Why My Daughters - And Sons - Are Getting the HPV Vaccine

It seems like time has really flown. My eldest daughter is in 6th grade this year, and will be entering Jr. High next fall. Which means she has started her Jr. High vaccinations. (Cue ominous music…)

My daughters - and my sons as well - will be getting the HPV vaccine. Here’s why.

First, let me explain that I am a proponent of vaccines in general. It has been immensely frustrating to see the panic over the last couple of decades that continues to grow, despite overwhelming evidence that vaccines are safe and effective. Even more frustrating is the fact that the panic all stems from a fraudulent “research study” published by a man named Andrew Wakefield back in 1998 claiming to find a link between vaccines and autism. Without getting into the entire issue, I will simply point out that Wakefield had a clear conflict of interest (his plan to market, along with a personal injury attorney, a supposed medical “treatment” for autism), cherry picked his 12 case studies, and in general, didn’t follow basic accepted techniques for a meaningful study. I will repeat in case anyone missed it, this was all based on 12 - a mere dozen - patients, who were cherry picked by Wakefield to support his theory. In most circles, we call this fraud, but apparently there is a significant contingent that remains willfully blind to it. Whatever the case is, there were a good number of larger studies, with the correct control groups, that were conducted that showed no statistically significant correlation (let alone causation) between vaccination and autism. This is all readily available information, but the conspiracy theories and fears remain. 

One of my favorite science authors, Phil Plait (see my review of Death From the Skies), has referred to vaccine panic as the Young Earth Creationism of the left. Now, I agree with him that it is an equally irrational position, believed in the teeth of the evidence as is YEC, and that it does infect a certain contingent of leftists. However, in my experience, it is equally popular on the right. I also believe that a certain amount of the panic on the right can be attributed to another factor that doesn’t play out in leftist circles.

I know this is just anecdotal evidence, but I strongly suspect it plays out on a broad scale. With the exception of those right-leaning friends and acquaintances who have been into alternative medicine snake oil for decades (which means they have a lot in common with leftist anti-vaxers), the anti-vaccine panic in right-leaning circles really gained traction starting in 2006.

What happened in 2006?

The HPV vaccine Gardasil was approved in the United States. The rise of the internet - and Facebook in particular - contributed as well, but I believe this one vaccine sent many parents looking for reasons to skip the vaccine, and fell right into the clutches of the quacks peddling anti-vax lunacy.

If my lifelong experience in Conservative Christian circles has taught me anything, it is that the one topic which brings out the most irrationality and damaging panics is that of sex.

Sex may sell, but fear sells better, and fear of sex sells better than anything else in Christian circles.

My experience has been that, with the crunchy hippie exception, the vaccine panic took off once a vaccine for a sexually transmitted infection was released.

As Professor Harold Hill put it, “Mass-staria!”

Obviously [sarcasm font], this vaccine was a leftist conspiracy to get our young people to have more sex!

I’ll do my best to rebut that in a bit, but first, what are the actual facts?

Facts about the Human Papilloma Virus

I’d probably skip this segment, except that I am willing to wager (from my own experience) that many who are passionate anti-vaxxers don’t really know much about HPV beyond the name.

First of all, let’s call it what it is: warts. In really awkward places. That’s not pleasant.

And worse than that, some strains have a bad habit of turning into cancer. In really awkward places. That can kill you.

If you are a woman, HPV can also cause infertility. Also not a really great outcome, at least if you want kids.

So, you generally do not want to get this disease. At best, you get warts in awkward places.

It’s not difficult to get either. The best estimates for the United States indicate that 80% percent of women will contract at least one strain by age 50, with men close behind.

While most won’t get cancer, plenty do. There are about 12,000 cervical cancer diagnoses every year in the United States, with around 4,000 deaths. 

Worldwide, the mortality number is estimated to be 275,000 yearly. (By contrast, the yearly worldwide death toll from war is estimated at 55,000.) No matter how you slice it, that’s a large number.

I have had a couple of clients who had cervical cancer, and my wife has some co-workers and acquaintances who either have had it, or currently have it - and the prognosis isn't good for some of them. This isn’t surprising. It is out there, and it kills.

And that isn’t counting the other cancers associated with HPV. Recently, actor Michael Douglas reported that he was suffering from oral cancer, most likely caused by an HPV infection.

I suspect many of my Evangelical friends, particularly the older ones, will clutch their pearls, and dismiss this as just something that happens to those vile Hollywood types, who presumably sleep around all the time. (And have oral sex. The horror!) Of course, this is a rather dismissive attitude to have, but beyond that, it is foolish. It isn’t that hard to catch HPV, and many people have it. One exposure, and you could end up with cancer.

So much for the reasons to want to avoid said disease. What about the vaccine?

Facts about the vaccine

All vaccines have some incidence of adverse effects. So do all drugs, herbs, and pretty much everything else we might possibly contact, ingest, or do. Of the most common activities, use of an automobile is probably the most risky, but most of us do it anyway. So the question is not, “could there possibly be a risk,” but “is the risk high enough to outweigh the benefit.” I would have thought this was common sense, but research shows that humans tend to overestimate risk, while underestimating benefits in many cases. This is why people can get in a car despite a high risk, but get freaked out about extremely unlikely events like shark bites. Another example would be the way people can be paralyzed about the possibility of a stranger abduction, even though most sexual assault comes from someone the victim knows well. The unusual is more frightening than the mundane.

In general, vaccines carry an extremely small risk, both numerically and in terms of likely harm in the more serious cases. In fact, the risk from the disease itself is far greater than from the vaccine. (Um, that’s why we use them, right?) Again, the risks associated with any vaccine are extremely low.

However, even as far as vaccines go, the HPV vaccine is safe. In fact, it has fewer adverse reactions than the average vaccine. Perhaps this is because it is newer, and the science is better? Perhaps.

Let’s look at actual numbers. In the eight years it has been licensed, there have been about 12,000 reported adverse events. (Out of more than 23 million vaccinated.) That’s just a few more reactions in eight years than there are cervical cancer diagnoses in every year. What qualifies as an adverse event? It’s not a hard bar to clear. The most common ones were...wait for it...redness and swelling at the vaccine site. Also common was fainting, dizziness, and vomiting.

Hmm.

This should come as no surprise. These are all common symptoms of a common item: the needle.

I am a regular blood donor, working on my 10th gallon. That’s 80 donations. I have had two “adverse events” myself. The first time I donated, I stupidly reopened my puncture, and bled all over. (Don't ask. It was stupid and embarrassing...) My then girlfriend (now wife) had to catch me. Another time, someone else fainted after donating, and it got to me. I had to be given a cold pack before I fainted. It’s natural. Blood or needles.

These are the “adverse effects” we are talking about in the vast majority of the cases.

My wife, who is not only a nurse, but worked in a pediatrician’s office during nursing school, has a theory about this. The HPV vaccine is primarily given to middle school kids. When she assisted with vaccines, the worst, by far, were 12 year olds. Particularly 12 year old boys, who sometimes had to be physically restrained for shots. (I would have been embarrassed at age 7, let alone age 12, but whatever.) So, the idea that there was plenty of fainting and complaints of pain from humanity’s most theatrical age should come as no surprise.

I won’t go through it all, but you can read the CDC fact sheet on all this. I’ll merely note that in all the cases where deaths were reported subsequent to an HPV vaccination, the autopsy revealed a cause of death unrelated to the vaccine.

I’ll add my own bit to this, from the mouth of my own 11 year old. She got four shots, the last of which was (intentionally) the HPV shot. She said the others weren’t bad, but the HPV one hurt. She’s tough, so that meant it hurt. (This is the girl who fell off a wall, cutting her leg down to the viscera, and still had the presence of mind to notice that the viscera was interesting. I think she was 8 or 9 at the time.) She didn’t faint after the vaccination, and she did her gymnastics class without incident the next day. No big deal.

Is the vaccine effective?

It turns out, yes it is! Despite a low vaccination rate of around 33%, the incidence in girls 13-18 has been reduced by more than half. Imagine if it was universally used.

That’s the truth about the vaccine. So why is it such a huge controversy in Evangelical circles?

Sex

I’ve noted this before several times in connection with other topics, but for some reason, Evangelicals absolutely freak out and do batshit crazy things whenever fear of sex is involved. It’s how you get the courtship/betrothal movement, the perpetuation of Rape Culture through slut shaming, and how you get fanatical opposition to a useful vaccine.

I remember when the vaccine first started trials. Predictably, Evangelicals everywhere started saying that if you gave your daughter this vaccine, she would have less incentive to avoid sex before marriage.

Really?

I remember hearing this argument from my youth, and I never bought it. I mean, really. There are a variety of situations where one might have sex, and I don’t think any of us would calculate, “Let’s see, I could catch, say, 22 diseases. Oh, wait, it’s only 21. I’m good!” This is to say nothing of the risk of pregnancy, for that matter. But even then, for the very most rational of us (the Spocks of sex…), the difference between herpes and herpes plus HPV is unlikely to change behavior one iota. For the more normal situation, the decision to have sex, or to use protection, is likely made without reference to any particular disease. It is made from hormones and desire. The more prepared and rational use at least some protection. The others don’t.

So, does the HPV vaccine make a difference in sexual behavior?

Absolutely freaking not.

Here is the relevant study. (There are others too. I just link one of several.) Guess what? No difference. 

I’m not surprised.

The Evangelical Obsession with (Female) Virginity

I’ve been thinking about this a good bit, in connection with my Modesty Culture series, and also in connection with my observation of Evangelicalism during my life of experience.

I believe that there is a bit of a sadistic side to our tribe, that really, really, wants to see sexual sinners punished severely for their sins.

We want to see blood, death, abject misery.

This is why we resist AIDS research. At least as long as it was associated primarily with homosexual men. Because we really wanted to see them die. 

We were Jonah sitting outside the gates of Nineveh, waiting eagerly for the smiting.

And so it is with (women) who fail to meet our standards of purity. We really, really want to see them punished to the utmost for their sins. (We can’t stone them anymore, at least in the Western world.)

I believe that this is a significant reason for the resistance to this vaccine, and why I also believe that it would have been a different story if the consequences of the disease fell primarily on men, rather than women.

After all, it is mostly women who suffer the infertility, cancer, and death. They are (presumably) sluts who weren’t careful who they screwed, and now they pay the penalty. If the primary result of HPV was that penises fell off, I strongly suspect the discussion would be completely different.

Even for those who lack the true inner sadism, I believe there is a deadly fear of young people, particularly women, having sex. Thus, losing even one potential deterrent is terrifying. If the primary goal is to deter sex before marriage (which is, after all, the worst sin except for homosexuality), then all extreme measures are justified. The saving of the soul is more important than the prevention of death of the body.

Likewise for birth control. While my parents did a fantastic job of educating me about sex, birth control, and STIs, many Evangelical parents believe that to explain birth control and disease prevention is tantamount to giving permission and encouragement to have wanton random sex. (Again, the evidence is contrary, but that is a subject for a future post.)

But the bottom line is, that there is a widespread belief that having sex before marriage is a much worse event than the possible preventable consequences. If a girl (let’s be honest, this is primarily about women and sex) has sex, she might as well (and probably should) get pregnant and die young as an example to other girls to avoid her fate.

And hence the hostility.

I have a number of problems with this. Theologically, it is problematic to tie a woman’s worth to her virginity, although it sure is a cultural constant over the course of recorded history. But we seem eager to dismiss the worth of those who have failed to follow the rules.

I believe, however, that this is not only lacking in empathy and compassion, it also flies in the face of the actual real-world risks.

It’s possible to catch HPV without being a slut

I know this will come as a terrible surprise to many older Evangelicals - although it shouldn’t. Even within the most conservative circles, very few people - even Christians -  are virgins on their wedding night.

I know. Terribly shocking.

Statistically speaking, most are not. And probably even more rare is the couple where both are virgins. Sure, it happens. But it is far from universal. Also, this is nothing new. Rates of premarital sex have been north of 85% since the 1940s. (Yes, the “greatest generation.” Many of whom probably continued the age-old tradition of having a little fun with the local whores while on deployment...the double standard sure rocks.)

Beyond the statistics, however, let’s examine the implications. If the only people who are “acceptable” are those who are virgins on the wedding night, what does that say about Christianity? Are the only people we care about the few that lack a sexual history? Should everyone else be dismissed?

What about someone who comes to the faith later in life? Do we still wish for them to be punished as much as possible for their past failings? (Don’t answer that. I suspect I know the answer.)

As someone who works on the legal areas of Family Law and Estate Planning, I get to know a bit of information about people. Nothing like comparing marriage dates and birth dates of the children to reveal something about many wonderful, religious people. It is a common human event, shall we say. And believe me, you don’t know by looking at people. Many of them make it 50+ years and are some of the best people you have ever met…

But let me make this more personal. And yes, if you are a high profile pastor and author, you are fair game. Particularly if you made your reputation preaching “purity culture.”

Josh Harris Didn’t Marry a Virgin

Veterans of the homeschool movement all know about Josh Harris. Son of Gregg Harris, one of the luminaries of the early movement (and probably the least nutty of the Reconstructionists.) Josh wrote I Kissed Dating Goodbye, probably the most influential piece of work in the history of the Courtship movement. It took the idea mainstream, beyond the environs of Bill Gothard’s cult movement.

The point of “courtship,” if it wasn’t obvious, is to prevent young people from entering romantic relationships in any way that might lead to sex before marriage. In the most extreme (betrothal) cases, the couple was not allowed to develop feelings of any nature, before they were irrevocably committed.

My wife attended a few homeschool conferences at which Josh spoke, and she can attest that all the good Patriarchy girls were mooning over the outrageously hunky Josh, and dreaming of the day when they could marry him - or at least someone like him.

So what happened?

Josh not only didn’t follow his own courtship prescription - he dated just like anyone else from the secular culture - he married a girl with a sexual past! He admits as much in his book, Boy Meets Girl.

Now, let me say at the outset that I have zero problem with this. He met a girl and fell in love. I would imagine she is a decent sort. Love is unpredictable sometimes, and I find no shame in unexpected love. Hey, I don’t believe in “love at first sight,” but… 

But think of the poor Patriarchy girls that kept themselves pure - without even a hint of romantic involvement with anyone - until the time that a young man approached their fathers. They were promised, explicitly or implicitly, that the Josh Harrises of the world were available only to the pure, and that they would receive the reward of their purity. (And, I might add, many of these girls were not permitted to attend college, because their destiny was to be a wife and mother. Oh, and did I mention that Josh met his wife at their mutual place of work? Hmm.)

Okay, so that happened. How does this relate to the HPV vaccine? Well, because his wife has a history, she might (potentially) have HPV. In the Fundie worldview, she would richly deserve to become ill as punishment for having sex. But what about Josh? He might catch the disease from her and become ill. Should he be punished for not marrying a virgin? (Again, don’t answer that…)

But what if you flipped the script? Even Fundies tend to - in practice - support a sexual double standard. A man can reform after a wild youth, unlike the forever-tainted woman. What about the D-Day soldier, American hero, who had one night with a local girl, but returned and married the wholesome Donna Reed sort? He could be infected, and not know it. She then marries him, not knowing his past, gets sick, and pays the penalty for his past indiscretions. Do we punish her? She couldn’t guarantee she knew his history?

Or what about the woman whose spouse cheats on her, eventually infecting her. Do we wish cancer on her as well?

Or what about the worst case scenario that we hate to even contemplate? What if the woman was raped as a teen? Surely she didn’t choose her partner in that case! Unless we consider her responsible for her rape. (Wait! Don’t answer that one either!)

This reaches a lot further than just the person who initially caught the infection. It can have negative effects on down the line, from the “innocent” spouse to the children who may have an ill or dead parent.

Sexual Sin is the one we care about punishing

Did you know that the direct costs (medical expenses) of diabetes in the United States was around $176 billion in 2013? That’s close to double the annual budget of the State of California (my home state). If it were a country, California would have the 6th largest economy in the world. And its budget is significantly lower than the cost of diabetes in the United States.

I know there are exceptions, but a significant percentage of the diabetes in Western nations - particularly the US - is caused by obesity. In traditional Christian terms, we might say “gluttony.” (Again, I am oversimplifying. Obviously, overeating is a factor, but not the only factor. Just like promiscuity is a factor in the transmission of HPV, but not the only factor.) So, one could arguably attribute this disease to sin.

We are spending a lot of money on mitigating the effects of that sin.

Why are we okay with trying to mitigate the effects of gluttony, but not sex? Is it just because we can’t think logically when sex is involved? Or is it because of the need to control young people? Do the sins of older people not really count? I don’t get it.

I sometimes feel that this issue reveals the insecurities of our tribe. We are deathly afraid that we really don’t have a convincing case for some of our doctrines, so we panic when we lose any weapon, no matter how small. Losing even one STI as a threat scares us. If we were really confident that we had a solid case, I don’t think we would feel the need to make dire threats about death, disease, and hellfire. But I think the older generation in particular is terrified that the younger generations, even Purity Culture luminaries like Josh Harris, don’t find that a girl’s virginity is the most important thing about her. (For a bit more on this, check out this installment of my Modesty Culture series: it’s at the bottom in the footnote section.)\

The bottom line

I believe the science is in favor of vaccinations in general, and the HPV vaccine in particular. I strongly doubt that vaccination status will have any effect on the sexual decisions my children make. If they marry virgins, stay faithful, and only ever have one partner, then I suppose they might get a needle stick for no reason. But they can only control themselves, not their partners. Why not have the extra protection against the sins of a partner? 

Will it provide complete protection against disease and pregnancy? Of course not! But why not reduce the risks we can? 

But more than that, I don’t believe that it is my job to ensure that my children are punished for any possible future sexual sin. Life is messy. My own extended family has its own failures. Crap happens. We make mistakes. Sex happens. I don’t believe I will be thwarting divine justice by reducing the consequences of human frailty. Whether it is my child that has an encounter leading to exposure, or their eventual spouse, I would prefer that they not suffer lifelong and possibly fatal consequences for that mistake.

My approach to sex and sex education is better left to a future post. Suffice it to say that so much of our current Evangelical fixation is inextricably bound up with a view of women as property, which leads to an obsession with female purity and modesty. My approach leans toward a strong emphasis on consent, and in linking sex and love rather than sex and power.

Some links:

This is my go-to resource for actual facts regarding vaccinations. It is a wealth of primary source, and links reliable sources, not conspiracy theory artists like Joseph Mercola and Mike Adams. 

Another great source of information, updated regularly, about “alternative medicine” falsehoods and the actual research is this site.

My own post from last year on cancer, pseudoscience, and victim-blaming. 

Late addition: An excellent take on the "mitigating the effects of sin" debate from the Christian Medical Fellowship (UK)

Just a bit on naturalnews.com

I considered doing a separate post on this one, and I might reproduce and expand this bit in the future.

Before I figured out how to block links from specific sites in my Facebook news feed, I noticed that a number of my friends - both liberal and conservative - were posting links from this site. Many of these people were otherwise intelligent and well read sorts, who I would not have suspected of being gullible.

Still, the headlines seemed so obviously out there that I did a little poking around. It turns out that Natural News is a site run by a certain Mike Adams. In many ways, it is pretty typical for alternative medicine snake oil. It has the usual canards: vaccines cause autism (no), fluoride is the cause of most heart disease (no), everything can be cured with diet and herbs (um, no), and recently (although the post was removed) that Ebola can be cured with herbal supplements (um, freaking no).

But, I do want to point out that he also uses his site to promote some even more out there conspiracy theories. To my friends who link this guy, you need to consider if you really want to be associated with these ideas.

For example, he is a “birther” (President Obama wasn’t born in the US, and there is a huge conspiracy to cover it up), a “truther” (9/11 was an inside job, the project of GW Bush and a Jewish cabal), and claims that the Sandy Hook shooting was a government fabrication.

Oh, and he is also an AIDS denialist, and claims that contrails from airplanes are actually “chemtrails,” intentional spraying of poison by the government. Um, yeah. That’s your go-to guy for medical information. Good luck with that.

Oh, and Mercola too:

Many of my gluten free friends like to quote this guy. (Note: celiac disease is real, and if you have been diagnosed with it, don’t eat gluten!) He is probably the most popular proponent of the idea that all humans should stop eating grains.

Guess what? He is also an anti vaccination advocate.

And an AIDS denialist. Yep.

And he has been disciplined by the FDA for making false medical claims about his lucrative supplements and selling untested supplements. (In other words, God only knows if his supplements actually contain what they claim to contain.)

Cite at your own risk.

The AIDS denialist brotherhood:

Adams and Mercola are in “distinguished” company with their AIDS denialism. The ever-entertaining-and-loathsome Douglas Wilson, he of the plagiarized pamphlet and book defending the institution of slavery, and he of the “A man penetrates, conquers, colonizes, plants” fame.

Yes indeed, these are your AIDS denialist brothers...

Check your sources:

Seriously, the internet has made it comically easy to actually check the abstracts of studies - and in many cases, read the full reports. There is a wealth of knowledge available to help determine what studies actually say, and whether they are particularly useful. (A knowledge of the science of statistics is probably helpful too.) Only the most lazy or ideological simply link questionable stories from sources given to fabrication and conspiracy theories. 

At best, you will reveal yourself to me and others who actually do look at primary sources to be lazy and deluded. At worst, you could end up harming yourself or others with "treatments" that don't work and can cause harm.  

Update February 14, 2015:

There is a new study out on the issue of whether the HPV Vaccine increases risky sexual behaviors. Guess what? 

IT DOESN'T. 

This is a 5 year study involving a large number of individuals. You can read the JAMA summary here.    

And yet, the single biggest reason that parents refused the vaccine was fear that giving it would increase promiscuity. You can read the abstract of that study here.

Update April 21, 2015:

Hey, yet ANOTHER study showing that there is no correlation, let alone causation, between MMR and autism. Here is the abstract on JAMA. This is a large sample (97,000) study, using medical records (from insurers) for both vaccination and autism spectrum statistics. An interesting fact: of those children with an older sibling with ASD - and thus at more risk for ASD themselves (genetics, yo!), there was no difference in rates of ASD between vaccinated and unvaccinated. So even among the most at risk, vaccines have ZERO EFFECT.

Update July 31, 2015:

Indeed, here is yet another substantial bit of evidence that the HPV vaccine is thoroughly safe. This  research combines the results of clinical trials, studies, and other data, involving millions of vaccinated individuals (far from the dozen used by Andrew Wakefield in his fraudulent "study"), which shows zero correlation - let alone causation - between the HPV vaccine and autoimmune diseases, nervous system disorders, anaphylaxis, blood clots and stroke. This is in direct contradiction to some recent inflammatory headlines by irresponsible journalists. Once you look at the actual data, not a couple of anecdotes, the evidence is clear: the HPV vaccine is safe, and does not increase sexual activity.