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Girls as Guinea Pigs: What the CDC's "Gardasil for Boys" Issue Says About Sexism in Medicine

The CDC's pending decision over whether to recommend vaccinating boys against human papillomavirus will be interesting in terms of what it says about sexism in medicine: The issue is complicated because the vaccine is already recommended for girls. As more girls become immune to HPV, herd immunity kicks in and the additional benefit of vaccinating boys becomes more marginal. One possible outcome is for the CDC to say, in effect, "Thanks for taking all those shots, girls! Now we don't need to do the same to boys."

That might be medically "correct," but it certainly wouldn't be fair, especially as girls could have received the identical benefit had all boys been vaccinated first.

Merck (MRK)'s Gardasil and GlaxoSmithKline (GSK)'s Cervarix were approved for girls first because eradicating two strains of HPV also prevents 70 percent of cervical cancers caused by those strains. Cervical cancer can be fatal. Even though there were good reasons to vaccinate girls first, it's still the case that the girls were the guinea pigs. For the CDC to not require the same treatment for boys seems rather cynical. (The FDA has already approved Gardasil for boys, but the FDA's mere approval is different than the CDC's recommendation that it be added to the list of vaccines that children should receive.)

It would also say something about the federal government's attitude toward gay and bisexual men. Vaccinating boys would deliver the most benefit to the gay community. According to the Oral Cancer Foundation:

More than 60% of men without HIV and 90% of men with HIV who have sex with men are infected with HPV in their anal canals.
About 5,000 cases of cancer caused by HPV in men occur each year, but the vaccine costs $300 for each boy. There's an argument to be made that the cost just isn't worth it. To make that argument, however, you have to admit that it's not worth saving those boys who will be disproportionately gay. Plus, asking boys to get the shot reminds parents that little Johnny might not marry the homecoming queen when he grows up -- a concept that is intolerable to many religious Americans.

OK, so it's expensive. But here's the upside: We have a chance to eradicate one-third of all sexually transmitted diseases, and the cancer they cause. More than 24 million Americans have HPV at any one time. Three out of four Americans aged 15 and 49 have been infected with genital HPV. And HPV doesn't just cause cervical cancer; it's associated with head, neck, oral, penile and anal cancers.

Gay or straight, that seems like an opportunity we should take.


Image courtesy of Wikimedia Commons/Eugene Peretz, CC.
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