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I received the following question from a student today that I found very thoughtful but reflective of poor communication on the part of medical policy makers:

“I saw a clip of Bachmann denouncing the vaccine as forcing these ‘innocent
girls’ into getting a ‘government injection,’ implying that if you give it
to them you’re admitting and condoning that they’ll someday have
sex (which is bound to happen according to your stats today). She also
claimed you can become mentally retarded from the vaccine because of a
mother who told her it happened to her daughter. These ill-informed,
oblivious, and over- traditional views are not going to help public
knowledge or health reform. What do you think? How can health reform move forward with statements like this pulling us backward?

“On the other hand, do you think something like Perry’s executive order in
Texas for the vaccine is a bit extreme? I’m all for getting this vaccine out
to as many girls as possible, but I’m not so sure if a mandate is the best
way to go about it, because I feel like people should have the choice not to
get it. Then again, doesn’t the government mandate immunizations like polio,
tetanus, etc, so how is this different? The key thing that makes this
different is it’s an STD, but I could see that government interference with a
vaccine for an STD could easily go sour (interesting that Perry’s order was
overturned).”

My short answer is “Why is this different from Hepatitis B?” No one asks why they are getting Hep B (well, less than .01% of the folks). The main difference is that we ONLY know that HPV vaccine is effective for about 10 years pre-exposure and up to a certain age, whereas Hep B is partially effective post exposure (birth canal) and we now know has a much longer known immunity so we moved it to birth to prevent “chronic hepatitis B.” No one questions why we are giving a shot for a disease known to be caught through blood and body fluid exposure to innocent babies. This may happen with the HPV vaccine (to prevent congenital warts, perhaps?) but it’ll be a while. The big question is did Texas pay full price or get a significant discount for buying in bulk?

In the interest of disclosure I did receive training regarding the Gardasil in the late 2000’s and was on their speakers’ panel for a year. I chose to do this because IT IS A SHOT THAT PREVENTS CANCER (see Snopes to debunk the stupid e-mail). How often do I get to say I prevented cancer? For now,  every time a 9-12 year old comes to the office. Under the Affordable Care Act, for  no co-pay so as not to discourage people from having their children’s cancer prevented. Under Governor Perry, would have been the same. Under President Perry, apparently not so much….

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“We don’t know what form health reform will take.” Quote from an Alabama hospital executive August, 2011

The Affordable Care Act offers an opportunity to provide improved health care to our citizens. Instead, we in Alabama sit in meetings discussing the latest TEA Party musings about the role charity should play in health care delivery and whether we should prepare for a President Bachmann health care approach.

It’s not like we are doing so well we should sit on our laurels. Look at the data. Our citizens can expect to die almost 3 years (on average) before those living in the rest of America. In the worst county, Winston, the number is 10 years.

Out of 100 babies born, 3 more (9 per 1000) will die in Alabama than on average in the rest of America (6 per 1000). If you are African American, your newborn is twice as likely to die (13 per 1000) than the average American. If you are unlucky enough to be born African American in Cherokee County Alabama, you have almost a 10% chance of  dying in the first 30 days.

In Alabama, you are more likely to die of diabetes than in the rest of America. In Marengo County, you are 3 times more likely to die of diabetes than in the rest of Alabama. There are 4.5 primary care doctors per 10,000 people in Marengo County (7 per 10,000 in the US), and of these 11 primary care doctors, 4 are over 65.

If I were in charge, we would be having a different discussion.

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