Bachmann, Perry and HPV

Let me begin by dispensing with the easiest parts first.  Michele Bachmann is an idiot.

“I’m offended for all the little girls and parents that didn’t have a choice,” [Bachmann] said. (Actually, any parent can opt out on a child’s behalf.) She said that girls who were harmed by the vaccine don’t get “a mulligan.” Later, the offended Bachmann ventured deeper into scientific illiteracy, telling Fox News that a woman had approached her after the debate and told her that she had a daughter who had “suffered mental retardation as a result of that vaccine.”

To say that I am extremely skeptical about Bachmann’s story is to be charitable.  I do not believe a single word of a story about a child suffering any kind of cognitive deficit following HPV vaccination, which reads as unmitigated bullshit to me.  At one point there was concern that a relatively rare neurological condition called Guillain-Barre Syndrome may occur with greater frequency following vaccination with the HPV vaccine Gardasil, but that connection has been investigated and rejected.  There is zero evidence to suggest any possible connection between mental retardation and HPV vaccination (or the appropriate use of any other vaccine, for that matter).  Bachmann’s demagoguery is social conservatism dressed up with the usual anti-science vaccination hysteria, a combination I find unpalatable in the extreme.

In fact, I don’t imagine the Tea Party’s own Jenny McCarthy would care about this issue at all were it not a way to take aim at an ascendant Rick Perry, who is drawing fire for trying to make HPV vaccination mandatory in Texas.  As much as I find Rick Perry wholly unappealing as a politician, and would vote for a shaved ape before I cast a vote for him, on this one issue I think he was trying to do right by the kids in his state in defiance of political expediency.  He has my grudging admiration in this isolated case.

That being said, I do not support mandatory HPV vaccination.

My reason why not is relatively simple — I think parents should have the right to make crappy healthcare decisions for their children with minimal government coercion.  Parents are allowed to smoke around their kids, to ply them with unhealthy foods, and to allow them hours of unsupervised television viewing.    As a matter of course I exhort them to do otherwise when given the chance.  But unless a child is being imminently endangered by their parents’ poor decisions, I do not believe the state should intervene.

I support mandatory immunization for almost all other vaccine-preventable illnesses because a refusal to vaccinate one’s child is not merely bad parenting, but bad citizenship.  Parents who refuse to vaccinate their kids believe they are obviating risks to their own children that they expect others to assume for theirs, but want to reap the rewards of the resulting herd immunity.  When a sufficient quotient of parents in any given community make this choice, a threshold for herd immunity is missed and previously-eradicated illnesses begin to reappear.  This happens time and again, as this randomly-selected data point illustrates.  Failure to vaccinate against such diseases as measles, pertussis or diphtheria endangers everyone, particularly those who because of age or medical condition cannot be vaccinated themselves.  Vaccination for these illnesses should be mandatory.

Failure to vaccinate against HPV has ramifications only for the patient and those who will later have sex with him or her.  Sexual activity involves risk, of which infection with HPV is but one.  While I believe it is hopelessly naive for socially conservative parents to believe their children will have lifelong monogamy with an equally monogamous partner, adherence to this lifestyle choice will effectively prevent HPV infection.  There is little risk of people being inoculated with HPV through no action on their part, so the implications of vaccine refusal are much more circumscribed than they are with regard to most other vaccine-preventable illnesses.

Do I believe it is a very bad decision for parents to eschew vaccinating their kids for HPV, motivated by ideology and unrealistic expectations?  You bet.  You can rest assured that my children will be vaccinated against it when the time comes, and I strongly advocate for it for all of my patients.  Do I further think that social conservative’s opposition to lowering the risk of sexual activity creates consequences that fall disproportionately on women? I sure do.  Believing that increased risk of cancer is an appropriate price to pay for failure to meet a ridiculous standard is horrifying and morally repugnant.  However, we live in a country where people are free to make morally repugnant choices all the time, even when the consequences fall on their own children.  As much as I would want every parent to vaccinate their children against HPV, I do not believe the state has sufficient justification to force them to do so.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. (I posted this on another blog written by a Perry Apologist. It seemed relevant to post here. I don’t have time to edit, so I apologize for the harsh tone, it wasn’t directed at you (Saunders), but the info re: Perry’s motives is quite relevant.
    -Thinking Pragmatic Indy Conservative from Texas)

    While I’m with you on getting over the “sex=death” bit being sold to teens- you’ll find that in Texas, that is the mantra and it’s spearheaded by Perry.

    Under Perry’s direction, Texas takes more Federal$$ than ANY other state for our mandatory AbstinenceOnly sex ed programs.Those programs don’t even broach the subject of condoms (there is mention of “barrier protection” & how its not very effective).The program is a scare tactic that not only says “SEX=DEATH!!”, but it also says that there are no ways to really mitigate against said death. It doesn’t teach about reducing the frequency of, or treating, STD’s- including the vaccine.

    Then there is also the problem that young women under 18 aren’t allowed to discuss STDs, contraception, pregnancy, etc.- without parental approval or parental presence. That’s right, a 17yr old on UT’s campus can’t legally discuss her sexual health at the Campus clinic. Even a teen who has already had a child (or multiple children) can’t discuss sex with her physician or health care professional.

    So, unless Perry steps off his “Sex=Death” platform, there are going to be a lot of sexually active teens, and parents who think “not my child”, that are never going to hear about Gardasil.

    We’re also one of the leading states in teen pregnancy, and the leading state in repeat teen pregnancies. (that number may be off one or two states depending on if the data has changed).

    When these stats were given to Perry, Perry replied “I know Abstinence Only sex ed works… in my heart” (slight paraphrase).

    So it’s a little hard to believe that Perry, with his draconian sex ed & backwards medical rights for young women, to all of the sudden decide that it was time to reverse his views on the rights to information for young women- especially when it was based on,at that time, still fairly young science. The trial info was there, but not much of a track record of use in the population. (I’m not an anti-vaccine’r, I think Gardasil is great, I’m just pointing out another aspect of Perry’s hypocrisy)

    Perry has deep ties with Merck, not only financially, but personally. It’s no secret. He reaped more than $5k financially, and in addition there was the traditional Texan cronyism involved.

    Down here in Texas, you’d be hard pressed to take a random room full of people, and find more than a couple of people that would admit to liking Perry, much less voting for him. Of course, people are voting for him, but it’s a bit shadier than on the surface. Perry speaks out of both sides of his mouth, and acts accordingly. Texas politics is a dirty game, and he’s been the king.

    If Perry wanted to save young womens, young peoples, lives-we’d change the sex ed program.At least to an honest & correct discussion of STD’s, contraception,& pregnancy. Gardasil could easily be marketed there verbally, so Perry could get his fundage and complete his crony contracts. He could let young women discuss sex with their doctors without fear of their parents reprisals.

    Stop with the Perry Apologist bit. Those of us in Texas know who & what he is. We don’t call him Slick Rick for nothing.

  2. being monogamous doesnt = no HPV. The implication that you get HPV because you are a ho bag has always offending me deeply. I was borderline NUN and i had an irregular pap smear and had to go for further tests which were deeply traumatic and violating. If i was given the chance for my daughter to increase her chances of avoiding such things, I’d jump at it.

    I think the HPV vacinne should be mandatory, or at least the full details and implications of NOT having it be mandatory – because some parents are too stupid or selfish to think ahead to just the kind of protection it offers. You are protecting them against other people.

    by the way, I am british, so different healthcare. I still find it massivley hard to understand/comprehend living without access to free healthcare (well kind of) for things like pap smears, birth control etc and also how someone would argue that its not a good idea. Sure, the NHS is not perfect, but the idea that something like a pap smear is something you’d see as a luxury is scary.

    sorry, my rant radar goes off on hpv stories. ill shut up now

    • Danielle, if you’ll look at my post, you’ll see that monogamy as a preventive measure for HPV requires that both partners have been equally monogamous throughout their lives. As you can see, I consider this expectation highly unrealistic. Nowhere do I say that getting infected with HPV means you are a ho bag, as you say.

      And I suspect your experience was informed by recommendations for pap smears/follow-up care that are no longer used. I am sorry to hear you had such a rough go of it, and it’s for reasons such as yours that the recommendations have been greatly revised in recent years.

      I agree that HPV vaccination is a very good idea. I do not believe it should be mandatory, however.

  3. hey, sorry you must forgive my ranty ness. the issue is so emotive. i didnt mean that you said people were ho bags, just that that seems to be the underlying suggestion (not by you, but in general) when people talk about HPV and the implications of a vaccine or how people get hpv)

    i dont think monogamy cant prevent it. you would both have to be virgins and stay together forever to prevent it.

    i will watch from afar how this unfolds. apologies again for bordering on troll like!

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