Friday, February 8, 2008

Going for It!

My doctor has agreed to give me an off-label Gardasil vaccination, and I have just indicated to her that I'd like to proceed with it.

Okay, now, some important disclaimers:

I am absolutely not recommending that you follow my lead, or do not follow my lead in this. I am by necessity working with limited information. I will share with you my thinking, but only for completeness sake. I am not a doctor. My doctor did not recommend that I have this vaccination. The FDA has not approved it for use in patients like myself.

Those disclaimers aside, do I think this is a good idea for me?

Let's break it down. I think there are two basic concerns. Safety and efficacy. On top of that, there's are just costs (time and money, it won't be covered by insurance), and meta-concerns.

First, safety. Published tests only cover Gardasil safety in women. Two things give me additional comfort here, but they should not necessarily be something *you* take for granted. First, Merck has been running for several years a test on men. These tests have not been released to the public, but Merck has announced it intends to ask for approval for men this year in any case. While I have no illusions that Merck would not push for approval of a borderline safety case, the completion of the study, combined with the rarity of gender-specific safety issues in similar vaccines, make my comfort in the general safety of this choice strong.

Second, efficacy. I am far from convinced that this will be effective. The number I keep pulling out of my ass is about 30%, reflecting that the vaccine is effective in younger unexposed women, but lacking additional data on older people and men, and without any actual evidence that I have or have not taken on various HPV strains. I'd almost be surprised if I'd never taken on HPV in some strain or another at this point in my life. Moreover, Herpevac, IIRC, a HSV vaccine, was shown to be effective in women and not men, there's some precedent for gender-specific activity, although that may or may not reflect the differences in the anatomy. Very little is known (or at least published) about effectiveness with respect to anal, penile, throat and mouth cancers. So, I pull "30%" out of my ass. That's enough that it might make a difference to me, or a partner, or a partner's partner someday, but far from anything certain. If I'd come up with 10%, I wouldn't be doing this. If I'd come up with 70%, I would have pushed for this sooner.

Price: I'm paying for this out of pocket. *shrug*. The three injections are going to run me about $360, as I understand it. But that's why I have money, to make my life better. I'm not particularly cost-sensitive, of course that's an issue for most folks.

Other terms: One concern my doctor expressed, not so much as an accusation as a "I would be concerned if X, but I don't imagine that's your way.", was that I'd presume efficacy and change my behavior based on the thought that the vaccine was effective when it might not be. This both has implications for my own health and my partners, and this leaves me, I feel, with an ethical duty to not only explain to potential partners why they should not feel particularly "safer" because I've done this. And I think that's probably right.

Anyway, I weighed it all, and there, the decision is made, the die is cast. Wish me luck. Wish us all luck, a successful vaccine that prevented oral, throat, penile anal and cervical cancer in large swaths of the population would be a very great thing indeed.

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