Angry Doctor

Monday, March 05, 2007

What is the hurry?

angry doc found this letter to the ST Forum published in January this year (emphasis mine):

Cancer vaccine poses risk of degenerative diseases

I REFER to the letter by Ms Karen Tan of the Ministry of Health ('Cervical-cancer vaccine has its limitations'; ST, Jan 9) and the advertisement by Empowered to Protect (The Sunday Times, Jan 7).

We should not rush into advising mothers to protect their daughters against cervical cancer by recommending the anti-cancer vaccine to them. As rightly pointed out by Ms Tan, 'the long-term effectiveness of the vaccine is still not known'.

As the human papillomavirus is transmitted sexually (a sexually-transmitted disease like syphilis and gonorrhoea), mothers should instead teach and advise their daughters (and concerned doctors, their patients) how to protect themselves, e.g., by not exposing themselves to multiple sexual partners and to take other appropriate measures.

Aluminium hydroxide is one of the vaccine's components. With three injections over six months, a young girl would have received 675mcg of aluminium. This aluminium will stay in the body, and studies have shown that aluminium is associated with degenerative diseases like Alzheimer's, Lou Gehrig's and even Parkinson's disease.

If you consider having such diseases is better than having cervical cancer, then having the anti-cancer vaccine injection would be your informed choice.

With proper Pap-smear screening programmes, the incidence of cervical cancer in Singapore has been declining over the past 30 years, as Ms Tan mentioned. We should work on this instead of depending on a vaccine that has not weathered the test of time, unless, of course, those who will be having the injection become part of the ongoing experiment to test its efficacy.

There is still doubt about the efficacy of the vaccine, otherwise why should patients who have been vaccinated be advised to continue with Pap-smear screening for cervical cancer?

The Health Sciences Authority should not have approved the use of Gardasil if this doubt exists. What is the hurry?

Dr Tan Soon Kiam

What's the hurry, Dr Tan? Well, if I may quote Associate Professor Tan Huay Cheem of the National University Hospital: 'In real practice, we can't always wait for clinical trial data.'

Here is the Ministry of Health's reply to Dr Tan's letter (emphasis mine):

Gardasil safe but discuss vaccination with doc first

I REFER to the letter, 'Cancer vaccine poses risk of degenerative diseases' (ST, Jan 11), in which Dr Tan Soon Kiam raised concerns about the safety of aluminium present in vaccines and the basis for the approval of Gardasil by the Health Sciences Authority (HSA).

Aluminium salts have been used widely in vaccines for more than 70 years, as an adjuvant to enhance their efficacy. Their safety record is well-established.

Many scientific and regulatory agencies have reviewed the use of aluminium in vaccines. They have found no sound scientific evidence of long-term adverse effects such as Alzheimer's, Lou Gehrig's or Parkinson's disease.

Besides Gardasil, many other commonly-used vaccines contain aluminium. They include vaccines for hepatitis A and B, and immunisations against childhood diseases like diphtheria, tetanus (lockjaw) and pertussis (whooping cough).

As the national regulatory authority for medicinal products, HSA ensures, through a scientific review process, that approved medicinal products in Singapore meet appropriate standards of safety, efficacy and quality.

Several scientific studies have demonstrated that Gardasil is effective for preventing cervical cancer, precancerous lesions and infection caused by sexually-transmitted human papillomavirus (HPV).

Hence, there is sufficient basis to approve this vaccine for the target group of females aged nine to 26 years.

Gardasil has also been approved for marketing in the United States, Australia, Canada, Europe and New Zealand.

HSA wishes to emphasise that Gardasil has not been approved for use in the general population. Anyone interested in the vaccination should discuss this with a doctor who will consider factors such as age and personal history of previous exposure to HPVs.

Vaccination does not replace the need for ongoing Pap-smear screening. Healthcare professionals should familiarise themselves with the approved indications and relevant prescribing information on Gardasil to provide the most appropriate advice to patients.

Dr Gerard Wong
Deputy Director (Product Evaluation & Registration)
Health Products Regulation Group
Health Sciences Authority

The reply does not tell us that Gardasil does not guarantee 100% protection against HPV infections (no vaccine is 100% protective, Dr Tan), or that not all cervical cancers are caused by the strains of HPV which Gardasil is designed to protect against. That is why Pap smear screening will still be required.

The 'vaccine scare' is as old as the practice of vaccination itself, but it certainly has become more widespread in recent years with the availability of internet access. The problem facing the modern parent/patient is not one of lack of information, but one of information overload: how does one decide if the information one is reading is reliable?

Can vaccines cause harm? Certainly they can; but so can many diseases which one can now be immunised against. To paraphrase House, pretty much everything in modern medicine is about the risk-benefit ratio; vaccines just happen to be a more emotionally-charged aspect of modern medicine because we give them to babies and in many cases they are compulsory.

While doctors need to acknowledge parents' and patients' concern over vaccine safety, we must continue to base our advice and decisions on evidence and science, and not seek to convince our patients with anecdotes and unproven theories.

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  • I am surprised by Dr Tan Soon Kiam's comment "There is still doubt about the efficacy of the vaccine, otherwise why should patients who have been vaccinated be advised to continue with Pap-smear screening for cervical cancer?"

    I am assuming that he is a medical doctor; as such he should know that there are no guarantees in medicine. (Except, of course, that eventually, everyone dies).

    By Blogger aliendoc, At March 05, 2007 4:13 pm  

  • Well, I googled up his name and it seems Dr Tan is a doctor (assuming it is the same person the search engine has turned up).

    Do google up his name yourself, and you might be even more surprised at what else you might find...

    By Blogger angry doc, At March 05, 2007 5:26 pm  

  • yep. google his name, you'd be surprised

    thing is, there's always the docs trained in the EBM era, and the docs trained in the 'first do no harm/watchful waiting/masterly inactivity' era

    sometimes it's hard to say who's right - while the probability of vaccine complications is small - can we really afford that chance?

    especially if hundreds or thousands might possibly be afflicted with some weird cross-reacting antibody reaction or some delayed degenerative problem?

    we can only make wild speculations about what will happen, for if there would be a problem, chances are that the mechanism would be totally novel and unexpected.

    but then if we chicken out on every new thing, medicine would simply not progress and we'd still be stuck in the stone ages.

    so, how do we actually strike a balance? while EBM is - afterall - evidenced based and probably the best guess, it doesn't really tell us the implications of a bad guess.

    By Blogger KC, At March 06, 2007 11:12 am  

  • But Dr Tan is not a 'watchful waiting' type of doctor, or he would not have advocated the use of chelation therapy for cardiovascular disease while there is no evidence of its efficacy, would he?

    The question is: how does Dr Tan decide when to ask 'What is the hurry?' and when to say 'we can't always wait for clinical trial data'?

    Or, why does he not ask 'what is the hurry' when it comes to chelation therapy, and why does he not say 'we can't always wait for clinical trial data' when it comes to Gardasil?

    By Blogger angry doc, At March 06, 2007 12:50 pm  

  • Since it is men who are also infected and are passing HPV around let's start giving the vac. to only you men docs and see if the trials went on long enough to satisfy your concerns about longterm effects?!Got any takers??

    By Anonymous Anonymous, At March 08, 2007 1:51 am  

  • to anonymous:
    Ahem, not a man doc here. I'm also WAAAY beyond the recommended age group for the vaccine. Otherwise it would definitely be something I would get for myself.

    By Blogger aliendoc, At March 08, 2007 9:08 am  

  • The current unsettling worldwide campaign to frigten women into believing in a virus-causing cancer hypothesis is ignored by those who want to hang it all on the risks from aluminum injections.

    At the FDA Hearing (May 18, 2006) transcript one can find the following on this "unmet medical need": "it has to do with the E6 and E7 proteins that are produced by HPV high risk types, particularly HPV 16 and 18, and that when there is a high risk lesion or a high-grade lesion, such as CIN 3 (note: a precancerous lesion), what has happened essentially is the virus has infected an immature cell that is prone to replicating and in some fashion, that E6 and E7 has gotten expressed to high levels and it has allowed those cells to accumulate, essentially in a mortalized clone of cells, that you can imagine over time that does not have the normal breaks to say stop replicating, clean up your DNA or die. It's the -- E6 and E7 are efficient in allowing that cell to continue to replicate with the DNA damage. And that over time, the 15 to 20 years on average, leads to an invasive cancer clone."

    Astoundingly, this is simply asserted by Dr Koutsky, with no reference to be found in the Hearing transcript.

    This modification of the mutated onco/suppressor-gene model does not represent a valid scientific consensus. Please consider:

    (1)the following review by George L. Gabor Miklos of "Oncogenes, Aneploidy and AIDS - A Scientific Life and Times of Peter Duesberg" by Harvey Bialy (North Atlantic Books, 2004) at => New book blows the lid on AIDS and Cancer lies (PDF file)

    (2)the book contains a complete consideration of the critical issue of what, precisely, causes cancer;

    (3)"George L. Gabor Miklos and Phillip J. Baird: The Latest Surge in the War on Cancer - Tour de Force or Tour de Farce?" at
    (4) Cervical Cancer Vaccine -- A Shameful Example of How Medical Research is Taking Dangerous Short-Cuts By Nicholas Regush

    Additionally, Dr Duesberg made a recent presentation which directly refutes Dr Koutsky, here:

    It is important also to note that the particular use of PCR technology discussed at the May 18, 2006 FDA Hearing is not endorsed by the Nobel Laureate inventor of it, i.e. Kary Mullis. Why? Because there is no prior documentation of the infectious virions that the PCR is allegedly detecting. Without proper isolation from those with pre-cancerous lesions, how can one determine that HPV's putative pathogenic effect is due to a viral transmission has in the first place? The transcription of E6 and E7 mRNA from HPV DNA episomes in the nucleus, and subsequent translation of these abnormal proteins, may simply be a consistent marker of the genomic rearrangements of stressed cells in karyotypic transition within the cervical environment. This well-documented biological property of HPV DNA ("latency" within the nucleus) means that transmission of its genetic material can only take place by an exchange of epithelial cells between sexual partners.

    So I respectfully ask the esteemed contributors to this forum: what good can a vaccine possibly do given this scenario?

    By Blogger Eugene Semon, At March 14, 2007 6:12 am  

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