Do motives count when a policy is in womens' favor?

[politicat]

This whole HPV vaccine (of which I am an ardent and fervent supporter) and mandatory vaccination (of which I am also an ardent and fervent supporter because, having done graduate work in historical epidemiology, I know from history that the ONLY way to destroy a disease is to vaccinate against it and wipe it out of the host population) argument is really getting on my last nerve.

Here's why: 99% of the time, women's health care public policy gets the really short end of the stick. It took a federal law (that was hamstrung before it was passed) to ensure that women had access to birth control devices and drugs through their employer-provided health insurance (though it can be circumvented.) We still do not have appropriate funding for annual Pap smears for women who fall in the income gap between access to Medicaid and full employer-based insurance. We provide pre-natal care to the "fetus" not to the woman who is pregnant, and to be poor and want or need an abortion is to usually go wanting because of the Hyde Amendment. Older women are still not getting the proper screening for osteoporosis and breast and ovarian cancers.

So when a real victory for women's health care -- a vaccine against one of the nastier forms of cancer we are subjected to -- comes down the pike, is there singing and dancing in the streets? Do we react with joy, do we throw flowers at those who worked long and hard to develop it? Not really. When the vaccine came out, there was a little bit of "Huh. Kinda interesting" around, and a fair amount of grousing about the profits that the makers were going to see. (For comparison, List price for Gardisil is $120, list for varicella (chicken pox) is $80. Both require 3 doses.) Considering that in inflation adjusted dollars, the MMR and polio vaccines were pretty expensive upon introduction; the major difference was that at the time, in the US, the federal and state public health systems considered eradication of polio (especially) a priority, and so subsidized the cost of administering the vaccine; there was also a much better funded public health system though the system as a whole was more primitive.

And now... there's a lot of anger - from liberals as well as conservatives - at Perry's decision to require Gardisil for all pre-teen girls. I am pretty sure that Perry sees it as a win-win situation -- Merck makes money and makes his donors and supporters happy, while he is seen as the guy that took a stand for women's health and started the "end cervical cancer" campaign. Though it's turning into a lose-lose -- his fundie supporters hate him for not letting "God and Nature" punish women who have had sex by contracting cancer, and those liberals who might have given him some credit for doing something for women's health are more interested in setting up the pillory because the vaccine is provided by one company that is going to make money on this.

I don't like Gov Goodhair. He's rarely made a good decision, and rarely makes his improbable good decision from the right motives. And on this one, his motives are better than normal, but still not laudable. But honestly, I don't care. He's making a decision that is good for women for once in his sorry life. I am not giving him props for it -- lucking into something is not a reason for congratulations -- but I am going to be grateful that it is happening. And I am not going to complain about Merck making money. Vaccines are expensive to develop and don't pay off well. (And as a kid who got chicken pox at 16 and tried real hard to die from it, I am very grateful for every vaccine that exists.)

So it appears that I'm having problems understanding why actions that are in women's best interests also have to be taken with the right motives (which apparently exclude profit) and perhaps by the right people. This is reminding me of Molly Ivins' old rant on the best being the enemy of the better. On women's health care, I will take half a loaf or even a slice to get the rotten, dysfunctional, misogynistic old system changed. Brick by brick, baby, and a day at a time, and it if starts with an expensive vaccine that will make a lot of money for some rich old men... and just happen to save a few thousand women's lives and fortunes every year in the process... Hand me that bread knife.

Doesn't women's health care matter to liberals anymore? Or does it only matter when it's middle class mommy/wifey types getting mammograms and the pill covered, and middle class women wanting to keep their access to fertility treatments? Because what I am hearing, distilled down is this: Women's health care is not a liberal issue when it applies to young women who will become sexually active within a couple of years. They are not entitled to preventative health care, even though their moms are entitled to a similar preventative care (mammograms). And it is especially not a liberal issue when the formulator of the issue is not from our ranks and is not on our happy list. And it is most definitely an issue that liberals will despise if there are profits to be made.

If that's where liberalism in America is going, it's leaving behind the feminists.

[Morgana LaFey]

1. Oh, please

You totally lost me here: I am pretty sure that Perry sees it as a win-win situation

And I'm pretty sure he's a goddamned sociopath like Bush, whose ONLY concern is himself and his wealthy friends, so that ANY good for ANY one else is purely incidental. And, like Bush, he'd be okay with people dying later on, if it came to that.

You yourself have given a precisely honed argument as to why nothing but suspicion should go along with what you most surely think of as some pro-woman health policy decision, and I quote: 99% of the time, women's health care public policy gets the really short end of the stick.

Why do you think it's different THIS time? Because it's a win-win proposition? Hardly. Because it can make Merck a lot of money, and position Merck as THE provider of the drug before Merck's competitor can bring their to market in 6 mos. or so, and do it all completely without risk of harm (isn't that new law in place that we can't sue drug mfgrs for their vaccines??)

Please, if YOU think this is about women's health, you're just -- well, naive at best.

The damn drug has been inadequately tested (not sufficienty involving the target age groups AND not nearly long enough) and even Merck admits they have no idea how long the vaccine lasts. This is a prescription for tragedy and heartbreak, IMO, not success for women in the fight against one form of cancer.

[politicat]

3. Did you miss the part where I said I don't like Perry?

I really don't. I think he behaves poorly, makes decisions based on how well it benefits him personally, and wouldn't piss on me if I was on fire. I dislike him heartily. But the one thing I've learned in dealing with local politics is that I have to be able to see how the other guy thinks so that I can put together effective strategies to combat him/her or to get him/her to come to a compromise agreement. (Usually him. Our local selfish fat cats are 99% XY.) Empathy is a very useful trait, even when dealing with sociopaths, which I don't think Perry (or Bush for that matter) is. Selfish and thoughtless, yes, but sociopathy gets thrown around a lot when what one really means is selfish and thoughtless jerk. One does not need to be pathological to be unpleasant and as a professional ego-shrinker, I am very reluctant to medicalize icky personalities, in part because I don't think there's a happy drug on the planet that can make a selfish jerk be less selfish and more kind, nor any amount of therapy that can retrain the determinedly self-absorbed. We can treat the truly mentally ill. We have yet to come up with anything that works on generalized assholery. But I don't care about Perry. That individual is irrelevant. The policy is the question, not the person, and the policy is not a partisan issue -- it's a health issue. Which is why the whole motive of the individual issue is really bothering me.

As for the testing... it is illegal to test drugs on minors. Period. There are comparatively few drugs that can be administered to minors because we're rightly not allowed to test on them officially, and only through long use and grandfathering and off-label usage can we find pediatric meds. (The MMR was grandfathered in since it has been in use for decades; most current generation anti-depressants are off-label, which is why we get counterindications and a lot of paradoxical reactions; and for that matter, even aspirin, though in use for a century, isn't technically suitable for pediatric use because it is linked to some fairly serious issues when given for fever reduction.) The pediatric formulary runs about 1,000 drugs; the adult formulary is at least five times that number.

Thus, when Pfizer was doing the varicella testing back in the late 80s and early 90s, even though I wanted to be part of the test group, I was too young and could not join the tests, though they would have benefited me a LOT. (For one thing, I would have skipped those four days on a respirator...) However, a five year testing period is about right for a vaccine-- and that's what this drug has been through. The current version of the HepB vaccine had a 5 year testing process. The first publication on an HPV anti-viral was in 2001, in JAMA (Lexis-nexus pulled it.). It went into human trials, on the only legal subjects, adults, in 2004. Again, that's about right. So by the rightly passed ethical laws that we have about medical testing, the only subjects for this drug were ones who were less likely to be the best beneficiaries of it. Again, the comparisons to varicella are perfect here -- there aren't a lot of people who make it to 18 without getting chicken pox, so testing was hard, but the target audience of small children are those who benefit most from the vaccine. HPV is pretty much the same, except that there's a longer window in childhood. Varicella needs to be given by about 3, while HPV can wait until the immune system is a bit more robust at 10-13. There was varicella testing approved by the FDA on children, but only after a) it was approved for adult use (in 1993) and b) a long variance process consisting mostly of paperwork and c) several years' worth of off-label administration without causing children to grow extra feet or become maliciously telepathic or pyrokinetic.

Something the FDA learned with varicella, however, is that vaccines, in comparison with other drugs, have nearly no provable, trackable, real side effects (and don't have rumored and hysterical side effects, either). In comparison to a new antibiotic, for example, a vaccine has about 1 in 10,000 chance of a serious side effect, while the antibiotic runs about 1 in 300. So it is a lot safer statistically for a vaccine to be released to the general population after a 5 year test cycle than for another drug, and it is a lot safer for a vaccine to be given to populations outside of the testing population than a new antibiotic. (To compare 1 in 300 to 1 in 10,000.... Assume you get 10 pieces of mail a day. The first is getting a paper cut once a month while you open your mail. The second is getting a paper cut once in four years while opening your mail.) Vaccines, unlike other drugs, aren't nearly as likely to harm, and thus have special rules governing them. I don't think the FDA is perfect; I have many issues with their practices and procedures and am often disgusted with them. But they're better than having no oversight by a large margin, and they could be a lot worse about rushing and failing to regulate, too. And to be perfectly honest, I trust peer-reviewed medical science a whole heck of a lot more than I trust either teenage abstinence pledges or blogosphere rumor.

Why I think it's different this time? Simple peer review. The drug works. It prevents the transmission of the 4 HPV strains that are cause 70-90% of cervical, anal and non-tobacco related oral/throat cancers. Prevent transmission of those strains and the incidence of those cancers goes from 1 in 8,000 per year to lower than 1 in a million per year. Warts really don't serve us any evolutionary advantage; at one time, they were probably better behaved, but that one time is about 750,000 years back and it really is time we served them with divorce papers. The fact that the drug is relatively cheap, at least compared to Paps, mammograms and bone density scans means that it can actually be distributed to the population at risk for a cost that won't make people balk at paying it. The optimum time for giving the drug is before the individual begins any sort of sexual activity (including petting). It's a vaccine. Vaccines don't cause genetic damage, they don't cause other diseases, and they only very rarely have non-anticipated side effects. I've watched someone I care about die of cancer. I've watched someone else I care about lose all hope of having a child thanks to cervical cancer. I'm willing to give some benefit of doubt to prevent other women from suffering.

[Morgana LaFey]

7. What treatments are there for sociopathy and psycopathy?

Inquiring minds want to know. What treatment will make a serial murderer no longer a serial murderer?

I saw your "I don't like Perry" and was unimpressed. It's NOT about "like." It's about capacity and willingness and opportunity and procilivity to do actual harm to actual human beings -- and in this case exclusively female human beings, and mighty young ones at that.

I think he behaves poorly, makes decisions based on how well it benefits him personally, and wouldn't piss on me if I was on fire. ....snip.... Empathy is a very useful trait, even when dealing with sociopaths, which I don't think Perry (or Bush for that matter) is. Selfish and thoughtless, yes, but sociopathy gets thrown around a lot when what one really means is selfish and thoughtless jerk. ....snip.... I am very reluctant to medicalize icky personalities, in part because I don't think there's a happy drug on the planet that can make a selfish jerk be less selfish and more kind, nor any amount of therapy that can retrain the determinedly self-absorbed. We can treat the truly mentally ill.

Honey, you've just described a sociopath. You may not want to "medicalize" it -- whatever that means in this context, but it's kinda out of your hands. Bush absolutely is a sociopath and my guess is that there's at least a 99% chance Perry is as well.

A sociopath is at the extremen end of the narcissism scale. Selfish jerks and the determinedly self-absorbed are narcissists. EXTREMELY selfish jerks -- the kind who will kill (or execute) with a certain amount of pleasure or even glee, the kind who have no remorse or conscience about anything, are narcissts gone wild, aka: sociopaths.

Your cheerful insistance that vaccines can't harm people isn't that reassuring nor IMO reality-based, frankly. There are a lot of folks who served in the first Gulf War who would argue pretty strongly with you. There are a lot of parents with autistic children who would argue with you -- and yes, I know that supposedly there's NO connection between vaccines and autism (and it's bunk). And as long as the subject has arisen, here's a link I like to pass on to everyone: This Is Your Brain on Mercury:

http://www.youtube.com/watch?v=VImCpWzXJ_w

All I can say is -- thank Goddess I don't live in Texas and no female I care about does either. I guarantee you -- absolutely guarantee you -- that there will be harm come out of this for some of those young women. The non-science indicators are all there: profit motive, conflict of interest, irresponsible and culpable pharmaceutical, rush rush rush to get it done (and not submit it to the legislature!!??? Sound like anyone else we know?) , a law that protects vaccine mfgers from lawsuits, etc. This is an absolutely iron-clad prescription for mayhem -- and harm.

[Morgana LaFey]

16. Since the subject came up elsewhere on DU

I'm bringing some of the links here, and the defintion of sociopathy from the DMR.

Narcissistic Personality Disorder (NPD)

(definition from from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994, commonly referred to as DSM-IV, of the American Psychiatric Association.)

Narcissistic Personality Disorder (NPD) is a pattern of self-centered or egotistical behavior that shows up in thinking and behavior in a lot of different situations and activities. People with NPD won't (or can't) change their behavior even when it causes problems at work or when other people complain about the way they act, or when their behavior causes a lot of emotional distress to others (or themselves? none of my narcissists ever admit to being distressed by their own behavior -- they always blame other people for any problems). This pattern of self-centered or egotistical behavior is not caused by current drug or alcohol use, head injury, acute psychotic episodes, or any other illness, but has been going on steadily at least since adolescence or early adulthood.

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. The disorder begins by early adulthood and is indicated by at least five of the following:

1. An exaggerated sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). The simplest everyday way that narcissists show their exaggerated sense of self-importance is by talking about family, work, life in general as if there is nobody else in the picture. Whatever they may be doing, in their own view, they are the star, and they give the impression that they are bearing heroic responsibility for their family or department or company, that they have to take care of everything because their spouses or co-workers are undependable, uncooperative, or otherwise unfit. They ignore or denigrate the abilities and contributions of others and complain that they receive no help at all.

2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal faith or love. Narcissists cultivate solipsistic or "autistic" fantasies, which is to say that they live in their own little worlds (and react with affront when reality dares to intrude).

3. Believes he is "special" and can only be understood by, or should associate with, other special or high-status people (or institutions). Narcissists think that everyone who is not special and superior is worthless. By definition, normal, ordinary, and average aren't special and superior, and so, to narcissists, they are worthless.

4. Requires excessive admiration. Excessive in two ways: they want praise, compliments, deference, and expressions of envy all the time, and they want to be told that everything they do is better than what others can do. Sincerity is not an issue here; all that matter are frequency and volume.

5. Has a sense of entitlement. They expect automatic compliance with their wishes or especially favorable treatment, such as thinking that they should always be able to go first and that other people should stop whatever they're doing to do what the narcissists want, and may react with hurt or rage when these expectations are frustrated.

6. Selfishly takes advantage of others to achieve his own ends. Narcissists use other people to get what they want without caring about the cost to the other people.

7. Lacks empathy. They are unwilling to recognize or sympathize with other people's feelings and needs. They "tune out" when other people want to talk about their own problems. They are aware that their feelings are different from other people's, mostly that they feel less, both in strength and variety (and which the narcissists interpret as evidence of their own superiority); some narcissists report "numbness" and the inability to perceive meaning in other people's emotions.

8. Is often envious of others or believes that others are envious of him.

9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes. They treat other people like dirt.

posted here: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=227526&mesg_id=230961









Another psychologist weighs in on B*sh's pysche (he's nuts):
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x227526
Link: http://www.newsday.com/news/opinion/ny-opsie105088567feb11,0,7521616.story?coll=ny-wintrtrck-headlines&track=mostemailedlink
see esp NPD def: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=227526&mesg_id=230961
also see: sychopaths, Secret Societies and the New World Order http://www.911-strike.com/psychopaths.htm
and: Bush isn't a moron, he's a cunning sociopath
http://www.onlinejournal.com/Commentary/Conover120502/conover120502.html

[noamnety]

2. By coincidence, I was just reading this:

Take this item, about a malaria outbreak in Borneo in the 1950s. The World Health Organization (WHO) sprayed DDT to kill mosquitoes. But the DDT also killed parasitic wasps which were controlling thatch-eating caterpillars. As a result, the thatched roofs of many homes fell down, and the DDT-poisoned insects were eaten by geckoes, which were in turn eaten by cats. The cats perished from the poisoning, which led to the multiplication of rats, and then outbreaks of sylvatic plague and typhus. To put an end to this destructive chain of events, WHO had to parachute 145,000 live cats into the area to control the rats.

(snip)

b) Abolish the private patenting of genetic sequences and seeds — so-called “intellectual property rights.”

c) Take private profit out of research and development of genetically engineered health-related drugs.

d) In the meantime, require all bio-engineered products and those derived from them to be clearly labeled.

http://stangoff.com/?p=467

Too much good stuff there to quote all the relevant parts. Anyway, it tracks with a lot of other things I've been reading lately about medicine, and how often the cure manages to create new problems, so that medicine is eventually putting forth most of its effort curing problems caused by medicine, and driving normal health care costs out of reach of the average person in the process, creating a two-tiered system of health care, with more and more resources going to the haves, at the expense of the have nots. Chapter 1 - Two Watersheds - from http://www.opencollector.org/history/homebrew/tools.html

It is not strictly necessary to this argument to accept 1913 and 1955 as the two watershed years in order to understand that early in the century medical practice emerged into an era of scientific verification of its results. And later medical science itself became an alibi for the obvious damage caused by the medical professional. At the first watershed the desirable effects of new scientific discoveries were easily measured and verified. Germ-free water reduced infant mortality related to diarrhea, aspirin reduced the pain of rheumatism, and malaria could be controlled by quinine. Some traditional cures were recognized as quackery, but, more importantly, the use of some simple habits and tools spread widely. People began to understand the relationship between health and a balanced diet, fresh air, calisthenics, pore water and soap. New devices ranging from toothbrushes to Band-Aids and condoms became widely available. The positive contribution of modern medicine to individual health during the early part of the twentieth century can hardly be questioned.

But then medicine began to approach the second watershed. Every year medical science reported a new breakthrough. Practitioners of new specialties rehabilitated some individuals suffering from rare diseases. The practice of medicine became centered on the performance of hospital-based staffs. Trust in miracle cures obliterated good sense and traditional wisdom on healing and health care. The irresponsible use of drugs spread from doctors to the general public. The second watershed was approached when the marginal utility of further professionalization declined, at least insofar as it can be expressed in terms of the physical well-being of the largest number of people. The second watershed was superseded when the marginal disutility increased as further monopoly by the medical establishment became an indicator of more suffering for larger numbers of people. After the passage of this second watershed, medicine still claimed continued progress, as measured by the new landmarks doctors set for them-selves and then reached: both predictable discoveries and costs. For instance, a few patients survived longer with transplants of various organs. On the other hand, the total social cost exacted by medicine ceased to be measurable in conventional terms. Society can have no quantitative standards by which to add up the negative value of illusion, social control, prolonged suffering, loneliness, genetic deterioration, and frustration produced by medical treatment.

[atommom]

4. I agree with you. The vaccine will be a good thing, regardless

of the fact that Gov Goodhair came up with the idea of making it mandatory, and regardless of the fact that it will make a pharmaceutical company richer. There is a lot of knee-jerk hatred and suspicion of Big Pharma, but they do still do some good. I've been dismayed lately by the fact that many here aren't happy about this vaccine's availability. It's partly a general fear of vaccines (which I think is misguided) ... and, I fear, partly a sentiment that it's just a minor women's health problem that Merck is using to make more money. The actual victims of the virus aren't getting much attention in all the hullaballoo. :(

[noamnety]

5. I don't think it's the "availability" that's the problem

I think it has more to do with making it mandatory - some women have a justified (imo) distrust of anything the state mandates in regards to our reproductive system.

It's hard not to feel disgust and resentment when the government announces that a corporation will now be directly profiting from every vagina in America and we have no choice in the matter, we won't be getting any of the profit sharing. If we have one, they will earn a bounty on it.

[Morgana LaFey]

6. Well put

DAMN well put.

[Katherine Brengle]

8. Not getting HPV and not getting cancer is a pretty decent profit...

I've also watched loved ones suffer and die from cancer, and I just can't find fault with wanting to eradicate some of it if possible.

I understand fully all of the arguments in this particular debate, and I still don't disagree with what is happening in the state of Texas.

No drug is perfect - there will always be some people whose bodies will react adversely. As far as we can tell, as of now, this vaccine is safe. It has undergone an appropriate amount of testing in adults, as the OP already brought up. I refuse to wait until my daughter already has HPV or already has cancer to see if the long term effects are as good as we should all be hoping. It would be wonderful if we could all afford to wait 20 years to see what happens, but in that time millions of women will get HPV. Thousands of them will develop cervical cancer. Thousands of these will die from it and thousands that survive will have suffered so deeply and been so physically scarred that life will never be the same for them.

I know people get squeamish about "mandatory" and I can understand this, but frankly I truly believe that it is in the best interest of the public and public health to kick the shit out of this disease as best we can, which means eliminating as many carriers as possible.

[orleans]

10. i'm not really up on all of this but what are the chances that a woman

will get cervical cancer? 1 in ...? 10? 100? 1,000? 10,000?

and then what are the chances that she will experience adverse effects due to a vaccine that has not fully been tested?

a couple days ago i read that 1 in 150 children have autism. from what i have read on that--including bobby kennedy's paper on the Thimerosal--odds are pretty good that the percentage of children with autism is as high as it is due to the mercury/thimerosal in the vaccines the children have been getting

now, thimerosal was created in 1929 by eli lilly--how many years did this phara company & our government lie to us or not fully disclose that there was murcery in these vaccines? and we're suppose to drag our daughters in for a "mandatory" vaccine that have not been completely studied?


and:
"IMPORTANT INFORMATION ABOUT GARDASIL
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases. GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer, "
http://www.gardasil.com/patient-information-about-gardasil.html

[Katherine Brengle]

13. One, the research

on the link btwn autism and vaccines is questionable, though I believe it is important as well.

Second, afaik, thimerosal is no longer a component of vaccines. We need to understand that over human history, we have done some stupid things -- the Romans built water pipes from lead -- do we worry now about drinking from the tap bc those people screwed up? Of course not.

Humans are not infallible, science is not infallible.

As far as this:

and:
"IMPORTANT INFORMATION ABOUT GARDASIL
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases. GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer, "

No drug protects every single person in every single instance. 70% and 90% are a big deal. But I guess some people can't be happy with some scientific advance - would you prefer no protection to 70% and 90%? :eyes:

[Name removed]

14. Deleted message

Message removed by moderator. Click here to review the message board rules.

[noamnety]

11. If the goal is purely to eradicate the disease

Why aren't boys getting a vaccine as well?

Why is all the risk and responsibility put on the women, when men are equally responsible for spreading the disease?

[Katherine Brengle]

12. Merck is currently testing the drug on males.

I assume priority was given to female testing bc we are the ones doing most of the dying and suffering due to this disease.

[noamnety]

15. Thanks

I'm glad to hear that.

I feel very cynical that governments will be as eager to make it mandatory for boys, or that parents will opt in for their sons at the same rates as for their daughters. I'm having a gut reaction that the perception is that men and women equally share and spread the virus, but - as wtih anything intrusive having to do with reproductive systems, the burden and risk will upon women disproportionately.

I'll be thrilled if I'm proven wrong.

[Katherine Brengle]

9. I agree with you.

I posted in more detail above a bit.