a dis­ease. If they did­n’t cause can­cer there would be no rea­son to get vac­ci­nat­ed. Oth­er than caus­ing can­cer, there are no symp­toms. (Oth­er strains of the virus — includ­ing some strains pre­vent­ed by Gar­dasil — do cause gen­i­tal warts but those strains are not linked to cancer.)

So the whole notion that a girl would get vac­ci­nat­ed with­out parental knowl­edge because the par­ents might find out she’s think­ing about hav­ing sex is, in my mind, wrong­head­ed. Girls should­n’t wait until they are plan­ning to have sex soon before get­ting the vac­cine. They should get the vac­cine before they start plan­ning to have sex. Oth­er­wise they’re just play­ing chick­en; the virus is dri­ving straight at them but they won’t get vac­ci­nat­ed until the last pos­si­ble moment.

Any par­ent who would accuse their daugh­ter of immoral­i­ty because she got a can­cer vac­cine ought to no longer have cus­tody of the child. At the very least, the daugh­ter’s answer to such con­cerns should be, «of course I’m not hav­ing sex. If I were, it would be too late to get my first vac­ci­na­tion.» But we def­i­nite­ly don’t want to wait until the girl is old enough to for­mu­late a ratio­nal response to an irra­tional parental accu­sa­tion. That might not hap­pen until she’s past sixty.

There are oth­er rea­sons some might be unhap­py with the bill — not only does it sus­pend parental notice, it pro­vides for the state to pay for these anony­mous treat­ments. As men­tioned ear­li­er, the text of the bill seems not to include pre­ven­ta­tive vac­cines where there has been no sex­u­al con­tact. Per­son­al­ly I’d rather see us pay for vac­cines before than treat­ment after­ward. In any event, it seems clear that there is some­thing more going on that peo­ple are unhap­py about and using Gar­dasil as a scape­goat. Unlike Per­ry’s exec­u­tive order, AB 499 was approved by the leg­is­la­ture before being signed into law and unlike Per­ry’s exec­u­tive order, AB 499 does not make vac­ci­na­tion com­pul­so­ry. So what is it that the oppo­nents of this bill aren’t talk­ing about?