Medical Update and more

I haven't given my regular readers, those concerned with Kezia's health and progress, an update for some time now ... why? Because there is nothing to report. Her neutrophil counts go up and down as they should do. When they go below a certain level, she comes off the IV methotrexate and mercapturine and when they recover, she goes back on them. The Dexamethasone trip occurs once a month and I (and others) have described (all too often) how shitty that is. No crises, everything routine. The cancer routine.

So what's new?

Dr Crippen reported last week on NICE's choice of the two Human Papillomavirus vaccines, Gardasil and Cervarix, that will be offered and administered to teenage females throughout the world to prevent cervical cancer. However, in the UK it seems, contrary to the rest of the world, NICE has chosen Cervarix that protects against less strains of cervical cancer and does not protect against genital warts. Why? Because it's cheaper, of course. Oh, and even though boys can spread around HPV and develop genital warts (which in their turn can spread HPV), there are no plans to extend HPV vaccination to boys (as I reported here - come on Dr Crippen, don't you ever read me?).

Dr Rant reports that top surgeon and health minister Lord Darzi, on whom the Department of Health is depending to push through its National Health Service reforms, found time to appear on BBC Radio 4's Desert Island Discs on Sunday. For our non-UK readers Desert Island Discs is a weekly radio programme that has been running for decades whereby a famous personality is requested to select ten pieces of music s/he would take with her/him if s/he were to be abandoned on a Desert Island + three other items.

Perhaps, 50% of Lord Darzi's musical choice I was in agreement with ... but his choice of a pencil and notepad seriously lacked a pencil-sharperner ... or perhaps even a knife - then he could perform surgery as well as sharpen his pencil.

Oh ... and we are honoured to have been added to Dr Rant's list of links.

HPV Inequalities

I have previously posted on the inequalities within the UK National Health Service roll-outs of the vaccine for Human Papillium Virus (HPV). That NHS Scotland has rolled it out to all teenage females whilst NHS England has been dragging its feet ... seemingly commentators suggest for politico-economic reasons.

Supposed concerns among parents are that teenage girls will become more promiscuous as they become protected against cervical cancer.

In England a trial of take-up of the HPV vaccination in 26 schools in Greater Manchester found that only 80% of girls of the eligible age group (needing parental consent) received the vaccine.

The percentage take-up was far lower amongst ethnic minority and/or low-income students. This can, of course, be for several reasons ...

However, of parents who stated their reasons for refusing consent lack of information about the vaccine and its long term safety were foremost and changes in sexual behaviour least. It is, of course, most probable that ethnic minority and/or low-income parents would be more unlikely to give reasons for their refusal to give consent. It would seem that the NHS needs to provide more information.

There are compelling arguments that vaccinating boys against HPV is equally important in combatting the spread of HPV to girls and the subsequent development of cervical cancer – after all, it does take two to tango. A trial of one of the vaccines (there are two Merck's Gardasil and GlaxoSmithKline's Cervarix) showed it to be equally effective amongst boys as girls.

In further developments Doctor David reports (here and here) the increase in oral cancer caused by HPV – which, clearly, affects males as well as females with the rate of oral cancer amongst young men increasing at such a rate that it may soon, in the US, surpass the number of cervical cancer cases. As smoking decreases HPV is becoming a more important cause of oral cancers than coffin nails. I am told by our GP that HPV can also be responsible for penile and rectal cancers.

So the NHS HPV vaccination programme neglects:

a) the English

b) ethnic minorities

c) males

d) those who are into oral sex whether homo – or heterosexual

e) those who are into anal sex whether homo – or heterosexual (although for the life of me I cannot understand why anyone would have unprotected anal sex these days.)

Of course, we'll have to wait for the National Institute for Health and Clinical Excellence to conduct a cost-benefit analysis but if you're black, male, homosexual or just plain sexually diverse ... don't hold on to the edge of your chair ...

Yawn.

Update: NHS management wrote a letter on 2 May to all PCTs, SHAs etc concerning the forthcoming HPV vaccination programme in England. We are informed that supportying materials and information are available here. As of writing and in typical NHS IT style the link is non-existant.

The Equality Impact Assment report is here.

In the News

Perhaps the most important health news we have come across today is that the vaccine for the human papillomavirus (HPV) that causes cervical cancer has been approved for use in the U.K. by the Joint Committee on Vaccination and Immunisation (JCVI). Department of Health press release here. BBC report here. The Scottish Executive has said it will implement vaccinations of all 12 and 13 year old girls as soon as possible (probably late 2008) but, typically, England is dragging its feet and the government wants an independent cost-effectiveness study before it will (or will not) implement a vaccination programme.

So here are some UK statistics for you culled from the web. I won't vouch for their accuracy but they are approximately correct.

Female population: 30.7 million
Females 12-13 years: c. 380,000
No. of new cases of cervical cancer per annum: 2800
No. of deaths from cervical cancer per annum: 1120
Cost of treatment per case: £2150
Cost of treatment all cases per annum: £6.02 million
Cost of annual pap smear: £12.50
Cost of vaccine: £250
No. of cases prevented by the vaccine: 70% - 1960
Cost of all treatment all cases per annum with a vaccination programme: £1.8 million (saving 4.2 million)

Make up your own mind.

In other news, a reminder that it is not just the high profile tropical diseases that kill in the developing world. An outbreak of measles in northern Nigeria has killed at least 20 children with at least 400 infected.

Staying in Nigeria, its government is suing the multinational pharmaceutical company Pfizer for deaths and disabilities caused by the 1996 trial of the meningitis treatment drug Trovan. The company claims that all participants in the trial gave verbal consent and it was acting according to Nigerian regulations. Even if it was, purely verbal consent would not be considered ethical here. Report here.

We have posted before on the importance of biodiversity to the development of new drugs and treatments. Now the drug Trabectadin, developed from a sea squirt, has been shown to control the cancer myoxid liposarcoma.

And finally, the search for a treatment for river blindness, which is thought to effect 18 million people in Africa, is documented in pictures here.