We at New Health Dialogue are emphatically not anti-vaccine. The development of vaccines for smallpox, polio, and dozens of other diseases has produced an incalculable reduction in human misery. The overwhelming majority of anti-vaccine messages (claims that the MMR vaccine caused autism) were based on junk science, and posed an irresponsible risk to public health.
All that said, we have to be equally critical of the evidence in favor of vaccination, especially when the evidence is new and uncertain. Jeanne Lenzer, a longtime colleague of Shannon Brownlee, took up that task in a column for Discover Magazine yesterday. In addressing the recent CDC recommendation that 11- and 12-year-old boys should get the Gardasil vaccine against Human Papilloma Virus, she chronicles the methodological problems with Merck's studies backing the drug. In particular, Lenzer takes issue with their exclusion of the numerous participants who didn't follow the treatment protocol exactly. In evaluating a public health issue like vaccination, it's important to understand how well the intervention works in reality--not just in the idealized world of a clinical trial. There's also some question about whether or not the vaccine protects not just against HPV, but against cervical cancer, which is the condition that the vaccine is intended to prevent. On top of that, there is real uncertainty (because the condition is so infrequent) about whether the vaccine is related to Guillain-Barré syndrome--a serious paralyzing condition which can be fatal.
Ultimately, Lenzer focuses on the dubious cost-effectiveness of the new recommendation. The risks associated with HPV in men are relatively small, and Pap smears and early treatment are effective at preventing cervical cancer death in women. At a few hundred bucks each for millions of kids, universal HPV vaccination isn't a cheap endeavor. We need to consider other efforts that might be more cost-effective--otherwise, as Lenzer puts it, "the hope that we would undertake low-tech, high-yield public health efforts might be the real pie in the sky thinking."