Good news! You may remember that the health care reform legislation enacted last year included provisions for preventive health care services to be fully covered without requiring patients to have copayments.
It was not clear, however, whether birth control would be included as a preventive service. It seems obvious to us, but the Institute of Medicine was asked to make some recommendations about which preventive services for women should be included, and included birth control in those recommendations, released yesterday.
If they are adopted, preventive services including birth control could become much more affordable and accessible to women in the United States.
The Institute, after reviewing the rate and consequences of unintended pregnancy, effectiveness of birth control, and cost and access concerns, concluded:
The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.
In addition to copay-free coverage of birth control, the Institute recommended:
screening for gestational diabetes
human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
counseling on sexually transmitted infections
counseling and screening for HIV
lactation counseling and equipment to promote breast-feeding
screening and counseling to detect and prevent interpersonal and domestic violence
yearly well-woman preventive care visits to obtain recommended preventive services
If you need something to read over the long weekend and have a really strong interest in sexually transmitted infections, you’re in luck – the CDC has released a 100+ page report, Sexually Transmitted Disease Surveillance, 2009, on statistics and trends in STIs.
The report focuses primarily on the common STIs of gonorrhea, chlamydia, and syphilis, with data on rates by geographic region, age, sex, and race/ethnicity. It also discusses antibiotic resistance (*shudders*) and drugs in use for treatment of these infections. This publication also includes sections on specific populations, including racial/ethnic minorities, adolescents, and people as they become incarcerated. There’s a lot of data here that might be useful for health care providers, program planners and activists, or other public health types.
There *is* a special section on women, but “women and infants” are lumped together, and the focus is primarily on how STIs might affect women’s reproductive capacity. There is no real attention there to women who may be past their reproductive years, who do not plan to have children, or who are not heterosexually partnered. *Sigh*
Today marks the 8th annual National Women’s Check-Up Day, a nationwide effort coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health to promote the importance of regular check-ups as “vital to the early detection of heart disease, diabetes, cancer, mental health illnesses, sexually transmitted infections and other conditions.”
Planned Parenthood has put together key points concerning sexually transmitted infections along with a handy quiz (see below) to help assess individual risk.
* It is estimated that nearly 19 million new cases of STIs occur each year, and that by the age of 25, one in two sexually active young people will contract an STI.
* Biological factors place women at greater risk of infection than men, and contribute to more severe health consequences for women.
* Chlamydia and gonorrhea, the two most commonly reported infectious diseases in the United States, are also among the most serious and preventable threats to women’s fertility.
* Both rates and consequences of chlamydia and gonorrhea are far more severe among women than men.
* If left untreated, chlamydia and gonorrhea can lead to infertility.
* Most STIs have also been associated with increased risk of HIV transmission.
* Many STIs often don’t cause any symptoms. Many people get or spread infections without ever having symptoms.
Amanda Lenhart, senior research specialist at Pew Research Center’s Internet & American Life Project, has posted her presentation on social media and young adults that was delivered this week at the National STD Prevention Conference in Atlanta. The slideshow covers the latest data on electronic and digital communciation, including cell phone usage and sexting.
Presenting with Lenhart was Kicesie Drew, who provides sex ed information via YouTube; Sally Swanson from the Adolescent Pregnancy Prevention Campaign of North Carolina, a group that usess texting to answer questions about sexual health; and Cornelis Rietmeijer, director of the Sexually Transmitted Disease Control Program/Denver Public Health.
More health professionals are turning to innovative techniques and technologies to reach young and at-risk populations. I recently took part in a symposium, sponsored by Chicago Department of Public Health and the National LGBT Tobacco Control Network, on how public health workers can use social media to reach the LGBT community. We looked at some of the promises and obstacles that new communciation tools present. One of the most important lessons: Know how your audience uses technology, and go where they go.
The Red Pump Project presents statistics about HIV/AIDS and women — and the great disparities. Though black and Latina women represent 24 percent of all U.S. women combined, they account for 82 percent of the estimated total of AIDS diagnoses for women in 2005. Consider that HIV is the:
* Leading cause of death for black women (including African American women) aged 25–34 years.
* 3rd leading cause of death for black women aged 35–44 years.
* 4th leading cause of death for black women aged 45–54 years.
* 4th leading cause of death for Latina women aged 35–44 years.
* The only diseases causing more deaths of women are cancer and heart disease.
* The rate of AIDS diagnosis for black women was approximately 23 times the rate for white women and 4 times the rate for Latina women.
These numbers illustrate the need for massive improvements in education, prevention and treatment — all topics the National STD Prevention Conference aims to address. High-priority issues are identified for each biennial conference, and this year’s top three issues couldn’t be more relevant or directly worded.
The last point is a great reminder of how change is both incredibly simple and complex: “It is essential to find ways to move beyond our longstanding societal reticence to openly discuss sexual health issues and to normalize conversations around STD prevention.”
Plus: In related news, Washington, D.C. will make 500,000 female condoms available — for free. The condoms will be available in beauty salons, convenience stores and high schools in parts of the city with high HIV rates, reports the Washington Post. The project is funded through a $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics.
OBOS is committed to expanding our audience and in this spirit we’ve asked former board member Moises Russo to translate into Spanish several of our blog entries. We hope to translate more entries in the coming year.
En OBOS estamos comprometidos a expandir nuestra audiencia de lector@s y en este espíritu le hemos solicitado a Moisés Russo, ex-miembro de la Junta de OBOS, que traduzca al español varios de los blogs que tenemos en la página electrónica. Esperamos continuar con dichas traducciones durante este año.
Una segunda vacuna diseñada para proteger contra el cáncer cervicouterino estará disponible pronto en Estados Unidos.
La semana pasada, un panel de la de Food and Drug Administración (FDA) dio su aprobación a la vacuna Cervarix de GlaxoSmithKline PLC*, esencialmente recomendando que la FDA apruebe la vacuna para el uso en mujeres de 10 a 25 años de edad. La recomendación no es obligatoria; la FDA puede rechazar la decisión, pero ésta generalmente acepta la opinión de paneles externos de expertos.
La vacuna protege contra dos tipos de virus papiloma humano (VPH), asociados al 70% de los cánceres cervicouterinos.
Escribiendo en el Wall Street Journal, Jennifer Corbett Dooren resumió las preocupaciones con respecto a la seguridad que la FDA levantó acerca de Cervarix, incluyendo “una mayor tasa de abortos entre las mujeres que recibieron Cervarix”. La FDA refirió además “no se puede excluir un ‘pequeño efecto’ sobre los embarazos”. (La vacuna no está aprobada para su uso en mujeres embarazadas).
GlaxoSmithKline intentó por primera vez conseguir la aprobación el año 2007, pero la FDA solicitó más información luego de que algunos reportes sugirieron una tasa más alta de abortos en mujeres embarazadas. Dooren escribe:
La agencia dijo que se requeriría de un estudio de seguridad post- marketing para monitorizar los resultados de embarazos en mujeres que pudiesen recibir Cervarix, junto con otras potenciales preocupaciones sobre su seguridad incluyendo el desarrollo de enfermedades autoinmunes como Artritis Reumatoide y Esclerosis Múltiple. En su revisión del año 2007 de Cervarix, la FDA indicó que tenía preocupaciones sobre un “desequilibrio” en posibles desordenes autoinmunes visto en algunos estudios clínicos. Sin embargo, la agencia ha dicho que revisiones adicionales de los datos realizadas por sus propios equipos y por un reumatólogo externo concluyeron que las diferencias no eran estadísticamente significativas.
Oficiales de Glaxo dijeron que estaban planeando un estudio de post-marketing que enrolaría a 100.000 mujeres en los EEUU, el cual incluiría un registro de embarazos. La compañía también se encuentra realizando otro estudio de post-marketing de grandes proporciones en Finlandia.
Gardasil, la popular vacuna contra el VPH fabricada por Merck y & CO. Fue aprobada por la FDA el 2006. Uno de los principales investigadores para la vacuna recientemente ha comenzado a denunciar preocupaciones con respecto a sus riesgos, beneficios y agresivas estrategias de marketing – principalmente que la protección puede no durar más allá de los 5 años, por lo que las niñas que sean vacunadas a una edad temprana pudiesen en el futuro aún encontrarse en riesgo.
El mes pasado, Rachel apuntó a una editorial del Journal de la Asociación Médica Americana sobre los riesgos y beneficios de la vacunación contra el VPH y analizó un comentario en la misma edición de JAMA (sólo resumen) sobre el marketing de Gardasil. Describiendo los hallazgos de los autores, Rachel escribió: “ La táctica de la compañía fue fomentar que todas las mujeres dentro de un cierto grupo de edad se vacunaran como una medida para evitar el cáncer, en vez de trabajar con oficiales de la salud pública para enfocarse en aquellas niñas que tienen un riesgo más elevado”.
Los Centros para el Control y Prevención de las Enfermedades (CDC por sus siglas en inglés) recomienda la vacuna para niñas de 11 y 12 años, y niñas y mujeres entre las edades de 13 y 26 años que aún no hayan sido vacunadas. Esa recomendación sin embargo se convierte en un mandato para las mujeres inmigrantes entre 11 y 26 años que buscan la ciudadanía Estadounidense. Gardasil fue agregada a la lista de vacunas requeridas el año 2008.
Simona Davis, una niña de 17 años en Florida que nació en el Reino Unido está buscando la ciudadanía Estadounidense pero se rehúsa a vacunarse. El noticiario ABC News tiene un reportaje completo sobre su rechazo a la vacuna. Davis, que es una cristiana devota que dice no tener intención de iniciar relaciones sexuales en el futuro cercano (menciona su promesa de virginidad como una prueba), está buscando una exención por razones morales y religiosas. Los Servicios de Ciudadanía e Inmigración de los EEUU han rechazado su solicitud.
“La decisión de incluir el VPH como una vacuna requerida fue hecha por el CDC”, ha dicho la vocera de los Servicios de Ciudadanía e Inmigración de los EEUU Chris Rhatigan a ABC News. “Nosotros seguimos la ley….La objeción a una exención debiese ser a todas las vacunas, no solamente a Gardasil”.
Un vocero del CDC ha dicho que se espera que el CDC publique nuevos criterios dentro de aproximadamente un mes para determinar que vacunas debiesen ser recomendadas a inmigrantes a los EEUU.
Last week, the CDC issued revised vaccination criteria for U.S. immigration which will reverse the requirement that female immigrants seeking permanent residence or entry to the U.S. be immunized against HPV.
The new criteria require that any mandated vaccine must be age-appropriate for the immigrant applicant, and must either protect against a disease that has the potential to cause an outbreak or protect against a disease that has been eliminated or is in the process of being eliminated in the United States. As HPV does not meet these criteria, the vaccine will no longer be required starting next month (30 days after publication in the Federal Register).
We have written several times about the requirement, including the CDC’s initial comment on the matter and various action alerts/campaigns asking the agency to reverse the requirement.
As we and others noted, the requirement was problematic for multiple reasons, such the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.
In the revised criteria document, published in Friday’s Federal Register, HPV vaccination is specifically addressed as follows:
CDC has applied the criteria and determined that once these criteria become effective December 14, 2009, the HPV vaccine will not be required for aliens seeking admission as an immigrant or seeking adjustment of status to that of an alien lawfully admitted for permanent residence….Therefore, while HPV may be an age-appropriate vaccine for an immigrant applicant, HPV neither causes outbreaks nor is it associated with outbreaks (per explanation in the background section). Further, HPV has not been eliminated, nor is in the process of elimination, in the United States. Therefore, because HPV does not meet the adopted criteria, it will not be a required vaccine for immigrant and adjustment of status to permanent residence applicants.
Under the new criteria, the zoster (chicken pox) vaccine will also be removed from the requirements. The agency continues to recommend the two vaccines for U.S. citizens, but vaccine recommendations will no longer be automatically translated to mandates for immigration.
A second vaccine designed to protect against cervical cancer may soon be available in the United States.
A Food and Drug Administration panel last week gave its approval to GlaxoSmithKline PLC’s Cervarix vaccine, essentially recommending that the FDA approve the vaccine for use in females 10 to 25 years old. The recommendation is not binding; the FDA can reject the decision, but it generally accepts the opinions made by an outside panel of experts.
The vaccine protects against two strains of human papilloma virus (HPV) that are associated with 70 percent of cervical cancers.
Writing in the Wall Street Journal, Jennifer Corbett Dooren summarized the safety concerns the FDA raised about Cervarix, including “a higher rate of miscarriages among females who received Cervarix.” The FDA also “couldn’t rule out a ‘small effect’ on pregnancies.” (The vaccine is not approved for use in pregnant women.)
GlaxoSmithKline first sought approval in 2007, but the FDA asked for more information after reports suggested a higher miscarriage rate in pregnant women. Dooren writes:
The agency said it would require a post-marketing safety study to monitor the outcome of pregnancies in women who might receive Cervarix along with other potential safety concerns including the development of autoimmune diseases like rheumatoid arthritis and multiple sclerosis. In its 2007 review of Cervarix, the FDA said that it was concerned about an “imbalance” of possible autoimmune disorders seen in clinical trials. However, the agency said an additional review of the data by its own staff and an outside rheumatologist concluded the differences weren’t statistically significant.
Officials from Glaxo said they were planning a post-marketing study that would involve 100,000 women in the U.S., which would include a pregnancy registry. The company is also conducting another large post-marketing study in Finland.
Gardasil, the popular HPV vaccine manufactured by Merck & Co., was approved in 2006. One of the lead researchers for the drug recently started speaking out with concerns about its risks, benefits and aggressive marketing — namely that the protection may not last beyond five years, so girls who are vaccinated at an early age may still be at risk.
Last month, Rachel pointed to a Journal of the American Medical Association editorial on the risks and benefits of HPV vaccination and discussed a commentary in the same JAMA issue (abstract only) about the marketing of Gardasil. Describing the authors’ findings, Rachel wrote: “The company’s tactic was to encourage all girls within a certain age group to be vaccinated as a cancer avoidance measure, rather than to work with public health officials to target those girls at the highest risk.”
The Centers for Disease Control and Prevention recommends the vaccine for 11- and 12-year-old girls, and girls and women age 13 through 26 who have not yet been vaccinated. That recommendation becomes a mandate, however, for female immigrants between the ages of 11 and 26 seeking U.S. citizenship. Gardasil was added to the list of required vaccines in 2008.
Simone Davis, a 17-year-old girl in Florida who was born in Britain is seeking citizenship but she refuses to get the vaccine. ABC News has a comprehensive story about her refusal. A devout Christian who says she has no intention of having sex anytime soon (she mentions her virginity pledge as proof), Davis is seeking a waiver for moral and religious reasons. U.S. Citizenship and Immigration Services has rejected her claim.
“The decision to include HPV as a required vaccine was made by the CDC,” Citizenship and Immigration Services spokeswoman Chris Rhatigan told ABC News. ”We follow the law … The objection to a waiver would have to be to all vaccines, not just Gardasil.”
A CDC spokesperson said the CDC is expected to publish new criteria to determine which vaccines should be recommended for U.S. immigrants in about a month.
I’m thrilled to be at the annual WAM! conference this weekend — so many great activists, writers, journalists, artists and teachers in one (very cool) space brainstorming, debating and learning from each other.
Yesterday I taught a day-long workshop on blogging (note to participants: hope you alert us all to your new blogs soon!). At this moment, I’m in the back row of the session “New Administration, New World Order: The Top Five Reproductive and Sexual Health and Rights Stories You’ll Want to Track — And How,” featuring Dana Goldstein, Jessica Gonzalez-Rojas, Emily Douglas and my boss, Kiki Zeldes.
Kiki’s talking about the not-quite-inaccurate-but-blatantly-biased condom information available on the CDC website under the Bush administration — the website stressed abstinence and downplayed the safety of condoms. Under the Obama administration, the CDC website has already been updated, and the new message states up front that correct and consistent use of condoms can reduce the risk of sexually transmitted infections. It’s just one example of subtle but important changes that can save lives. (Update: TheCh!ctionary.com captured Kiki’s comments.)
The only problem this afternoon is deciding which sessions to attend. I may duck next door to catch Deanna Zandt and Susan Mernit, who are presenting on social media tools.
Read more from the conference at these sites and also check out the Twitter feed …
Searching for Common Ground: Robert Pear of The New York Times reports on an apparent consensus emerging among key players in the health care debate:
Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.
While not all industry groups are in complete agreement, there is enough of a consensus, according to people who have attended the meetings, that they have begun to tackle the next steps: how to enforce the requirement for everyone to have health insurance; how to make insurance affordable to the uninsured; and whether to require employers to help buy coverage for their employees.
Health Care “Reform” is Not Enough: “Most current health care reform initiatives, including those of Barack Obama, focus on providing wider access to health insurance. They do little to address the underlying problems with our health care system,” writes Susan Yanow in On The Issues magazine. Yanow identifies the top five problem areas for women with our insurance-driven health system.
Plus: This list of 10 ways to spend less on health care during a recession is well-meaning, but the list assumes a level of privilege that leaves out millions. I keep thinking of this story from last week.
“Is Your Daughter Safe at Work?”: The PBS program NOW has collaborated with the Schuster Institute for Investigative Journalism at Brandeis University on an unprecedented broadcast investigation of teen sexual harassment in the workplace. Check your local PBS station schedule for air dates.
The NOW website has a terrific collection of useful links and resources, as does the Schuster Institute, including an interactive map with links to information about specific teen sexual harassment cases gone to court. Keep in mind the map reflects a tiny proportion of probable cases. Kudos to EJ Graff for kicking off this project with her article, “Is Your Daughter Safe at Work?,” published in Good Housekeeping in June 2007.
The Trouble With Repeat Cesareans: “Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them,” writes Pamela Paul at Time magazine. “More than 9 out of 10 births following a C-section are now surgical deliveries, proving that ‘once a cesarean, always a cesarean’ — an axiom thought to be outmoded in the 1990s — is alive and kicking.” A good look at the VBAC-lash.
North Dakota House Passes Egg-as-Person Bill: “On Tuesday, one body of North Dakota’s state legislature voted, 51-41, not only to ban abortion, but to define life as beginning at conception. Such a measure, considered extreme even by pro-life standards, would have far-reaching consequences on women’s health,” writes Kay Steiger at RH Reality Check.
Understandably, Rachel Has Some Concerns …: About a proposed Tennessee bill that calls for testing some pregnant for alcohol and drugs.
Gone Daddy Gone: I couldn’t agree more with Creativity magazine editor Teressa Lezzi, who writes at AdAge.com:
After this year’s Super Bowl, I just couldn’t do it anymore. As it was, any time I had to log on to Go Daddy I felt some combination of embarrassment and annoyance at the registrar’s approach to women and marketing. But after its execrable ad efforts around this year’s game, I found that I just couldn’t stomach contributing anything to this organization any longer. I’m transferring my domains and my insignificant little piece of business elsewhere.
GoDaddy turned me off years ago because of its super lame ads, though I sometimes have to deal with the company for other clients. If sexist advertising isn’t reason enough to stay away, GoDaddy’s user interface sucks.
Cervical Cancer Vaccine Usage in California: A study by UCLA’s Center for Health Policy Research found that one in four teenage girls in California — about 378,000 out of 1.5 million — received at least one dose of the Gardasil vaccine in 2007, its first full year of distribution, reports the L.A. Times.
Truth Catches Up: Remember the eye-catching “truth” anti-smoking ads? Researchers at the Johns Hopkins Bloomberg School of Public Health and the American Legacy Foundation estimate that the nations’ largest youth smoking prevention campaign saved $1.9 billion or more in health care costs associated with tobacco use. The findings appear in the Feb. 12 online edition of the American Journal of Preventive Medicine. The American Legacy Foundation, which launched the ads in 2000, spent $324 million to implement and evaluate the truth campaign.
Plus: Cigarette-maker Philip Morris was ordered to pay $8 million in damages to the widow of a smoker who died of lung cancer in a case that could set the standard for 8,000 similar Florida lawsuits, reports NPR.
In June of last year, the Society of Obstetricians and Gynaecologists of Canada (SOCG) published new guidelines [PDF] on the management of herpes simplex virus (HSV) in pregnancy.
There are two types of herpes simplex virus, HSV-1 and HSV-2. HSV-1 tends to be the cause of oral herpes (“cold sores” or “fever blisters”) and HSV-2 tends to be the cause of genital herpes, although either virus can affect the oral or genital areas. Herpes in pregnancy is of concern because of the potential to pass the virus to the fetus during or near delivery, especially when the woman is newly infected late in pregnancy.
SOGC’s guidelines recommend that women’s history of genital herpes be evaluated early in pregnancy, and that women with a history of genital herpes outbreaks be counselled about the risk of transmission at delivery. Suppressive therapy is suggested at or after 36 weeks gestation for women with recurrent herpes. They also recommend that “At delivery, women with recurrent HSV should be offered a Caesarean section if there are prodromal symptoms or in the presence of a lesion suggestive of HSV.”
In plain language, they suggest offering a c-section if the woman has an active herpes sore or symptoms suggesting one is about to appear. They explain that the risk of transmission at delivery is highest when a woman has a new outbreak in the third trimester, and that women should be counselled about the risk and offered a c-section.
The authors also note that there is likely little benefit to c-section if delivery is imminent, or with “prolonged rupture of membranes.” They recommend avoidance of scalp electrodes and fetal scalp sampling, and suggest that use of intrauterine monitoring devices be considered carefully.
Guidelines on the same topic from the American College of Obstetricians and Gynecologists, published in 2007, reach similar conclusions that c-section “is indicated in women with active genital lesions or prodromal symptoms,” but that c-section is “not recommended for women with a history of HSV infection but no active genital disease during labor.”
Neither guideline suggests that c-section is necessary for all HSV-infected women or even all women with outbreaks of the virus at delivery. For additional discussion of genital herpes in pregnancy, see this resource from the March of Dimes.
Last week, we posted about a petition created by the National Asian Pacific American Women’s Forum for organizations to sign on and oppose the new requirement that female immigrants ages 11 to 26, seeking permanent residence or entry to the U.S. be immunized against the human papillomavirus (HPV).
In response to a high level of interest from individuals who also wanted to share their opposition to the requirement, NAPAWF has created a separate petition to allow individuals to express their opposition to the mandate. This petition to the CDC notes the financial burden of this vaccination, the lack of an HPV vaccine requirement for citizens, and the lack of freedom for informed decision-making and patient choice imposed by the requirement.
The deadline for sign-ons is the close of business on Friday, January 30. Go here to add your signature.
The National Asian Pacific American Women’s Forum (NAPAWF) is coordinating the creation of a letter to the CDC opposing the newly-imposed requirement that female immigrants ages 11 to 26, seeking permanent residence or entry to the U.S. be immunized against the human papillomavirus (HPV).
We’ve written about this issue in the past, noting that the CDC has indicated that they did not intend for this vaccine to be required for legal status, and the National Women’s Health Network’s action alert requesting calls to your Senators and Representatives asking for the removal of the vaccine from the U.S. Citizenship and Immigration Services (USCIS) requirements.
The NAPAWF letter asks that the CDC reexamine and “modify its current system of adding new vaccination requirements for immigrants to prevent future unintended additions to the list of mandatory vaccinations and undue burdens on immigrants.”
It also outlines several of concerns about the vaccine requirement, including the lack of a sufficient threat to public health, the lack of requirement that U.S. citizens receive the vaccine series, and the high cost which creates a financial barrier for immigrant women.
Finally, the letter acknowledges related concerns about health disparities women of color:
Research that disaggregates data based on race and ethnicity show that cervical cancer has a disproportionate impact on certain immigrants… However, the CDC’s and USCIS’s decision to mandate Gardasil for young immigrant women will not resolve these health disparities. For many immigrant women, the high expense of medical care, the lack of health insurance, and the difficulty in finding culturally competent services means that they forego routine preventative health care services such as pap smears. These inequalities in access contribute to the high rates of cervical cancer among immigrant women. While we support safe medical technologies that protect women’s health, mandating the use of medical procedures will not fully improve immigrant women’s lives.
…
We believe our focus should be on strengthening culturally-competent outreach efforts, increasing access to preventative health care services, such as Pap smears, for all groups of women facing a disproportionate risk of cancer. We also believe that all women should have the same right to informed decision-making over whether or not they want to get vaccinated against HPV.
Organizations can sign on to the letter prior to Friday, January 16 by emailing Nancy Chung of NAPAWF at nchung at napawf dot org.
Last month, I wrote about the new requirement that immigrants seeking permanent legal status in the United States receive the HPV vaccine (along with other required vaccines).
Briefly, my concerns about this change included “the lack of an opt-out provision (in contrast to requirements for U.S. citizens), the expense of the series, the lack of significant public health risk posed by omitting this vaccine, and the vulnerability of the affected population.” See the original post for more details and links to further commentary.
On Tuesday, the National Women’s Health Network issued a call for people concerned about this issue to contact their Senators and Representatives to request that they support “removing the HPV vaccine from the U.S. Citizenship and Immigration Services (USCIS) requirements for the adjustment of status” and suggesting a core message that “I, along with the National Women’s Health Network, support providing women with all possible tools to prevent cervical cancer but strongly oppose the USCIS HPV vaccine mandate.”
The organization explains:
“Based on the research made public to date the HPV vaccines appear to be highly effective and very safe. While the National Women’s Health Network (NWHN) supported FDA approval of Gardasil, it is important to acknowledge that it is a new technology and clinical experience with it is limited. There are some questions about the effectiveness of the vaccine that cannot yet be answered, and, as with any new product, there isn’t any data about its long-term safety.
Although the HPV vaccine is an important tool for reproductive health, it is a relatively new technology and the NWHN believes that obtaining it should be an informed decision rather than a response to a mandate for only one sector of the population. We urge you to take a moment and to call or email your members of Congress to ask them to reverse this policy. We need to ensure that immigrant women are not faced with yet another barrier to adjusting their status.”
You can find your Senator or Representative online. I’ll update this post with links to NWHN’s suggested phone and email scripts if they become available online.
Gay Marriage Legal in California, Massachusetts and now Connecticut: The Connecticut Supreme Court on Friday struck down the state’s civil union law with a 4-3 ruling that same-sex couples have a constitutional right to marry. From The New York Times:
The ruling, which cannot be appealed and is to take effect on Oct. 28, held that a state law limiting marriage to heterosexual couples, and a civil union law intended to provide all the rights and privileges of marriage to same-sex couples, violated the constitutional guarantees of equal protection under the law.
Striking at the heart of discriminatory traditions in America, the court — in language that often rose above the legal landscape into realms of social justice for a new century — recalled that laws in the not-so-distant past barred interracial marriages, excluded women from occupations and official duties, and relegated blacks to separate but supposedly equal public facilities.
View the full ruling here (PDF). Opponents spoke of steps to enact a constitional ban on same-sex marriage, but on Friday night the plaintiffs in the original court case filed four years ago and their supporters were jubilant.
Garret Stack, 59, introduced his partner, John Anderson, 63, and said: “For 28 years we have been engaged. We can now register at Home Depot and prepare for marriage.”
Group Sues Over Required Ultrasound: The Center for Reproductive Rights has filed a challenge to an Oklahoma law that mandates a woman must have an ultrasound and listen to the doctor describe what her fetus looks like before she have an abortion. And that’s not all:
At the same time, the law prevents a woman from suing her doctor if he or she intentionally withholds other information about the fetus, such as a severe developmental defect. The statute also requires doctors to use a specific regimen for administering the medical abortion pill, despite that regimen being less effective and more costly than the one strongly recommended by the American College of Obstetricians and Gynecologists (ACOG).
The lawsuit, filed Thursday in Oklahoma County District Court, says the requirement intrudes on a woman’s privacy, endangers her health and assaults her dignity.
Set to go into effect on Nov. 1, the law would make Oklahoma the fourth state to require the viewing of ultrasounds before an abortion. The other states are Alabama, Louisiana and Mississippi.
South Dakota Abortion Ban 2.0: Lynn Harris of Broadsheeet offers a full, and funny, assessment:
The ban’s primary liability, according to polls, was that it contained virtually no exceptions. But as ringleader Leslee Unruh of Vote Yes for Life said at the time, like Jason popping up out of Crystal Lake, “We started something here in South Dakota.” And now, as you may have heard, abortion opponents there are aiming to get the job done. Which means: The ban is back (PDF), in sheep’s clothing. It now makes convoluted exceptions for rape, incest and, when there is a full moon and Mount Rushmore spouts Strawberry Quik, the health or life of the woman.
Unruh (who says that over 90 percent of women seeking abortion are using it as “birth control”) calls Abortion Ban 2.0 “more moderate, more reasonable, more of a middle ground.” Yeah … no.
Birth Control Watch: While some voters think access to birth control is not a political issue, those of us who follow the activities of the Bush administration and legislatures around the country know better. Birth Control Watch has a great section on federal and state proposals that will limit our individual decision making and access — it’s called extreme schemes.
An excellent resource to pass along, it includes information on Colorado Proposition 48, a constitutional amendment that seeks to establish legal personhood from the moment of fertilization (which even self-described “pro-life” Catholic Gov. Bill Ritter opposes), and the proposed HHS regulations that would limit patients’ access to information and services.
The two-minute activist gives a concise run-down of actions you can take, and the press room tracks related stories.
Speaking of the HHS regulations, more than 150 Congressional Democrats stated their opposition in letters to HHS. The Senate letter concludes that the proposed rule is “damaging to the health care needs of women, their families and all Americans and will only serve to cause havoc, not clarity, among employers and employees in the health care field.”
Courts Failing Domestic Violence Victims: “For every man convicted in a Cook County court of beating his wife or girlfriend, five men brought in on similar charges walk away legally unscathed. And despite official promises to help women pursue abuse complaints, that conviction rate is only getting worse,” reports the Chicago Tribune.
The Trib also looks at a specialized unit of the Cook County state’s attorney office with a much higher conviction rate. The unit, Target Abuser Call, employs a more intensive investigatory approach for the most serious cases.
Plus: Programs for batterers are underfunded but should be supported to break the habit of abuse, say domestic violence experts. “No matter how many women you take in, it isn’t going to cure the problem,” said Toby Myers, vice chair of the National Center on Domestic and Sexual Violence.
Plus: A judge in Canada tells a woman not to bother calling police if she goes back to her partner. via Feministing
Nobel Prize Winners: The 2008 Nobel Prize in Physiology or Medicine went to Harald zur Hausen of Germany, who discovered the human papilloma viruses that causes cervical cancer, and Luc Montagnier and Francoise Barre-Sinoussi, French researchers who discovered HIV, the virus that causes AIDS.
Montagnier and Barre-Sinoussi later told President Nicolas Sarkozy that they fear the world financial crisis will affect funding to fight AIDS.
One-Year Distribution Update On Gardasil: “About a quarter of the nation’s teenage girls received the controversial cervical cancer vaccine Gardasil last year in its first full year of distribution, federal authorities said Thursday,” reports the L.A. Times.
The Realities of Addiction: Writing in the Washington Post, Jacqueline M. Duda shares the painful story of her daughter’s drug addiction and death — including the difficulty the family had finding adequate medical treatment for addiction.
“Surely, we thought, college-educated suburbanites like us could locate professional help: drug counselors, doctors, therapists specializing in addiction. Surely detoxification centers would treat desperate addicts and work out a payment plan. Surely we could check her into some kind of residential treatment program with a minimum of delay,” writes Duda. “We were wrong.”
PSA to Raise Awareness Around “That’s So Gay”: “For the first time since the Advertising Council was founded in 1942, the organization — which directs and coordinates public service campaigns on behalf of Madison Avenue and the media industry — is introducing ads meant to tackle a social issue of concern to gays and lesbians,” writes Stuart Elliot in The New York Times.
The campaign, created pro bono by the New York office of Arnold Worldwide, urges an end to using derogatory language, particularly labeling anything deemed negative or unpleasant as “so gay.” That is underlined by the theme of the campaign: “When you say, ‘That’s so gay,’ do you realize what you say? Knock it off.”
There will be television and radio commercials, print and outdoor ads and a special Web site devoted to the campaign (thinkb4youspeak.com). Some spots feature celebrities, the young actress Hilary Duff and the comedian Wanda Sykes, delivering the message.
Combine girls, vaccines, and sex, and you apparently get a recipe for sensationalism and poor reporting. CNN yesterday featured a piece, “Should parents worry about HPV vaccine?” which notes that “Gardasil has been the subject of 7,802 ‘adverse event’ reports from the time the Food and Drug Administration approved its use two years ago.”
What the article doesn’t explain is how the Vaccine Adverse Event Reporting System (VAERS) system works. Reports to VAERS can be submitted by anyone, and are not verified or definitively linked to the vaccine without further investigation. This understanding was not demonstrated by the piece, which simply conceded,
“The company said in a statement that an adverse event report ‘does not mean that a causal relationship between an event and vaccination has been established — just that the event occurred after vaccination.’”
This phrasing makes it seem as though it’s just the company (that stands to make money) that believes that reports don’t indicate a causal relationship – it seems designed to make the average reader believe that this characterization is just the vaccine maker protecting its financial interests. While OBOS often points out ways in which pharmaceutical companies and medical device companies prioritize their own financial interests above people’s health, in this instance the company is simply explaining how the reporting system works.
The piece also doesn’t address how this figure compares to anticipated adverse events estimated from the original studies, how it compares to the rates of adverse events for other vaccines, or that, due to the current system, there are always more/different side effects reported after a drug is approved (in the “post-marketing” period) due to the numbers of individuals involved. For example, if a drug causes death in 1 in 500,000 people, and was tested in 2,000, the possibility of the drug causing death is not likely to be realized until it is on the market and prescribed to a large population.
On the other hand (and unmentioned in the CNN article), many adverse events may occur that are not reported. “Post-marketing surveillance” – including analysis of reports from those who have received the drug or vaccine after it has been approved – is a crucial aspect of safeguarding the public from dangerous drugs. Because individuals and physicians may not associate an outcome with the vaccine, and many individuals may not realize that they are allowed to submit reports directly, underreporting of effects is both possible and likely. The FDA uses this surveillance system to make changes to labels, educate physicians about risks, and re-evaluate their approval of a drug or vaccine, so it remains important that adverse outcomes are reported, despite the cautions about making judgments based on raw numbers of reports and difficulties in later determining which of those outcomes were directly linked to a specific drug, vaccine, or other product.
“Finally, CNN presents us with the terrifying story of a teenager who developed pancreatitis not long after taking the vaccine. While I am not insensible to how horrifying such a serious illness would be for a young girl and her family, it should be CNN’s responsibility to verify whether or not her fear that it was related to the vaccine could be founded – by researching how many of those incident reports dealt with pancreatitis, for example, or other autoimmune diseases. This type of reporting is important, after all, since it could impact women’s decisions and, consequently, their health.”
This approach is not limited to CNN – Judicial Watch is currently featuring the large, bolded headline, “Judicial Watch Uncovers New FDA Records Detailing Ten New Deaths & 140 ‘Serious’ Adverse Events Related to Gardasil.” However, the CDC has reported that of the 10 deaths they have analyzed, they could not establish a causal relationship between the vaccine and the deaths, and notes that “While Gardasil was being tested in the U.S. before it was licensed, 10 people in the group that received the HPV vaccine and 7 people in the placebo group died during the trials. None of the deaths was considered vaccine-related.”
In their report, Judicial Watch also suggests that Gardasil wasn’t adequately tested for adverse effects because the comparison placebo vaccine contained an aluminum “reactive, potentially harmful substance.” Without reading the original studies, this probably makes the comparison more valid instead of less, because the real vaccine also contains an aluminum compound (as do many other vaccines), and omitting it from the placebo vaccine would have skewed the comparison by confusing adverse effects of the aluminum with adverse effects of the actual vaccine substance.
I have to wonder if we’d be seeing the same level of fear-mongering if this were another vaccine, if opponents hadn’t suggested that it would cause young girls to become sexually active and that girls from “good homes” don’t get HPV. Yes, of course we should keep watch when a new drug, vaccine or product is approved and is targeted to women. Of course we should attempt to tease out real and serious side effects that didn’t appear in the smaller trials, and be wary of the financial motives companies have to put the best light on their product. Of course we should be aware of mandates for vaccination and ensure that adequate information and opt-out provisions are available. It may still turn out that there are serious issues with Gardasil that warrant a different assessment of the risks and benefits. However, incomplete and inaccurate reporting and misrepresentation of the science does nothing to assist women and families in making decisions about vaccination and safety.
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