Photo illustration by Natalie Matthews-Ramo. Photo by TongRo Images Inc/Thinkstock.

Why Is Slate Questioning Gardasil?

The benefits of the HPV vaccine still outweigh any potential harms. But the scientific process behind Gardasil was flawed, and the public deserves to know that.

I was vaccinated with Gardasil in 2007, right after the vaccine was first approved. If I were faced with the choice today, I would still choose to get vaccinated with Gardasil—even after editing Fred Joelving’s piece detailing the problems with the clinical trial tasked with ensuring the vaccine’s efficacy and safety prior to approval. That’s because the decision around vaccination is a decision that involves weighing the evidence on potential benefits versus potential harms, and to my eye, the potential benefits greatly outweigh the potential harms. Gardasil has been shown to effectively prevent HPV, which is very likely to reduce your chance of cervical cancer. Gardasil has not been proven to have any significant side effects.

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What Joelving’s story does suggest, thanks to its remarkable and thorough reporting, is that the clinical trials in which Gardasil was tested may have been inadequately designed, and that this failure in design likely rendered the trial incapable of accurately assessing whether the vaccine causes autoimmune disorders in a very small number of genetically predisposed young women who receive it. This flaw doesn’t really change the calculation on whether or not people should receive Gardasil, in my opinion—even if the vaccine does cause autoimmune disorders in a very small number of genetically predisposed women, and that’s a huge if, the benefits of the vaccine are still likely to outweigh the potential harms.

So why run this story? From my perspective, this story has important ramifications for public health. Because even if it turns out that Gardasil does not cause autoimmune disorders in anyone (which is possible), the fact remains that these trials were designed in a way that meant they would probably be unable to reliably assess this potential relationship. And to me, that’s worrying because clinical trials, particularly those used to assess medicine that will be used on large numbers of people prophylactically, ought to be able to make such assessments. And if we’ve been failing on this front, we should know that, so we can correct for it. This is how science is supposed to work.

If this story were about almost anything besides a vaccine, I doubt I would be writing this. The value of understanding potential side effects and ensuring that our clinical trials are robust enough to do so would be apparent, I suspect. But because it is about a vaccine, this is much more complicated, because there’s a (legitimate) fear that this story could be used to bolster a case that vaccines are bad and untrustworthy. And bolstering that case could have real and serious ramifications for public health if it leads to more people not getting vaccinated.

That’s possible. It’s also, in my opinion, a terrible reason to not run an excellent and nuanced piece of journalism about something that is true and, indeed, something that is in the public’s interest to know. I would even go as far as to say that refusing to cover a possible problem with a vaccine because it might cause people who are already distrustful of vaccines to be more distrustful is itself a counterproductive action: It further entrenches us on opposite sides that become driven more by ideology than by truth. And the truth is that science can be imperfect, and evidence can be incomplete. When that is the case, we should be upfront and transparent about it—in fact, I believe that doing so serves to bolster our credibility rather than diminish it.

Sometimes reassessments of science happen in the lab. Sometimes reassessments of science happen on the pages of a newsmagazine. When the latter happens, it is also the media’s responsibility to be clear about how the individuals reading the story ought to interpret it. One of the best and worst things about health journalism is how closely it intersects with its readers—everyone has a body, and so everyone has increased incentive to parse this information, and to assess if it should influence their own choices about how to care for themselves. The stakes are high and ever-complicated by how difficult it is to properly convey the distinction between public health and personal health.

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This story has important implications for public health, much more so than for personal health. It is also a story that shows how investigating questions of public health can intersect with personal health—as Kesia Lyng’s story demonstrates, we rely on individuals to help us assess those bigger questions. But when it comes to the personal health of its readers, this story does not offer much advice, and that’s on purpose. The takeaway is not that you should not get vaccinated—as noted above, I still would. The takeaway is that science is an iterative process, and the more upfront we are about that, the better.

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