Healthcare decisions for young teens without parental consent??

Back in 2011, California started something that is a bit horrific if you ask me, or if you ask my wife, or our friends, or just about anybody on the planet regardless of their beliefs.  The opportunity for a child of the age of 12 to choose to have a vaccine without parental consent.  This was driven by the Gardasil vaccine and the hope of it stopping HPV and possibly HPV induced cervical cancer.  Here is an excerpt from a FOX news piece from the time… (LINK)

California Gov. Jerry Brown entered the national debate over child vaccinations for sexually transmitted diseases, signing a bill that would allow girls as young as 12 to receive the so-called HPV vaccine without parents’ consent.

The bill was signed Sunday. Human papillomavirus is the leading cause of cervical cancer.

I love this excerpt, as it throws doubt on both the reasons why you would want this vaccine (the “so-called HPV Vaccine), as well as on the reasons why you wouldn’t go without it… (HPV is the leading cause of cervical cancer).  Just enough fire, and just enough fuel to make this a really hot topic.  But, sadly this topic was not as hot as it should have been at the time.

A recent article, however, in the Journal of Medical Ethics where the discussion of ethics comes into play, and somewhat started with this medical doctor who authored the paper (LINK) looking at the question of “why not”.  The context for the question, however, in my mind, is completely off point.

As medical students, we had been encouraged in our ethics course to notice and question ethical issues in the clinical setting.  I remember wondering why, though we could offer the patient diagnostic testing for sexually transmitted infections (STIs) in confidence, we could not offer the patient the HPV vaccine.  I began to wonder–if we could offer testing and treatment for STIs to adolescents without parental consent, shouldn’t it also be ethical to similarly offer medical services to prevent STIs in the first place?

His follow up statement to this question…

In 2011, Governor Jerry Brown signed into law AB499 (California), which explicitly permits adolescents to consent to confidential medical services for the prevention of STIs, including the HPV vaccine. Other states that have laws similar to that of California include Alabama, Arkansas, Kansas, and Montana.  In Texas, Representative Sarah Davis proposed HB97-S which would allow minors to consent to vaccines that prevent cancer –including the HPV vaccine.

The questions I ask regarding the entire push towards this policy, a push towards a policy which is designed to allow sexual activity to occur at a minor age while removing some of the natural pressure to be cautious.  In addition, this move puts the decision to choose options that might also have consequence, into the hands of a minor who perhaps only sees the potential reward (reducing the risk of HPV), and perhaps sees none of the risks from this decision.

Let’s take a step back, and consider the lobbying effort that went into this legislation, and what drives that effort.  Merck, the manufacturer of Gardasil, the vaccine used to “prevent” HPV, has suffered one of the most traumatic financial losses ever, as it relates to their drug Vioxx.  Just a few years ago they suffered massive losses due to the securities risk (not the actual drug-induced damage, but rather the fallout to stockholders) and settled for nearly $1B.  Which came 9 years after they settled claims to drug using victims for a total of $4.85B.  Nearly $6B in claims over this one drug.

I bring this up because the company was guilty of hiding important data, thus bringing an ethical question to light.  What does Merck work for?  Money or improving the quality of life and health of the people who consume their products?  I would argue that the goal of increasing shareholder value is the primary goal of Merck, and pretty much every publically traded company for that matter.  And ultimately, these companies will look for ways to do so without true concern for the long term impact or effect they have on an individuals health.

Lets come back and look at Gardasil.  The moment legislation places a vaccine on the required list, the vaccine manufacturer enjoys new protections.  They cannot be sued for side effect or death due to vaccine implementation.  The responsibility is moved to the government, and the company that provides the drug is no longer at risk.

Since 2006, legislators in at least 42 states and territories have introduced legislation to require the vaccine, fund the vaccine or educate the public or school children about the HPV Vaccine.  At least 25 states and territories have enacted legislation, including Colorado, District of Columbia, Illinois, Indiana, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Nevada, New Mexico, New York, North Carolina, North Dakota, Oregon, Puerto Rico, Rhode Island, South Dakota, Texas, Utah, Virginia, Washington and Wisconsin. The Michigan Senate was the first to introduce legislation (SB 1416) in September of 2006 to require the HPV vaccine for girls entering sixth grade, but the bill was not enacted. Ohio also considered legislation in late 2006 to require the vaccine (HB 703), which also failed. 

The action that is moving this drug towards protected is a huge win for Merck.  An offset for the losses incurred from Vioxx, and it is the path for many new drugs.  Manufacture a vaccine, facilitate the effort to prove its effectiveness… whatever that really means, and pray for good press over bad press so that you can enjoy your cash flow.  And finally, work to initiate legislation that takes the least likely population to investigate risk, and give them the ability to provide self-regulation of its administration… 12 years old and up.

Do you believe you were wise at 12 years old?  Do you believe your friends displayed wisdom at that age?  How about the 12-year-olds that you know today?  Do they question authority in a way that allows for discernment?  What if this drug had a large and growing number of people who say it either killed or maimed loved ones or themselves?  Would the 12-year old that you are picturing in this scenario discern what is worth reviewing and what is not worth reviewing?  How would they protect themselves from the concerns?

You see, though the medical doctor making his rounds, sees a child who needs protection from a sexually transmitted disease… I see a company who is acting as the predator.  And the prey is our children.

Medical Doctor, Christiane Northrup, has given a significant amount of her time and effort (through web site blogs as well as other efforts  – https://www.drnorthrup.com/?s=gardasil&submit=Go  ), to reduce the usage of Gardasil.  She comments that there have been thousands of serious side effects, and this was in 2006.

Snopes says that there were not 32 reported deaths by 2007 –

The message quoted above warns that the Centers for Disease Control (CDC) has already received nearly 12,000 complaints about adverse medical issues related to Gardasil vaccinations and that 32 young women died after receiving Gardasil vaccinations. Although this information is accurate in a strictly literal sense, it is a misleading presentation of raw data that does not in itself establish a causal connection between Gardasil and the posited medical dangers.

But I would argue that the reasoning isn’t enough to say that these were not related deaths, and actually more likely related simply because of the effort of groups that can be swayed with money (like Snopes), who have come out to defend the vaccine…

All serious reports for Gardasil have been carefully analyzed by medical experts. Experts have not found a common medical pattern to the reports of serious adverse events reported for Gardasil that would suggest that they were caused by the vaccine.

As of December 31, 2008, there have been 32 U.S. reports of death among females who have received the vaccine. There was no common pattern to the deaths that would suggest that they were caused by the vaccine.

Snopes article – https://www.snopes.com/fact-check/on-gardasil/

In all of this, there is a simple conclusion.

THERE IS TOO MUCH AT STAKE, AND THERE IS TOO MUCH TO WADE THROUGH TO MAKE AN IMMEDIATE INFORMED DECISION

Therefore it should be illegal for a minor to give self-consent to receive this vaccine.  My daughters would say no, no matter what their bend towards sexual practices might be at any time in their lives… they have been given enough information by me, that I have no doubt they would say no.  Even though I tell them, “there might be a time when you choose to receive vaccinations for many diseases, and that is fine, as it is your decisions once you are 18… and I won’t argue with you about it…”

Be well and Be blessed! – Dr. E

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