Life as an Extreme Sport

Outsourcing Health Care

I used to joke that going into medicine was a safe bet for just about anyone, because it’s the one thing you’re not going to find outsourced. Well, it appears I was wrong. What worries me about this, though, is not issues like safety and standards – those do seem to be addressed, at least somewhat. What worries me is that this is an ‘out’ to the current state of medicine/health coverage in the United States, creating a system where there is no issue for those insured, or those who have the money to travel abroad not just for heart surgery but heart replacement, but a system where the gulf between “have” and “have-not” continues to grow. This doesn’t begin to address the under or un-insured, and furthers the rift between those who, even if they are not well off, are well enough off to afford these things, and those for whom $9,000 is an impossible amount of money.

In the growing divide between with money and poor in our country, we seem to focus on the services available (or not) to those on the with money side, and ignore those who don’t have it. It’s an almost Calvinist approach, assuming there is something morally wrong with those who can’t afford what we’ve deemed the basic necessities of life.

While it’s certainly not a bad thing that people without access to health plans or the finances to bankroll $50,000+ surgery, it’s not good that this is being seized as a possible option to ease American health insurance problems, because it doesn’t address a huge problem that exists: those with the dual problem of low income and no insurance.

The Gardasil Controversy

This post on the Modestly Yours site, where I was directed by a friend (cuz y’all know I sure don’t qualify), perpetuates many of the myths and beliefs about Gardasil, the HPV vaccine. I did reply to the post in their comments, but since they are moderated and I was blunt in my disagreement, I don’t necessary expect the comment to make it to air (as it were). So, in the interests of preserving what I wrote, because damnit, I actually bothered to fact-check,…

Sorry, but I strongly disagree.

First, to clear up some misunderstandings in your post. Gardasil actually protects against four of the main variants of HPV, types 6, 11, 16 and 18. To break it down, HPV 16 and 18 cause 70% of cervical cancer and adenocarcinomas, and 50% of the precancerous histologic lesions, CIN. The four variants together cause 90% of genital warts, which can be infectious and invisible for both men and women, and are not protected against from common prophylactic means (they can be, but as they can grow in areas not covered by condoms, they can be transmitted when you believe you’re having safe sex). Since warts can be flat, smooth, internal, or simply invisible, it’s extremely hard to get an accurate number of how many cases of HPV/genital warts there are – 200,000 per year is the tallied number, but it’s expected to be significantly higher. Unfortunately, the highly cancerous versions of HPV tend to be the ones that are invisible to detection.

It’s also worth remembering that HPV is indicated in other forms of genital cancer, as well as soft palate cancers.

Secondly, the vaccine age approval is nothing more than a reflection of the ages that Merck tested the vaccine in. This has practical reasons: most people, by age 26, are infected with HPV. Women who test clean of any of the variants being covered by Gardasil are encouraged to have the vaccine, regardless of their age. While their is not proof it will work, the body really doesn’t have an internal clock going “oh, you’re 28, so Gardasil won’t work in you.”

While the majority of HPV cases do clear up on their own, those are the low cancer risk variants that can be unsightly, but cause no real harm. (There are, after all, over 40 variants.) But the vaccine is not targetting these low cancer risk variants, it’s targetting the ones that kill.

Gardasil is also one of those vaccines that has been developed not just by the Big Pharma, but in conjunction with the National Cancer Institute, whose interest is in protecting the public, not in benefiting the stockholders. While it’s certainly more than sane to be suspicious of Big Pharma’s, and to carefully read the FDA decisions, the CDC isn’t implicated in or even involved in vaccines on the level you imply. Beyond that, the true test of science is empirical study and peer review – this is where the issues with Vioxx came out, after all. In the case of Gardasil, empirical evidence from around the world backs up the claims of the NCI and Merck. There is nothing in the vaccine suspension that brings any cause for concern, and is in fact the standard suspension for any number of vaccines we give children and ourselves daily.

Finally, though, your argument about “social engineering” and “childhood” are the most spurious. You’re suggesting that by vaccinating a 9 year old against HPV, the 9 year old is going to run out and become sexually active. This is hogwash, plain and simple. There is absolutely zero data that would even give this the merest credence – tell me, when you received your tetanus vaccine, did you go out and step on a rusty nail, just because you could? I mean, it might have been painful, but it wouldn’t run the risk of hurting you.

This is the exact same logic you’re using to argue that Gardasil is going to confer some sense of irresponsible behaviour on girls. But when you take the emotional “omg my baby is going to have sex eventually” aspect out of it, and transfer the example to something as benign as tetanus, the fallacy of the argument becomes clear.

But beyond that? Children receive numerous vaccinations through-out their childhood, and well into adulthood. If you think kids pay any attention to what’s being injected into them, you’re giving way too much credit to your kids. For them, it’s a doctor visit, it’s a needle, and that’s all. Go up to any 12 year old and ask them what vaccinations they’ve had – they might be able to list tetanus, especially if it was under a painful circumstance, and MMR, but that’s it.

Yes, there are recommendations for avoiding HPV infection, and they’re the same for avoiding any STI. But all it takes is sex with one person, and you cannot judge infection visually – there’s no way to know. (And this doesn’t even address things like date and stranger rape, and the vaccine is not effective after exposure.)

Thinking beyond the self for the moment, there are also future children – fetuses can be infected by HPV upon birth. Many women with precancerous and suspicious HPV are recommended and counceled to have their pregnancies time with a “clean” cervix in an effort to downgrade the risk to fetus.

Yes, it can be uncomfortable to realize that children are going to behave in ways that you don’t approve of… but as a parent, your job is to protect your child as best as possible. That means protecting them from danger, and cervical cancer is really, really dangerous. Yes, the short term means acknowledging the sexual potential of your child, but it is, in the long run, the better thing for your child.

Dead Cats to Remain, well, Dead



CC, short for Carbon Copy,
the first cloned cat.

Genetic Savings and Clone spun off Texas A&M six years ago, promising to revolutionize cloning through its chromatin (as opposed to nuclear) transfer technology. And specifically, it was going into the market of cloning dead pets.

Lou Hawthorne, CEO of the company, tried to cast the company from the beginning as offering a beneficial service to grieving pet owners, especially owners of mutts, whose “unique genetic material” would be lost; unlike a purebred, it would be impossible to get a cat or dog that looked just like the muttly beast recently departed from your life. The company said that the being of the animal was a combination of experience, intelligence and temperment, and that the last two were clonable and the family would need to provide the experience necessary to get a similar animal.

Needless to say, a lot of people didn’t buy that temperment and (especially!) intelligence is solely genetic.

On top of that, pricing a cloning service at $50,000, later dropped to $32,000, for people who want to recreate their mutt, seems to be automatically pricing most people out of the field. But Hawthorne was convinced that, by late 2007, the company would be both delivering litters of kittens and puppies, and making a profit.

Well, six years later, Genetic Savings and Clone has announced they’re closing their doors at the end of this year. Seems that cloning pets just isn’t a profitable venture – in fact, they only ever produced five cats: three research cats, one at $50,000 and one for $32,000.

That said, and it’s probably pretty obvious where I stand on the idea of cloning companion animals, I will give the company credit where it’s due: from the getgo, they publicly discussed the ethics behind their business, set up an internal code of bioethics that was published and adhered to, invited people to tour facilities on an as curious notice, and engaged in a lot of public debate with bioethicists, scientists and the media. They certainly believed in what they were doing, and went above and beyond all government regulations in animal care. They welcomed government oversight, so long as it meant that they were able to continue their own high level of care, and actively worked to shape the genetics/cloning debate the country had.

We might be on opposite sides of one opinion, but at least we would have agreed that it’s a necessary conversation that needs to be had, and had in public.

The Lancet says “Key data ‘missing’ in drug trial”

So at first, this reads like a woops sort of deal:
Drug research experts from the Netherlands say UK regulators did not receive findings that might have warned them of damage TGN1412 could do.
Okay, the information wasn’t there, the assessors made their decision based on what was there – seems perfectly sound, sensible, and tragic. But when you keep reading the article, small things jump out and become alarming. For example,

In the case of TGN1412, the scientists from the German company TeGenero reported that the site in the body where the drug binds was identical in humans beings and monkeys. However, no detailed data on such a comparison was included.

So the assessors read a claim and simply accepted the statement of the researchers, not fact checking what was presented to them? The article goes on to say

When the Dutch researchers explored this they found clear differences between humans and monkeys.

The research file on TGN1412 also lacked information about how the drug affects certain human immune cells compared to monkey immune cells.

Dr Adam Cohen, from the Centre for Human Drug Research in Leiden, the Netherlands, said: “Essential information was absent.

So not only was essential information missing, but the information provided was inaccurate? What exactly were the assesors doing? Grading for grammar?

On top of that, the Lancet article

recommends drugs which affect the immune system, like the monoclonal antibody TGN1412, may be best given to people who are already ill.

This in and of itself is problematic. While yes, often times the only way to test the effectiveness of a drug is to test it against the illness, the first stages of safety testing should not be done in an already vulnerable population. What needs to be done is the assessors overhauling their practices to actually look at the data being presented and verify it for accuracy and completeness before approving human trials. Yeah, the pharma company appears to have lied, but this shouldn’t be surprising – the pharmaceutical companies are out for their bottom dollar, and they’re going to push things as far and hard as they can. The people who are there to act as a safety check need to actually do safety checking! It’s that simple.