Asymmetrical Information

Do you also mean aside from opposition to the HPV vaccine?

Most public health advocates want health decisions based on science, but their use of science is almost always selective.

Well I suppose you might have a non-profit group that concerns itself with funding operations for the indigent, or rescusing dogs from neglectful owners, or releasing political prisoners from Chinese jails, or advocating a gas tax as a way of reducing greenhouse gas emissions, or etc.

When I first got into the health promotion field, I was shocked to learn that most medicine at that time in the early '90s was not based on evidence.

Doctors do what they were taught by their old professors and they do what they think works from their own observations, not from what is known from rigorous systematic evidence reviews indicate.

News editors and some for-profit organizations (like the sleeping pill and mattress industries mentioned in the NY Times story) fuzz up science all the time. And, of course, scientific evidence tells us that we are descended from lesser species, yet more than half of America believes otherwise.

Yours is an easy conclusion to draw -- if you believe words actually have meaning!

Disclosure: I work for the Center for the Advancement of Health.

I don't have a problem with you giving the hpv to your kid. I have a problem with anyone even suggesting that it be one of those mandatory things we should get along with all the other vaccines the govt things we should pump our kids with. No thanks. But feel free to inject something else into your child so you can know they can sleep around and be immune to the adverse affects of one single strain of an std.

I don't have a problem with you giving the hpv to your kid.

Really? I'd expect pretty much everyone to be against that.

Are there non-profit groups in Washington advocating using something other than science as a basis for making health decisions*?

Sure; the various "alternative 'medicine'" pseudosciences amount to a multi-billion-dollar industry, and have plenty of lobbyists on the Hill. They're constantly pushing things like, for example, Medicare coverage for homeopathic treatments, touch therapy, and herbal remedies. They also managed to get herbal supplements excluded from FDA testing and licensing requirements for a long time.

But feel free to inject something else into your child so you can know they can sleep around and be immune to the adverse affects of one single strain of an std.

So either the only thing keeping your daughter from sleeping around is fear of cancer, or you want her to get cancer after she sleeps around. Either way, you're obviously a lousy parent.

Dan, there's no such thing as a risk-free vaccine. When it's a new vaccine, like any other medicine, there's even a chance of ill effects haven't been identified because they don't show up until many years later. So, the relevant questions for having your kids vaccinated and for whether the vaccine should be mandatory are:

1) How does the (unknown, almost certainly very low, but certainly non-zero) risk of an adverse reaction to a new vaccine compare to the low (and lifestyle dependent) risk of HPV?

2) Why would the government be better qualified to make that decision than parents?

> Why would the government be better qualified to make that decision than parents?

Govt would make better decisions if it was liable for the consequences of those decisions.

I'm more than happy for you and everyone else to consider me a lousy parent if it means I'm not required to give them a vaccine which I believe will adversely affect them. I have no proof for this, but then again I'm not arguing that your arm falls off once they stick the needle in you. I think there are many adverse, unseen affects to pumping our kids full of weakened viruses. At the least I'm erring on the side of caution when I pick and choose what is absolutely necessary.

My daughter was noticably different after we vaccinated her. Maybe she was just growing up, maybe it was our imagination, or maybe it's not such a great idea to pump your kids with various injections if you don't need to. Come, you are all economists...surely you know how the demand curve works? It's the same for vaccines. If everyone is vaccined, it's highly unlikely you need to be. So pump those dieseases and viruses away into your kids! Mine will be safer.

" saying that it is based more on extrapolation than on hard epidemiological data."

Isn't the point of taking epidemiological data so that one may make intelligent extrapolations?

"Why would the government be better qualified to make that decision than parents?"

Access to better expert advice. For most complex medical questions, parents are at the mercy of experts whom they are not qualified to evaluate well. While government officials are at the mercy of those same experts, they are more well equipped to pit the experts against eachother so as to be better able to discern the truth.

Now, whether they really seek such advice, take it when given, and put it into practice is debatable. It is also debatable whether government should be allowed to make that decision even given that they are more qualified to do so.

I understand the mandatory vaccines for measels, chicken pox etc. The government is required to offer a public education to all who want it. These infectious diseases present an unnecessary risk when offering that education. However, HPV is not a risk associated with any service the government is required to provide. There is no need for it to be mandatory.

I do think it is a good idea. It is beneficial enough (at first glance) that it should be offered free to any who want it. By free, I mean at taxpayer expense) Those who can not afford it, will be even less likely to be able to afford treatments for cervical cancer, which we might otherwise be paying for.

I like the idea of providing free services to people who would not be able to afford them (they have cable tv service and internet to buy for crying out loud). Otherwise they will just be a drain on the tax payer later. Because the taxman has to take care of everyone right?

So let's see. If I can't pay my rent, my family and I get kicked out. I suppose that will put us at all sorts of health risks living outside in the snow and we'll have to use your medical system and run up the bills without paying for them. Hey in the long run it is cheaper just to pay for a roof over my head.

When will this crap end? The simple fact is, most people CAN afford most of the necessities of life. They decide to spend their money else where. If anyone wants a free vaccine for their kids they have to pass the TV test. If you have a TV and a DVD player, no food stamps, no vaccines. Clearly you have the money to spend on things you think are worthwhile while expecting someone else to pay for the things that are necessary.

If you want to live a life with various luxuries, those are not guarenteed to you, you have to work harder for them.

"I like the idea of providing free services to people who would not be able to afford them (they have cable tv service and internet to buy for crying out loud). Otherwise they will just be a drain on the tax payer later. Because the taxman has to take care of everyone right?"

When an expense is cheaper for society in the long run, yes. Hell, I'd pay for free cable for the poor if it made economic sense in the long run. They give free cable to prisoners because it is indeed cheaper than not giving it to them. We give free police protection to the people who pay no taxes because we have learned, the hard way, that those left outside the protection of the law form criminal enterprises which prey upon taxpayers.

By paying for those who want the vaccine but can't (or won't) afford it, you reduce not only the risk to them, but also the risk to those who do not want the vaccine. There are times when a cost to an individual is not appraised as worthwhile to that individual, but is worthwhile to society as a whole. Those are the times government foots the bill.

Njorl,

I agree with your points in principle but not in practice, at least as is currently practice. In the case of vaccines, with a blanket requirement, that should be something that is paid for by the individual and they need to be REQUIRED to pay for it, or have a very heavy burden of proving they can not pay for it.

I can't think of very many cases where you can't afford $20-$100 for a once in a lifetime (pretty much) vaccine. And when you claim you can't afford it, please make sure to show me receipts that you're not spending $5+ for lunch every day at taco bell. I don't mind helping out, in fact I'll gladly do so to those truly in need. But I don't think people should get public assistance if they are not making every effort to watch every dollar.

And hey, if you don't like the strings that are attached with the freebies, then don't expect them to be free.

> And, of course, scientific evidence tells us that we are descended from lesser species

Of course science says nothing of the sort. Evolved from different species, but not "descent" or "lesser". Kind of an embarrassment to have someone in the government who can't make value-less scientific statements. Perhaps it proves the point - there is no such thing as a completely objective organization, anywhere.

I think that the public health folks are well-meaning. But they darn well know that their most powerful weapon in their arsenal is the school requirement. It seems to me that weapon is being abused.

Consider the below list of required vaccinations for schooling from wikipedia:

1. Diphtheria, pertussis, tetanus
2. Measles
3. Rubella
4. Mumps
5. Polio
6. Hepatitis B

One of these is not like the other. One of these vaccines is not the same.

Required qualifiers: I'm not anti-vaccine. I don't believe in anti-vaccine theories (autism, thimerosal, etc.) I actually have had the HepB vaccinations. Given the opportunity to give my (theoretical) daughter anti-HPV, I lean towards yes.

"I can't think of very many cases where you can't afford $20-$100 for a once in a lifetime (pretty much) vaccine."

The HPV vaccine is 3 times for $120 a pop, $360 total.

When I say make it free, I mean "government program free". If you've ever tried getting something from the government to which you were legally entitled but didn't really need, you know what I mean. People with health insurance will get the shots through their own plans just to avoid the waiting. People with great need, those on medicaid already will get it paid for by the government through that already existing infrastructure. Of the rest, people who want it badly enough will endure long waits to get their free shots, or, if they have means, they will just pay face value to avoid the hassle.

I'm not saying we should act like there is a public health emergency and devote the entire public health sector to innoculating for HPV.

As you say, there is no outbreak. There is no school where 80 kids got HPV. There's no reason for this vaccine to be treated any different than the flu as far as public policy is concerned. If you're at risk to get it or you want to be safe get it.

Telling me that it will actually cost 3 times as more than I thought to dish out the free vaccine isn't winning you any support.

If it was $300 a pop to keep kids protected from something really nasty which spreadsy by contact, maybe you'd have a point. But even then I still think the burden of proof needs to be high that you can't cough of the 300 bucks for your kids health, but have no problem spending that much on cabel tv for the year.

"Why would the government be better qualified to make that decision than parents?"

Access to better expert advice.

"Jane" asked the question:
Are there non-profit groups in Washington advocating using something other than science as a basis for making health decisions?

Various groups have attempted to recast "gun control" as a public health issue for years. The New England Journal of Medicine is infamous for its political and unscientific studies, especially those by A. Kellerman, that always conclude "more gun control GOOD thing!" no matter what the data may show.

The Children's Defense Fund has been known to strut into the area of "health" in interesting ways, generally with some sort of figleaf of a "study", but I can't recall details right now.

Putting a white lab coat on someone, and proclaiming whatever that person says to be "science" is often useful to forward a poltical agenda...

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