Is This Reverse Sexism in Medicine?

Sexism in medicine is nothing new. Even years before someone coined the phrase "evidence-based medicine" medical research largely ignored women. Or, researchers studied their disease of choice in a sample population of healthy young men and simply assumed that the results could be generalized to women. In short, women were considered (in the eyes of medicine) slightly smaller men.

No more. In fact, anyone with a pulse has no doubt noticed that last month was Breast Cancer Awareness Month. And if your neighbourhood is anything like mine, everything that would stand still long enough got a pink ribbon pinned to it. It's nice to see a woman-specific disease garner such attention, although I have to admit I'm starting to think that the pendulum is swinging a bit too far in the opposite direction.

Not to take anything away from breast cancer-- it's a horrible disease (although the much touted "1 in 9" statistic is a bit misunderstood). As is any cancer. But I think many people would be surprised to know that lung cancer is still the number one killer of both men and women. And both the incidence and the mortality are still increasing in women. Much less talked about, much less publicity, much more death. Why the discrepancy? Maybe because it's easy to 'blame' lung cancer on smokers, whereas breast cancer can't be blamed on any particular lifestyle choice.

But it's not breast cancer that is irritating me today. Last year, Gardasil was approved in Canada. Gardasil is a vaccine that effectively prevents against human papilloma virus types 6, 11, 16 and 18. HPV, also known as genital warts, is a sexually transmitted disease (or sexually transmitted infection in the new, more politically correct terminology) that leads to cervical cancer in women. HPV types 16 and 18 together account for about 70% of cases of cervical cancer. The other two subtypes of HPV, 6 and 11, account for 90% of cases of genital warts.

My concern is in the way this vaccine is being marketed. Women, telling women, that this vaccine will prevent most cases of cervical cancer. True. But this vaccine isn't approved for use in men. Is it wrong that I'm bothered by this? Fair enough, the repercussions of cervical cancer, which kills one woman a day in Canada, are significantly more severe than the repercussions of genital warts in a man. But who do you think is passing this virus to women anyways? Targeting only half of the population seems shortsighted. Not to mention the fact that any man who has ever suffered an HPV outbreak would likely donate a kidney for the chance to turn back time and avoid the outbreak.

The following anecdote is not for the squeamish-- I remember seeing a 23-year-old guy in the emergency room during my surgery rotation last year. He had, essentially, a cauliflower growing out of his anus. His genital wart outbreak had not only made his penis nearly unrecognizable, but had formed a protrusion from his rear forming a 10 cm lumpy mushroom. Food analogies aside, this had a significant impact on his life. The smell, a combination of infection, bleeding and inability to clean feces from this mass had caused embarassment to the point that he hadn't left the house in 4 days. He was in the emergency room begging to be seen by a surgeon earlier than the consult that had been set up for him the following week. If there were a vaccine available that would have prevented this guys outbreak, how upset do you think he'd be if he were told it was 'women only'?

And it's not just the fact that the marketing has been directed solely towards women. The vaccine itself, a product of pharmaceutical giant Merck, hasn't even been approved for use in men and boys. Medicolegally, a doctor is not permitted to administer or prescribe it to males.

If I were a guy, I'd be right pissed.

In the interest of all of those blog-readers with sensitive stomachs, I opted to make this post image-free. You can all thank me later.