On 9 September 2009, a US Food and Drug Administration (FDA) advisory panel recommended that the FDA approve Gardasil (Merck)—the quadrivalent human papillomavirus (HPV) vaccine against HPV types 6, 11, 16, and 18—for use in males aged 9-26 years to prevent genital warts (condyloma acuminata). The vaccine was 90% effective in preventing genital warts and reducing the incidence of persistent HPV 6 and HPV 11 anogenital infections1—which cause about 90% of genital warts in HPV niaive males—and 79% effective at reducing of the incidence of persistent anogenital HPV 16 infections and 96% of HPV 18 infections. Therefore, carriage in the male population of the two HPV genotypes that cause 70% of cervical cancer worldwide in women could be greatly reduced by widespread HPV vaccination. The question is should men be vaccinated?

In the linked study (doi:10.1136/bmj.b3884), Kim and Goldie report an independent analysis of the cost effectiveness of male HPV vaccination in the United States.2 They found that only under the most favorable assumptions for the benefits of adding male HPV vaccination to …