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?