January 6, 2011
This will not be the first time I have focused on HPV… In fact, about a year ago, I posted on this topic. Today, I want to mention that Janice Krieger and some of her colleagues at Ohio State published an article in Human Communication Research about the importance of mothers talking to daughters about HPV [http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2958.2010.01395.x/abstract]. Another article published in the Spring of 2010 has similar conclusions [http://pediatrics.aappublications.org/cgi/content/abstract/125/5/982].
Mothers’ confidence about talking to their daughters about HPV — believing that they had knowledge and could answer their daughter’s questions — had an important effect on the likelihood of talking. Also, mothers’ belief that the HPV vaccine is an effective response in preventing cervical cancer motivated them to have these conversations. Both findings emphasize the need to communicate about HPV and the HPV vaccine to form knowledge. The findings, as the authors note, also bring to light a need to observe these actual conversations and their effects. For example, mothers may talk about HPV as being a common and easily transmissible virus. Or, mothers might say that HPV causes cervical cancer. The latter might lead daughters to assume that brothers and male friends are not at risk for HPV. That would be an inaccurate conclusion.
I have a granddaughter who is seven years old. She happens to live in Texas. This is one of the states that considered making the HPV vaccine mandatory in order to be in public school [http://politifact.com/texas/statements/2010/feb/06/rick-perry/perry-says-hpv-vaccine-he-mandated-would-have-been/]. It didn’t happen … for various reasons. For one, the vaccine is really a series of three shots — not one. The cost for the three shots is about three hundred dollars [http://cancer.about.com/od/hp1/f/hpvvaccinecost.htm]. Time and money… and debate about sexuality.. and religion… then there is the belief that government should not mandate anything… How do we communicate strategically to build mothers’ confidence to talk about those things? And what do we say to boys as well?
http://www.nytimes.com/2010/10/29/us/29vaccine.html
Bethany,
I have to admit it was disappointing to hear that all your doctor said was “It protects against cervical cancer and some types of genital warts, so I recommend it,” especially if you expressed interest in more information about the vaccine. I wonder was this doctor a little older? I know that recently Med schools have required simulated patient workshops, designed particularly to allow the students develop patient doctor communication skills. My father currently works organizing such workshops for several med schools in south west Ohio. I know from personal experience having worked as one of these “simulated patients” That one of the areas the students were graded on was their follow through to make sure the patient was informed appropriately, including asking “do you have any more questions about…” and in the case of medications or in this case a vaccine the students had to make an effort to provide the patient with either a pamphlet or a website address (written down and handed” so the patient was capable of seeking out further information. If your doctor was fairly young then I think it was a case the the doctor failing to do what he was supposed to do. But it does the beg the question, should doctors be made to retrain their communication skills, so that caps in the system such as the example you’ve pointed out occur less frequently. But there’s also another problem that I see inherently related to this issue. The time restraint that most doctors face with their expected pace to see patients is realistically not enough time to (if there are other things to address) bother a lot of time on a vaccine that prevents some types of cancer if you happen get a certain type of STD, that a lot of people he recommends it to may decide not to get it anyways.
The debate over the appropriate use and potential mandate of HPV vaccines is yet another example of failed social mediation; the debate over “the belief that government should not mandate anything”, Should we or should we not have national health care? the role of social security? An idea “that people should be held responsible for their own health” has to go all the way or it’s not effective. What do I mean by that? You can’t go with out nationwide health care but still mandate that hospitals still have to take in the sick and dieing if they show up, because the cost ends up back into society eventually. Even if you want to pretend you’re not paying for it, your own bill gets added to as it takes more money for the hospital to run. The patients do get taken care of and often at more total expense then it would have been if they had access to doctors and medicine. Cost of preventative practices overall will cost society less than what will go wrong 20 years down the road. So unless you’re able to fully take the stand that we will not care for the poor and sick, I mean totally decide that they are a lost cause, a policy of “uh sorta take care of yourself” is ineffective and “1/2 ass”. Look at the mandates existing that have saved countless lives from infant and school vaccines to fluoride in the water. Society has come to a point where it has to stop toeing the line of demanding social justice with out mandating and facing the personal costs of ones social responsibility to take care of everyone. Should people get vaccinated? Yes absolutely, and society needs to make its efforts towards making that a reasonable thing to mandate.
I think everyone had some very valid points to make about the blog article. I really liked how Anna brought up the point about religion more so in her article. I feel I didn’t look into that aspect of the issue enough and how it can really make for controversial issues. Religion can really cause a huge barrier with openness in dialog between sibling and parent, especially dealing with sex. I also agree with the point of once women are old enough, for example being in college these decisions on health are more up to them and what they wish to do to their bodies. I was unaware that free vaccines were being given, and I feel this could be a good and bad thing. Good because women that are unable to talk to their mother about issue like sex or the vaccine can now go ahead and get it done. On the other hand this might cause serious controversy between the school and parents paying thousands of dollars for their child to be attending. The issue between health and communication is a difficult situation for many families and I feel everyone made very strong points address this issue and topics with the blog article.
Jason, I really liked your last comment regarding the need for patients to realize that the immunity offered by the vaccine vastly outweighs the short-term side effects. I have this same mentality too. I spoke with a doctor (I’m hesitant to call her “my” doctor considering I see a different doctor/nurse practitioner every time I go to UHS…) about HPV and also how my pediatrician actually had dissuaded me from getting it when I was in for my entrance to college physical. After learning the basic info regarding Gardasil through classwork, it didn’t sound so bad. I know about that there were adverse side effects, but the percentages looked small; I felt it was highly unlikely to affect me. I knew that my mother disapproved because it was still fairly new (relative to something like the flu shot…), but I also knew that my mother didn’t want to talk about sex except that “no good husband would want an unpure woman.” (Yea, she’s from the old country but I love her dearly still.)
Anyway, reading all of your comments made me think about the most shattering realization I made after making my decision to become “One Less” (it’s already to late!). /After/ I got the first round of Gardasil, I wanted to read the insert that comes with the vaccine. I Google’d and found a pdf of it. (source: http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM111263.pdf) Did you know that Gardasil has only been studied for up to 60 months after completion of all three rounds? That’s only 5 years!
The issue reflects ethical issues-no question about that. The health communicators in this situation could be mothers, doctors, mother figures (what about father figures, people?), even school teachers! Just as my classmates have pointed out in their comments posts, young girls serve to benefit from stern conversations regarding the HPV vaccine. Whether this conversation should be the mother’s sole responsibility is a point with which I rather disagree, but it’s true; if the mother/other maternal figure is still the “all-knowing, and super-wise” woman we ran to for answers in childhood, it only makes sense that we’d ask for her advice. Of course, that’s also assuming we don’t think she’d react poorly to us asking about something like pre-marital sex.
Oh wait, that’s kind of a big deal caveat, isn’t it? The HPV vaccine is commonly mis-titled as an STD prevention measure. While yes, the incidents of contracting/transmitting the virus via methods other than sexually are not high, the misnomer makes communicating about the vaccine facts doubly difficult for families that don’t communicate openly or that stress Confucian principles of filial piety (for example). Religious values of the family may extend farther than the law in the home. Even though legally, a college-age woman (or man for that matter) can make her own health decision, her mother’s constant reminder that she may literally die if her daughter were to be engaged in pre-marital sex make for hard times when her daughter wants to discuss the HPV vaccine.
We stress having a health advocate with us in the doctor’s office or hospital when facing a tough decision or hearing a potentially dreadful diagnosis, so it only makes sense to have an equally vested advocate when making a decision in regards to such a controversial and fairly new vaccine.
The PA Department of Health has offered the vaccine for free through clinics held at our school’s health center and an improved advertising campaign has brought in more students (of both genders) — so I overheard, anyway. The ads (from Merck) push us to be “One Less” (which some one online pointed out is grammatically incorrect, by the way… in her words, “I guess ‘One Fewer’ is not as catchy, though.”) and now that the economic issue is no longer, thanks so a credible source like the state DOH, why wouldn’t men and women alike go protect themselves and the ones they love?
As we discussed in class, the internet can be so harmful or helpful. The information out there about the HPV vaccine(s) is so vast, one could easily lose the whole night to researching the personal stories. Many of them (who am I kidding? Only people with grievances write deeply moving stories to post online…) have sad endings’ young, active women becoming chronically ill and weak husks of their former selves, constantly being shuttled from doctor’s office to another. What of it is true? What of it is heightened reaction? No one wants to suspect a family who’s already gone through/still going through so much pain…
When the PA DOH has made the vaccine accessible (financially) to the students here, many jumped on the savings of $300+ dollars. Others just felt that it was a safe and easy way to prevent something as serious as cancer! Some even went as far to say “why not make this a mandated vaccine?” Oh right, Texas tried. I read on another blog an alternative perspective of why that was not a hot idea. (for further reading: http://evilslutopia.com/2007/01/gardasil.html and http://evilslutopia.com/2007/05/gardasil-2.html — excuse the language…) The author highlighted the fact that once a vaccine is federally mandated for all school-age children, any subsequent unpleasant situations will no longer be the manufacturer’s responsibility. Is it possible to create fair procedures that don’t involve commercial biases and manipulative politics?
Autumn brought up two valid points. One, which I think we all agree with is that mothers (or even fathers, although the mother and daughter conversation would be less awkward) need to talk to their daughters about safe sex. This is a critical conversation that needs to be addressed before the daughter(s) are exposed to it in high school and even earlier nowadays! It’s true, why does it take the rise of HPV to persuade mothers to talk to their offspring about safe sex. Too many instances in our culture where we need a something bad to happen for us to wake up and take action. Fortunately, although many people are HPV positive, cervical cancer only affects a small proportion of females.
The second point was the comment about the mandatory vaccinations in Texas. Again, this is a very debatable issue. Vaccines are necessary, yet it is unethical to force them upon people who wish not be vaccinated. We need to find a way to promote vaccination without forcing the issue. Many parents only hear bad information and side effects associated with the vaccine (nausea, allergic reactions) and thus ignore the positive effects (immunity). For example, I recently was talking to my parents about the flu vaccine and my mother said that she never got vaccinated because she didn’t want to get sick. She always hears about people having adverse reactions to the vaccine and she feels she’s better off risking coming down with the flu. Meanwhile, two years ago I shadowed Dr. Sullivan, an Infectious Disease physician in Altoona. He said the same thing…everytime he gets the flu shot he becomes sick for two days…he hates getting it every year. Stories like these are circulating and are being heard by the parents….we need to convince them that the price of immunity outweighs the risk of a minor reaction to the vaccine.
I think that Bethany makes some good points in her blog. Why would we have the HPV vaccine mandatory when the flu shot isn’t? I had never thought of it that way until I read that. Of course there are some differences in the two vaccines. One only being one shot and the other being a total of three. This brings to mind the questions why do we have to look at this shot as STD prevention? Why not look at it as cancer prevention? When we think of it like this we can start to think why not give this vaccine to everybody? Make it readily available and routine to get when you become of age to receive it. If someone came to you when your child was born and said this is a cancer vaccine its will help prevent the risk of certain cancers I am willing to bet many people would get it. While I do agree that your healthcare is up to the individual person it is still not a bad idea to make it a mandatory vaccine. Communication of all this is the only way to make this happen. The ability to get the word out on how important this vaccine is will only drive more and more people to be conscience of it all.
After reading these posts it left me with a lot of insight and some questions at the same time. To say I am highly educated on the HPV virus would be a lie but this all strikes a chord when I think of my teenage sister. Her being a junior in high school makes me wonder what steps she has taken when it comes to HPV prevention. I know my mother was very open to me when talking about sex and the “sex talk” came up more often then I really hoped for. In a way I believe it made me much more aware of the precautions that should be taken. When I read that the shot was recommended for girls between 11 and 12 I was a bit shocked. I know for me sex was about the last thing on my mind but we all have different backgrounds and childhood’s so who is to judge. At the same time trying to explain to a 12 year old what HPV is and what it can do to you might be a hard message to convey. Ultimately, it is up to the parents to inform and convey messages about sexual health. Many schools have sex education programs or what have you but in all seriousness it is mostly a giggle fest. The parents have such a huge impact on their children’s life, and their sexual health begins with them informing and giving advice.
When reading the New York Times article on whether boys should get the vaccine I found it very interesting. I don’t think it would be a bad idea at all. Even though men have far few side effects of HPV they can still be carriers and infect other females or males. If we want to be preventative in our sexual health then the vaccine should be given to males. Whether to make in mandatory for public schools is another issue in which I hold no opinion. The vaccine has been shown to work and has been improving sexual health for years.
I think that Autumn made a good point about making the vaccine mandatory for public schools. She discussed how making the shot mandatory is like forcing our health care upon us. Though in many cases the government does this to protect us, I have to question their logic sometimes. For example, it would not make sense to me to make the HPV vaccine mandatory while the flu shot is not. Whether common knowledge or not, thousands of people die yearly due to the flu, and many could have been prevented by mass vaccination. In addition, the flu shot is much cheaper, and is delivered by a single injection. It appears to have many more benefits than the HPV shot, yet it is not currently mandated.
In addition, requiring girls to get the shot may eliminate all conversation about HPV. Most of us received the MMR vaccine when we were young, but I wouldn’t be surprised to learn that most people don’t even know what MMR stands for. It simply becomes a routine procedure thus leaving loop holes for lost conversation. Because HPV is considered a sexually transmitted disease though, I think that patients and their doctors should have to have discussions about transmission and how the vaccine will help prevent infection; especially because girls will receive the shot when they are old enough to begin having these conversations.
Overall, I think we need to remember how important communication is at many levels (expert, societal, and lay) when it comes to discussing vaccinations of all types, and we should take on the responsibility to learn more about them when presented with the opportunity to do so.
This article blog addresses a very solid point about that it’s important to talk to your children about sex male or female. It is a shame that it takes an issue like the HPV shot for parents to then begin talking to their children, because it’s important to do if you believe in them having sex or not. Although a good point was made that while it is important for parents to talk to their children, sometimes it is done in a miss informing way. While the mothers within this article were trying to help explain the HPV shot and its importance the message is leaving the daughters with an incorrect message.
If the vaccine had been made mandatory in Texas I think that could have started a huge controversy, between the school board, parents, and the healthcare system. Also it would have become a big issue as to why only public school student and not private within Texas, which could send the wrong message to parents with children in public school. Also if Texas had gone through within then other state would probably have started making the Vaccine mandatory as well. I do think it should be taken into account how important it is for women to get the vaccine, because it’s true that HPV can cause cervical cancer, but making a HPV shot mandatory it’s a rational way to deliver a healthcare system. It needs to be addressed and talked about, but forcing is never a positive way to deliver.
I feel both entries by Bethany and Jason made very strong points, for example sex as taboo. I really agree that many mothers are scared to talk to their daughters or feel that talk about sex could lead them to having it. It’s very important for young women and men to be informed about sex, because there are so many different diseases out there you can receive. I really liked how Jason brought up how close he is with his mother and how mothers are the key, because they are the educators and the ones with previous experience. I find this point to be very true, I know I always go to my mother for advice and questions. It’d so easier to just talk with your daughter and explain things to her dealing with sex and important issue like how to prevent HPV, then having to deal with their sibling after they have already received some kind of disease such as HPV, because they had no knowledge about all the negative effects of unprotected sex. Communication is key with your children and these mothers need to see that it’s so important to talk to your daughters, so they are informed and more protected.
Nice post, Bethanie. I totally agree with your comment about sex being tabooed, especially in conversations with moms and daughters. This reminds me of an article we read in my Intro. to Global Health class last semester. It was a primary research article focusing on the communication barriers between mothers and daughters in relation to conversations about a positive HIV status. STDs are put on a whole new level of severity just because of their title: “SEXUALLY transmitted diseases.” In many culutres, including our own, mother’s are sacred. They are the supporters, the “make every think better” at home doctor. I for one depend on my mother’s advice for everything. Even if she doesn’t understand something… like when I talk about my research, she always has a bit of advice. Therefore, mothers are key in communicating with their daughters about safe sex and HPV because they have life experience and it’s their responsibility. They need to make sure that their conversation remains ethical in that they don’t deprive the daughter of free will (given that she is old enough and responsible enough to have complete free will). For example, mothers may recieve decieving information online or on the news about how cervical cancer is guaranteed if you are infected with HPV and she may relay that information to her daughter in a threatening manner.
Another ethical issue raised by this post is the idea of who is targeted for the HPV vaccine?When you see the commercials or hear about HPV in an ad or in the news, all you hear about are female hosts. You rarely here about the virus effects on males, a causitive agent of genital warts and less likely, cancer. Is it acceptable to only give it to females and not males. Although cervical cancer is more common than anal or head and neck cancer caused by HPV in males, is it ethical not include boys and men when talking about the vaccinations for schools and for the public? I think that everyone should be vaccinated with the HPV vaccine. It’s effective, so use it. Men can get infected also and can even transmit the virus to females (the virus can be spread by simply kissing!).
This idea leads to another issue…what right does the government have to implement mandatory HPV vaccinaions for public schools? This is a concept of procedural justice. Does the government have the right to implement legislation that mandates children to recieve the HPV vaccine before entering public school? Several states are currently debating this issue. This will have huge social consequences. We live in the United States, a cultural “melting pot.” Several people, due to their religion cannot recieve medical treatment. Do these people get a pass on the vaccine? If so many people get passes on the vaccines then the vaccination efforts will be worthless. Another issue is parental response. We’ve seen it before on the news….parents refusing to vaccinate their children for public school. I bet Edward Jenner, the inventer of the smallpox vaccine-the very first vaccine, couldn’t have predicted so much debate over his miracle cure. I personally agree with mandatory vaccinations. But after being in a couple global health courses, I’m also sensitive to the fact that we are surrounded by people with different ethnicities and religious practices. This is why I could never get into politics…or maybe I’d be perfect because I just contradicted myslelf…but this isn’t easy. You have to examine the degree of morbidity caused by disease as well as its prevalence to determine if mandatory vaccination is required. You then have to realize that a small fraction of the population could have an adverse reaction or other resons, such as religion, for not being able to recieve the vaccine.
These issues should all be discussed among mothers and daughters…maybe not to the same extent. Mothers need to be the voice of wisdom when a daughter asks about HPV, the vaccine and cervical cancer. She should, to the best of her ability, not try to persuade or coax her daughter(s) into any one position, just act as a resource and support…don’t get mad that the daughter would bring this up and become accusing…just embrace the opportunity to discuss an important issue.
The HPV vaccine has drawn ethical concern since it was first introduced and advertised to the public. Probably the most controversial aspect is that fact that it protects against sexually transmitted diseases, yet is recommended for girls between the ages of 11 and 12. Because the issue of sex carries such a taboo, it seems as though any associated issue automatically carries that same negative feeling, even if it addresses, or in this case, prevents a health condition.
Despite all of the negative attention; however, someone is still held responsible for communicating about the shot. This specific post emphasizes the mother’s role in discussing the vaccine with her young daughter. Though it may sound like a great idea, it carries some inherent controversies. For example, relying on the mother assumes that she knows enough about HPV, HPV transmission, and how the HPV vaccine works to explain it to her daughter. Even more so, it assumes that mothers are comfortable discussing sex with their young daughters. On top of that, we must question whether the mother has access to medical information or can understand what she reads on the internet to describe the disease accurately. And to add another layer, it also assumes that her religion allows for discussions about sex, and that she will have the medical coverage to pay for the shots and doctor appointments.
I agree that people should be held responsible for their own health, but peeling away the complicated issues surrounding HPV can be time consuming and uncomfortable. Unfortunately, communication about this issue is often left for busy doctors who may also lack sufficient time to explain HPV and how the vaccine is effective. I experienced this first hand right before entering college. When I went to the doctor to receive my meningococcal vaccination, they asked me if I was interested in the HPV vaccine as well. I had no idea what the HPV vaccine was, and the best description the doctor could provide was “It protects against cervical cancer and some types of genital warts, so I recommend it”. I heard “protects against cancer” and agreed to it. After learning more about it later, I am happy that I received the shot, but I also realize that my explanation was lacking at best.
In a sense, mothers do have a responsibility to educate their daughters, but I don’t think it is fair to rely on them fully. Perhaps a better way to address the disease is to involve the community. Maybe workshops could be held to explain the disease, vaccine, and how to talk to young girls about it. Or doctors could provide brochures with this information to parents when they have appointments. Schools could also address the issue of STDs in general so that students understand the health risks associated with unprotected sex. That way, maybe the mother would feel more supported and less pressured to fulfill this responsibility.