How safe is Gardasil? And a new antivax FAQ

By Phil Plait | October 16, 2009 2:00 pm

Fighter for truth and science Ben Goldacre tweeted a link to a nifty blog post showing just how safe the Gardasil HPV vaccine is. Using easy-to-understand graphics, the post (on the very nice Information is Beautiful blog) makes it very clear that comparing the good it does to the very tiny risk, Gardasil is a monumental achievement. Actually, just all on its own it’s a big advancement in the fight against cancer. The post also puts it in place among other low-risk dangers like getting hit by lightning or being killed in an earthquake. I like that; I myself have compared it with dying from falling off a chair.

Also, there is a website called the Vaccine Information and Awareness Service (gotta love that URL) which provides a great repository of info about the truly awful shenanigans of Meryl Dorey and the (ironically-named) Australian Vaccination Network, the loudest and — amazingly, given how reality-free these people tend to be — perhaps least-accurate antivax group in Australia. It’s a good place to go when you hear the latest health scare nonsense from the AVN. I’m glad so many people are rising up against the voices of scare-mongering and antiscience. They pose a real health threat, as far too many people have learned.

While I’m at it, my friend and pediatrician Joe Albietz has another slam-dunk article about the awful antivax nonsense being spread about the H1N1 vaccine.

CATEGORIZED UNDER: Alt-Med, Antiscience, Debunking

Comments (33)

  1. I just blogged a story over at Facts, Not Fantasy that highlights a lot of misconceptions about the HPV vaccine.

    5th story down: http://www.factsnotfantasy.com/2009/10/today-in-news-16-oct-09.html

  2. It would be nice to know of the number of doses distributed, how many have actually been administered.

  3. I keep having to remember that Gardasil isn’t a fancy spice blend.

  4. Aerimus

    Speaking of vaccines, anyone catch last night’s Daily Show. For those that missed it, here’s a clip….

    http://www.thedailyshow.com/watch/thu-october-15-2009/doubt-break–09

  5. Aerimus beat me to posting the Daily Show Link

    Must see TV

    J/P=?

  6. Thanks for the Daily Show reminder, I will watch it when I get home tonight. We DVR it! :)

  7. reasonablehank

    “Vaccine Information and Awareness Service”:

    It’s impossible to imagine how much we love that URL, in Australia. The creator (and that may as well be Creator), of that site is our silent hero in the campaign against the ghoulish anti-vaccination cult.

  8. I’m pretty certain it’s safe enough, they do test these things. My concern is that it won’t be effective or even required.

    Smallpox vaccine, for example, has a proven track record, everyone knows this. Influenza vaccines, not so much, because influenza is a tricky little virus and it mutates all the time. All kinds of people are given the vaccine and still get sick.

    People need to keep in mind that so far (A)H1N1 hasn’t actually been that deadly. It has only killed maybe 4200 people worldwide. Regular strength, pick-your-flavour-of-the-year, influenza kills upwards of a 1000 people a day. So why are we spending all this time, effort and money to vaccinate people against this particular strain?

    There is the argument that it kills healthy people. But even if all of those 4200 people were in top shape, that’s still a pretty low fatality number on a global scale. There is also the argument that flu season is coming, but in the southern hemisphere, it’s already been here. There weren’t thousands upon thousands of deaths. Another argument is that it might mutate into something far worse, but if that happens, there is a chance the vaccine won’t protect you anyway.

    This is not a antivax argument, maybe more of a don’t-let-fear-get-the-better-of-you argument, because that may well be happening right now. It happened with bird flu, it happened with mad cow, it happened with SARS. I personally am not going to get vaccinated for the flu. There is a finite supply of it where I live. Someone more frail and more scared than me can have it instead.

  9. Alex

    cobolhacker: You have to include more than the actual number of deaths. Don’t forget all the non-fatal bad effects, for example asthmatics who are more likely to suffer an attack if they are also suffering from the flu.

    Even when you just consider non-complicated cases of flu there is a large economic cost to a flu outbreak, both obvious costs like health care, but also less obvious costs like a person deciding to not go out to the movies because they’re feeling ill.

  10. Thank you for this link — what a great visual representation. It’s important for people (especially the “well what are the odds of dying from cervical cancer?” ones) to remember that the vaccines protect against the strains most likely to cause cancer. If I may plug two links, I had one of these strains, and I wrote briefly about it here along with my reiteration that it was my experience AS WELL AS doing my own investigations into Gardasil that puts me in favor of it:

    http://newly-nerfed.net/2009/10/09/weekend-sendoff-tmi/

    Also, PalMD wrote an excellent post on this subject, including a link to his friend Stephanie’s story. Like me, she was not so lucky to get one of those benign infections that resolves on its own. As he says: “Yes, Pap smears work and she is not going to die of cervical cancer. But wouldn’t it have been better for her to have been able to prevent this altogether?”

    http://scienceblogs.com/whitecoatunderground/2009/10/hpv_vaccinination—the_is_rea.php

  11. Ausduck

    I think the best argument for flu vaccination is that: ok, you might not get sick from the flu yourself, but you could be responsible for passing the virus on to a more at risk family member or member of your community. (Thanks to Steve Novella & SGU Podcast back in 2008, I can’t remember the number, sorry).
    We (the health care professional ‘we’, of which I am a member) took the winter flu season & H1N1 very seriously here in Aus. Even though the number of deaths and critical cases were relatively low population wise, the numbers were elevated and H1N1 was the confirmed culprit. I still can’t recall a flu season where so many pregnant women ended up in ICU on ventilators – a very real risk. the rapidity of deterioration from a cough, sneeze and fever to respiratory failure was unbelievably quick.
    And our flu season isn’t over – the winter flu season is. We are gearing up for the summer flu season as well, and the pandemic response to H1N1 has not been downgraded by my state health department.
    Have my appt with the staff health nurse next week for my jab :)

  12. Scott

    Phil (and fellow commentors):

    What are your views on this case http://www.youtube.com/watch?v=h8riAeGh48U wherein a girl developed dystonia from this year’s seasonal flu vaccine and do you know of any debunking of this story? I am not antivax, but I have not heard any debunking of this story. This seems to be a pretty severe reaction.

  13. fred edison

    @Aerimus LOL for real. Thanks for the link and the laughs.

    I took my little girl into the vet today. It was time for her rabies & FVRCP vaccine shots. She’s fine, though being stuck in a cat carrier isn’t her favorite thing to do. As I type, she’s scooting around the house at the speed of sound. Just like she usually does.

  14. Skeptic Tim

    According to a recent report on the CBC, public health people have noted that Gardasil vaccination has resulted in a significant reduction in the incidence of genital warts (something of the order of 30 percent reduction or more) in addition to protecting against cervical cancer. Sorry I can’t direct you to the info source but I think its worthwhile to check it out.

  15. Gary Ansorge

    8. cobolhacker
    “So why are we spending all this time, effort and money to vaccinate people against this particular strain?”

    Because it has the potential to be 4 to ten times as deadly as the regular flu. That may not seem so bad, but that’s 1 percent of the populace so infected and THAT could run into the millions. We just won’t KNOW how bad it could have been if we manage to get enough people vaccinated because, unlike those who ignored Cassandra, we listen to our wise ones. Sometimes.

    4. Aerimus

    Saw that Jon Stewart show. He’s my favorite news pundit. Extremely rational and one of the funniest men currently on the tube.

    Gary 7

  16. Josh

    @Scott

    As much as I normally dislike the O’Reilly Factor, they’ve done a pretty good job of discussing some problems with the news story you posted:

    http://video.aol.co.uk/video-detail/cheerleader-with-dystonia-from-flu-shot-may-have-it-all-in-her-head/2264303090

  17. Jim Carson

    Bill Maher cleared up some misconceptions of his stance last night. He stated emphatically that he DOES accept and ascribe to the germ theory of disease, counter to the claims of Orac and others. He just thinks he can defeat disease by removing fillings from his teeth and other toxicity-based nonsense arguments.

    So he’s still a kook, just not completely a militant idiot.

    The most amusing part was where he pleaded that vaccine risk should be debatable, but anthropogenic global warming should not. Cripes, even the IPCC uses numbers like 90% certainty. Who here is only 90% certain that vaccinations are safe and effective?

  18. Mike Mullen

    A lot of people treat science like a restaurant menu; picking the items they like and ignoring the rest; “I’ll have the biology but could you hold the Evolution?”

  19. I seem to have to keep saying this, but this is a *poor* graphic. It’s *not* that easy to understand.

    1. Stephens’ Power Law (http://en.wikipedia.org/wiki/Stevens%27_power_law). Your perception of visual area doesn’t scale proportionally to the actual area.

    2. The top set of bubbles are not actually to scale. They’ve had to introduce a ring around the bottom pixel to show how small it actually is relative to the next largest ring.

    3. The second set of bubbles are a meaningless way to represent the information. They vaguely illustrate the relative sizes of the fractions (subject to point 1. above). But risk fractions are something I just can’t work with intuitively. In my head I turn them upside-down and think of a crowd of, say, 145,000 people, and one of those keeling over from the HPV vaccine. I just see the size of the circles as the size of abstract numbers. But those numbers were already abstract! The point of the graphic was to help us visualise them!

    4. The examples given in the bottom circles don’t actually provide any context. I get the message that you would have less chance of dying from HPV than dying in an earthquake. But I don’t possess any real sense of how likely I am to die in an earthquake, or even a car crash.

    As I tweeted at Ben Goldacre when he brought this up, check out http://junkcharts.typepad.com/ which talks about how you should and shouldn’t use charts and graphics to convey information.

  20. Ernest

    On a different note, here’s one JAMA editorial that expresses a caveat about HPV vaccination:

    http://jama.ama-assn.org/cgi/content/full/302/7/795?home

    And then here’s a BMJ research article that examines simple, inexpensive ways to interrupt or reduce the spread of respiratory viruses:

    http://www.bmj.com/cgi/content/full/339/sep21_1/b3675

    One interesting excerpt here:

    “The disparity in effectiveness between the high profile of influenza vaccines and antivirals and the low profile of physical interventions is striking. Public health recommendations are almost completely based on the use of vaccines and antivirals despite the lack of strong evidence.1 Vaccines work best in those who are universally considered least to need them10—namely, healthy adults. Antivirals may be harmful and their benefits depend on the identification of the agent (influenza).8 But physical interventions are effective, safe, flexible, universally applicable, and relatively cheap. There are many complex reasons for this disparity. Influenza vaccines, for instance, target only a limited proportion of influenza-like illnesses (around 10% to 7%).7 8 The comparative rarity of influenza as a cause of influenza-like illness affects the calculation of the effectiveness of influenza specific vaccines and antivirals. If the incidence of influenza in the unvaccinated population is low then the vaccine effectiveness ratio will be close to 1 and effectiveness low. However, physical interventions are directed against all viral diseases and therefore calculation of their effectiveness is sensitive only to the incidence of influenza-like illness, not of influenza. In addition, physical interventions are relatively cheap. The cost of masks ranges from $0.16 (£0.09; 0.11) to $1.9 each depending on make and complexity, from soft surgical masks to N95 masks.74 Prices are higher for well known brands and different designs and materials, although bulk purchase would result in sizeable discounts.

    Our review shows that public health measures can be highly effective, especially when they are part of a structured programme that includes instruction and education and when they are delivered together.”

    Food for thought.

  21. Skeptic Tim

    Re. my comment #15. an article at
    http://www.cbc.ca/health/story/2009/08/19/gardasil-hpv-vaccine-explainer263.html

    The article contains a rather thorough discussion of HPV vaccines. I found the following part (near the end of the article) particularly interesting:

    “…Another study, released in October 2009, found that the incidence of genital warts in Australia went down quickly and significantly after Gardasil was made available to all girls in schools in 2007.

    Before the vaccine was introduced, 15 per cent of women treated at the Melbourne Sexual Health Centre had genital warts, but the rate has now declined to six per cent, said Dr. Christopher Fairley, director of the centre, which is Australia’s largest sexual health clinic.

    Researchers say Australia is seeing the decline now because 70 per cent of women under the age of 28 have been vaccinated. …”

  22. @Teresa
    Apart from anecdotes you haven’t cited any evidence. Even in the articles you mentioned there is a lot of “no proven links” and “no evidence” etc etc etc.

  23. I love when the hysterical post links to pages they either have not read past the headline or didn’t bother to fully understand.

  24. @Ernest

    And then here’s a BMJ research article that examines simple, inexpensive ways to interrupt or reduce the spread of respiratory viruses

    While things like masks may be cheaper than vaccines in some situations, I would like to be assured that they (particularly the cheaper ones) actually reduce the spread of airborne material when used by the average person, who may not be using them correctly. Another concern with masks is that they require consistent use. If they are not comfortable to wear for hours a day, every day for as long as the individual is either infected or at risk for infection (e.g., during the whole flu season), then the efficacy of the mask becomes suspect.

    People are not typically all that consistent, particularly when it comes to something that is not comfortable to do. Combined with all this is the question of whether the mask-wearers would be good about hand hygiene. If they fail to wash their hands appropriately, then the mask doesn’t really make much of a difference.

  25. Sir Eccles

    I read this blog post about Gardasil and now I have the flu, a hacking cough and a runny nose, fairly damning evidence I say.

  26. Teresa is one of those who troll for threads like these and link bomb them like above. Move on…nothing to see here.

  27. J

    On the Gardasil graphic, by “distributed” to they mean that people were actually injected or that doctors received a supply? There might be a big difference here.

  28. Kevin

    This may not be seen – so I will post it to a second, related post so you won’t miss it, but Wired Magazine’s cover article is about the anti-vax movement.

    http://www.wired.com/magazine/

    I love that on the cover, in bold, green highlights are the words, “Vaccines do not cause autism”

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