Intended for healthcare professionals

Practice 10 Minute Consultation

Discussing human papilloma virus vaccination

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2730 (Published 22 June 2017) Cite this as: BMJ 2017;357:j2730

Re: Discussing human papilloma virus vaccination

Discussing human papilloma virus (HPV) vaccination in a comprehensive and open minded way, with young people and their parents, is an ideal to which we should all aspire.

Such is the amount of misinformation in the medical and public press, and so large are the profits to be made - “ Gardasil brought in $1.7billion for Merck “ (1) that Tom Jefferson, reviewer for the Cochrane Collaboration, and vaccine expert, remarked that “ the HPV vaccines’ benefits have been hyped, and the harms hardly investigated. It is extremely difficult to publish anything against HPV vaccination. Vaccines have become like a religion. They are not something you question. If you do, you are seen as an anti -vaccine extremist. “ (2)

Quah and Aggarwal point out that “ evidence on long term immunogenicity and prevention of cervical cancer is not available “, which may sound odd, if explained, as it should be, to young people and adults who assume from media hype that their life time cancer risk will be reduced by the HPV vaccine.
The authors do not enlarge on the evidence regarding the frequency and seriousness of alleged side effects, and the many deaths that have been reported, (3,4,5) following injection of a vaccine whose long term effects are unknown.

The suggestion in an earlier response from Peter MB English that “ a tentative “are you sure ? “ approach by healthcare workers is associated with a poorer uptake than a more direct “announcement” style of communication”, is interesting. He seems to assume that the higher the uptake of HPV vaccine, the better, something that many people who are aware of the uncertain safety profile of the vaccine would not agree with. (6)
The suggestion by English that one suitable approach is to say “ You’ve come for your HPV vaccine to prevent cervical cancer ? Are you happy for me to go ahead ? “ raises further problems.
Where is the evidence that the vaccine prevents cervical cancer ?
See the quote from Quah and Aggarwal above.
How well does the “announcement” style of communication suggested by English, fit with our current UK situation, following the Montgomery case ?
The onus is now on doctors to provide all relevant information about the risks of any proposed treatment, to enable fully informed consent.
Godlee, in a BMJ editorial, pointed out that such essential information does not simply reflect “.. a responsible body of medical opinion, the judgement now rests with ‘ a reasonable person in the patient’s position’ “. (7)

There can be few more important topics for doctors to consider and discuss, as part of their CPD/CME, than the ambivalent roles of HPV vaccines, as a means to affect, for better or worse, peoples’ health and well being.

Does this article help to clarify the issues, in a debate already beset by concerns about transparency, and possible conflicts of interest ? (2,6)

Some readers may be impressed by the confident advice in this article, and conclude that much anxiety about the vaccine is, as English writes, “ misplaced and undue “.

Others may wish to seek out more information, on side effects, safety and effectiveness, and patient experiences, before reaching conclusions about HPV vaccines.

1 http://www.globalresearch.ca/big-pharma-and-big-profits-the-multibillion...

2 http://www.dailymail.co.uk/health/article-3106372/Just-safe-cervical-can...

3 https://www.cdc.gov/vaccinesafety/vaccines/hpv/hpv-safety-faqs.html#A7

4 http://www.trueactivist.com/its-official-139-girls-have-died-from-hpv-va...

5 Jonathan Irwin describes the alleged effects of HPV vaccine on his daughter, and the difficulties in accessing advice and support from various sources. https://www.youtube.com/watch?v=yeP-eIyibQM

6 https://over-vaccination.net/cochrane-collaboration/

7 New rules of consent : the patient decides. http://www.bmj.com/content/350/bmj.h1534

Competing interests: No competing interests

27 June 2017
Noel Thomas
retd/part time GP
BronyGarn, Maesteg, Wales CF34 9AL