The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Tuesday, November 14, 2006

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.

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Anonymous charlotte said...

Wow. Where's the shocked emoticon for that post???? I think pics of a case like you saw should be shown to teenage kids as proof of what can happen if you have unprotected sex.

1:21 AM

Anonymous crimsonkid85 said...

no, no, no. i completely disagree with charlotte's post. teenagers are not stupid. education is key, not scare tactics.

2:07 AM

Anonymous Jen said...

Charlotte, warts can occur outside the boundaries of a condom so unprotected sex is not necessarily the culprit.

Teens also have to be educated (starting from the time they can speak in my opinion) in the importance of open communication with potential partners about all manner of things but especially infections--if they have herpes or warts it's not the end of the world but NO SEX during an outbreak.

I didn't realise that this vaccine isn't available for men. It's outrageous. It goes against the whole principles of vaccination to not innoculate the entire population affected.

Letter writing campaign anyone?

7:56 AM

Anonymous Jen said...

But remember, Merck is "Where patients come first" and apparently

“We try never to forget that medicine is for the people. It's not for the profits. The profits will follow, and if we have remembered that, they have never failed to appear.”

- George W. Merck, 1950

Er, then you'd think they'd want to vaccinate more people...

Here's the addresses to write to (go to my blog for tips on letter writing) and the name of the CEO:

Merck Frosst Canada Ltd.
16711 Trans-Canada Highway
Sortie/Exit 52
Kirkland, Quebec, H9H 3L1

Richard T. Clark, Chief Executive Officer and President, Merck & Co
Merck & Co., Inc.

One Merck Drive
P.O. Box 100
Whitehouse Station, NJ 08889-0100 USA

"A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has".
Margaret Mead

8:13 AM

Anonymous Anonymous said...

There are studies being done for men currently, the vaccine cannot be approved until it proves that it will be effective for men. Why wait to approve it for women (who have more risk of Cervical Cancer than men seeing as we have a cervix)until they see if it will be effective for treating men. Its not sexist, its reality.

From the website:
Why is the HPV vaccine only recommended for girls/women ages 9 to 26?
The vaccine has been widely tested in 9-to-26 year-old girls/women. But research on the vaccine’s safety and efficacy has only recently begun with women older than 26 years of age. The FDA will consider licensing the vaccine for these women when there is research to show that it is safe and effective for them.

What about vaccinating boys?
We do not yet know if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.

9:49 AM

Blogger Couz said...

So what's the reason that the trials on men couldn't be done concurrently with the trials on women?

Vaccinating men would decrease transmission to women, and those benefits aren't really 'indirect'. For more on the concept of herd immunity, see my post on the flu vaccine.

Plus, regardless of whether or not cancers in men are decreased, HPV outbreaks would be. And that's a benefit. If the studies are supposed to determine if it's cost effective for the government to cover the vaccine... well, it's not covered for women either. So why the wait?

9:55 AM

Blogger Nikki said...

Gardasil was THE hot topic at FMF two weeks ago. Every second speaker was talking about it. They pretty much all agreed with you - we need to vaccinate ALL our teenagers before they become sexually active, just like we do with Hep B. I spoke to one local family doc who was already planning to go home and vaccinate her 16-year-old son, approvals be damned.

7:48 PM

Blogger Liana said...

I think the HPV vaccine's real utility will be in developing countries where they can't afford/don't have the infrastructure to screen women for precancerous cervical changes. Did you know that in developing countries, cervical cancer is the leading cause of death from cancer among women? Heart-breaking, isn't it.

Couz, the reason why trials weren't done on men and women concurrently is plain and simple... money. It almost sounds as if you believe that Merck has the community's best interest at heart. The reason why the ads are targeted at women? Money, again.

And you're absolutely right... it doesn't make sense. Thanks for speaking up.

12:47 AM

Anonymous Diane said...

wait wait wait. My GP's office told me it was not yet available in Canada (only in the states). I wanted to get my daughter vaccinated (before it becomes an issue).


4:15 PM

Anonymous Anonymous said...

Okay, so this is good news for women who want to protect themselves against a relatively 'hidden' STI.

And I agree a vaccine should be made available for men too. But let's not fool ourselves. Having a vaccine for men does not also protect women either. After all, just because he MAY BE TELLING you the truth that he got a shot, that still doesn't protect you. No more than a guy would tell you he was on some form of birth control (if it was available)... he would likely tell you anything to get laid.

The bottom line is, folks, that we all have to take responsibility for our own behaviour. The sad thing for women is men tend to be the carriers and women get stuck with the side effects of high risk behaviour. Men cannot be tested for warts (except using vinegar).

Since the majority of the people who have to worry about getting HPV is women, I am of the opinion it was a priority to get a vaccine for women. And I understand that a vaccine for men would come along at some point.

5:27 PM

Blogger MENSA Supermodel said...

Couz, you are absolutely right. I have asked the same question at numerous lectures and at the national SOGC conference this year and got a similar answer to some of the other responders. For "cost-efficiency" it's not yet approved in boys/men. However, I do know that there are some keen male OB/GYN's that are right ready to vaccinate their sons as soon as it's humanly possible. The other problem is that these vaccines are over $300 a piece so pity the person who can't afford that but would prefer to not have a cauliflower grow out of thier vulva or their anus. Thanks for writing about this.

5:31 PM

Anonymous Anonymous said...

Diane, as far as I know the vaccine IS currently available in Canada but the government has not figured out what to do with it in terms of funding so currently you have to pay for it yourself. It's about $135 per dose. A friend of mine whose mother is an ob/gyn has had the first dose.

From the perspective of herd immunity I think it's very important to vaccinate as many people of both genders as possible. At the SOGC national clinical meeting this summer a speaker (sorry I don't remember who) showed a slide of sexual relationships within a highschool at one of the talks and there is certainly a lot of opportunity for a male to spread the disease to many others within the dense sexual contact web of adolescence.

9:25 PM

Anonymous Paul Auerbach, M.D. said...

Your comments exemplify why people are so fascinated by Emergency Medicine. Keep up the good work, and thanks.

5:02 PM

Anonymous Anonymous said...

You know another sad thing about the focus on women and breast cancer? Certainly it's something all women should know about.

But. Men. Get. Breast. Cancer. Too.

I haven't seen any men's breast cancer ribbons yet.

5:47 AM

Anonymous Anonymous said...

» International Trial Of Novel Breast Cancer Drug
14/12/06 07:03 from Breast cancer blog from
A clinical trial of a new targeted breast cancer drug, led by
physicians at Massachusetts General Hospital (MGH) Cancer
Center, has begun enrolling patients. The TEACH (Tykerb
Evaluation After CHemotherapy) trial will investigate ...

For useful content on breast cancer information, breast cancer foundation and emotional responses breast cancer: check
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6:22 AM

Anonymous Anonymous said...

I'm no doctor or scientist, but I did read that the reason the vaccination is for females only is because it is transmitted differently in females than in males. It has nothing to do with being sexist or only caring about females, it's just that the manner in which it spreads in females makes it easier to stop. Yes, I'm a male and yes I hope they find a vaccination for us too!

2:40 PM

Anonymous Anonymous said...

"charlotte said...
Wow. Where's the shocked emoticon for that post???? I think pics of a case like you saw should be shown to teenage kids as proof of what can happen if you have unprotected sex."

You can get genital warts while having _PROTECTED_ sex as with many other STD's.

I am proof.

I had sex with only _2_ partners,
and I got genital warts from the person I am in an ltr with. It didn't show up for 1 year.

I wish I had gotten this vaccine

3:55 AM

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4:57 AM

Anonymous Anonymous said...

What about gay men then? They're basically screwed then I take it?

And it's not just 'genital warts.' It's mouth, throat, and anus cancers too. Which are equally as 'hidden' as cervical cancer in women.

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gonorrhea have symptoms so knowing when to seek treatment can be tricky When symptoms do occur they are often within two to 10 days after exposure Many women with gonorrhea discharge think they have a yeast infection and self-treat with over-the-counter yeast infection drug Because vaginal discharge can be a sign of a number of different problems it is best to always seek the advice of a doctor to ensure proper diagnosis and treatment

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