Volume 189 - Issue 9
"I want the one for older women" — extending the human papillomavirus vaccine population base
Author: Lilon G Bandler
Med J Aust 2008; 189 (9): 526-528. || doi: 10.5694/j.1326-5377.2008.tb02156.x
Published online: 3 November 2008
Published online: 3 November 2008
To the Editor: It’s all very difficult isn’t it? Teasing out the issues around impartiality, weighing evidence and competing interests? Wain wrote a recent editorial for the Journal, and included a list of his “competing interests”:
Chair of the CSL Gardasil Advisory Board;
speaker fees, travel assistance and consultancy fees from CSL Biotherapies and from Merck and its affiliates in relation to Gardasil; and
shares in CSL Limited.1
He helpfully advises that Gardasil (Merck) “is available at no cost to Australian girls and women between the ages of 12 and 26 as part of the National Immunisation Program. The bivalent vaccine, Cervarix (GlaxoSmithKline), has to date not been included in the program, having initially been rejected by the Pharmaceutical Benefits Advisory Committee (PBAC) on the basis of uncertain cost-effectiveness, but subsequently recommended for inclusion.”1
This is disingenuous at best. Initially, the PBAC also “rejected the application for [Gardasil] . . . based on unacceptable and uncertain cost-effectiveness at the price requested.”2 At the request of the then Health Minister, the PBAC reviewed its decision after the company made some small changes to its submission, including a change in pricing.
At about the time Wain’s editorial was published, a hard copy of the previous Medical Journal of Australia article on human papillomavirus (HPV) arrived on my desk,3 courtesy of GlaxoSmithKline. That article on HPV vaccination listed the “competing interests” at the end. Clearly, all the authors have received some sort of funding through GlaxoSmithKline, CSL and/or Merck.
I am not impressed by authors who receive funding from pharmaceutical companies that market the drugs they are discussing. It seems to me that the problem lies with interests not competing, or at least not competing with the author’s intent. Perhaps a little healthy competition would bring out some more thoughtful, articulate articles, unaffected by any commercial pressures.
“A plague o’ both your houses.” Let’s consider where we could best spend our money without the help of the competing interests of various pharmaceutical marketing mechanisms. “HPV vaccination will not prevent all cases of cervical cancer, therefore vaccinated women should continue to have two yearly Pap smears.”4 Given that HPV vaccination (in this country) will not change the rate of cervical screening required in the near future, perhaps the money would be better spent on ensuring that all Australian women are screened in a timely manner. That is, ensuring that poor women, Indigenous women, rural women, and immigrant women are part of “Cervical screening in Australia . . . one of the great public health success stories, as witnessed by a continuing dramatic fall in the incidence of carcinoma of the cervix and mortality from this disease since the introduction of the National Cervical Screening Program (NCSP).”5
References
- Wain GV. “I want the one for older women” — extending the human papillomavirus vaccine population base [editorial]. Med J Aust 2008; 188: 501-502. 0_CBBFGBCH
- Australian Government Department of Health and Ageing. Quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine, injection, 0.5 mL, Gardasil November 2006. Public summary document. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbac-psd-gardasil-nov06 (accessed May 2008).
- Skinner SR, Garland SM, Stanley MA, et al. Human papillomavirus vaccination for the prevention of cervical neoplasia: is it appropriate to vaccinate women older than 26? Med J Aust 2008; 188: 238-242. 0_CBBECACC
- Australian Government Department of Health and Ageing. Policy for screening women vaccinated against HPV. Approved by the Australian Population Health Development Principal Committee — February 2007. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/hpv-vaccinated-policy (accessed May 2008).
- Farnsworth A, Mitchell HS. Prevention of cervical cancer. Med J Aust 2003; 178: 653-654. 0_CBBEBFAH