My innate immune system is here for chewing gum and binding viral glycans, and I’m all out of specific lectins.
Looks like this works by apparently binding complex N-glycans on the viral envelope. I can’t imagine this is particularly specific, but the good news is that in the mucosa, you should see relatively few N-glycans, so I guess it will hit the right stuff?
The antiviral valacyclovir was discussed in an article in The Economist recently. Is used to treat herpes simplex or herpes zoster (shingles). What the Economist article discussed is that the drug seems to reduce the severity and onset of dementia. The drug's patent expired long ago.
I'll be seeing my doc soon and will be requesting to begin treatment.
A family member ran into some insane insomnia when they took valcyclovir prophylactically. Like falling asleep at bedtime, and waking up 20 minutes later like they had a good a nap.
I never got the HPV vaccine and am now too old.
Recently I had a papilloma removed from my soft palate near my uvula. They checked it for cancer but not HPV, even though they said it was almost certainly HPV.
So for $129 I took the OraRisk HPV test which tests for 51 strains, including the ones associated with cancer, and the results came up negative.
So I maybe sort of probably don't have HPV, or may have but don't anymore. Or maybe something like that.
It can still help even with previous exposure. This is outdated information. Also it helps against 9 strains. Most people are not exposed to all 9 instantly.
Further you can be exposed without having intercourse. Skin contact is enough. Even walking barefoot in the gym.
You will have to pay yourself probably, but since you paid $129 for a test I'm assuming you could afford at least one vaccine dose.
Also the NHS did a study and found a single dose is sufficient.
So I showed my doctor sources from the NHS (I'm not in England), and he agreed to do it, although I had to obviously pay out of pocket. There's also no safety limit for age[1], so there's no reason not to give it to you if you pay for it.
Yeah, the whole HPV testing landscape is kind of a mess - lots of "maybe, sort of, probably" vibes even after paying out of pocket for extra tests. It's frustrating how unclear everything still is, especially for something so common.
Targeting the mouth - where a lot of these viruses actually spread from - seems like such an obvious approach I'm honestly surprised we don't already have something like this in common use
> The ART-5 is a mastication simulator that mimics human chewing motions, adapts to food texture changes, and provides immediate, reproducible computerized feedback. FRIL release studies in the chewing simulator used PEB buffer that includes protease inhibitors and not human saliva.
It seems to just be a single line of each type of tooth.. but it does look dog like in profile.
While this advice is good, the article is discussing HSV (herpes simplex virus), not HPV (human papilloma virus), which have quite different symptoms and epidemiology. There are, as yet, no approved HSV vaccines.
Second part of the PSA, one should keep prophylactic antiviral medication on hand incase you get exposed to someone with HSV. With 60% of the population positive for HSV, everyone should have an antiviral on hand. acyclovir, famciclovir and valaciclovir
HSV-targeting antivirals like acyclovir lower the chances of transmission when taken regularly by an infected individual. They do nothing if taken by those not carrying the virus. Keeping them on hand accomplishes nothing.
From the page you link:
> If you have genital herpes, you will probably be somewhat less likely to infect your partner if you use antiviral medication for prevention. The medications used for this purpose include acyclovir, famciclovir and valaciclovir. They must be taken every day over a long period of time, though. Using them as a creme or ointment is not suitable.
So it's been a while since I had an HSV scare, but from my research at the time you definitely want to start antivirals as soon as possible after symptoms start(assuming you know since it doesn't always cause symptoms). You want to reduce the viral load and let your body catch up which limits the spread and reduces severity of future breakouts.
Annoyed at how the guidance has changed on this over the years. At first it was just a narrow slice of 20 something women. Then girl teenagers. Then men and women under 30. Then under 40.
If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
I am not sure why all the replies are indicating you are anti-science or anti-vax.
It is annoying to be told something from your doctor, internalize it, have your doctor suggest flu and covid vaccine for years but never HPV, and then be told on HackerNews "you should have the HPV" and now I am supposed to tell my doctor I can do his job better than him because I read something on the internet even though most doctors specifically grimace when you do that?
I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.
> I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.
You're assuming that the purpose of the EHR (Epic) is to implement public health recommendations or to establish minimum standards of care. That's a reasonable assumption for someone who doesn't work in the field, but unfortunately it's incorrect: neither of those are top-level goals for EHRs.
You're on the right track with money, but that's not exactly how I'd describe the goals. My impression is the primary goals are getting things coded and billed properly and thoroughly, and getting things documented in a way that minimizes legal liability.
The one computer system that has all my lab results, knows every doctor I have ever visited and has every summary of every medical visit I have had in the last 5 years doesn't want to use the data it is storing to suggest a follow-up?
That sounds like a quid pro quo with some trigger shy lawyers. I can't possibly imagine the long game for Epic is to never use that. It is a shame people are dying of HPV caused cancers because Epic can't use the data it has. Sad. Probably why American medical outcomes are so poor.
Becoming a doctor in America requires studying 1 semester of statistics which can have been satisfied by a passing score on an AP statistics exam in high school, years before entering practices. The only thing you know about an MD is they got a C or better in biology and organic chemistry at some point, then tolerated years of abuse to get admitted to the guild. There is really no reason at all to believe that a typical MD knows how to interpret medical literature better or even as well as you can.
I find about 1/3 of doctors are dipshits and utterly shocked that someone would read a scientific paper, or learn about their own conditions or diseases. Half of the doctors are overjoyed when they come across a patient like me.
Medical ethics focus on the benefit to a specific individual - your patient.
This defuses the "Should I kill one to save ten?" moral dilemma - the individual is your patient, even if the other ten are also your patients, you must not harm the one. But for vaccines it also means that the wider societal implications are not ethically relevant
So, medics won't recommend that you give patient A an intervention which is of no benefit to A but is really helpful for everybody else. For example, that you vaccinate teenage boys in the expectation that this way they won't infect teenage girls (with whom statistically many of them will have sex) with an STI that harms those girls.
As a result, the guidance cared about proven benefits to you even though taken neutrally you might have been enthusiastic about a vaccine that might or might not protect you but is definitely a good idea for the wider population. The initial studies understandably focused on the numerically larger problem: If we vaccine young female patients does that prevent relevant HPV infections, and then, as a proxy we might assume they also won't get cancer. Such studies can't tell you whether it prevents men getting cancer because that wasn't measured.
So the recommendation to vaccinate boys was delayed because first somebody has to study what might seem obvious - does the vaccine also prevent HPV related cancers in males? It is, after all, possible that some subtle mechanism means the vaccine isn't effective for this purpose, and it would not be ethical to give schools full of boys a vaccine that they personally do not benefit from having - even if societally maybe that's a good choice.
Beyond the female/ male differential, for adults and older, it's basically a stats game. Most adults have sex. Having sex means you're likely to contract HPV, more sex, more exposure. Is it worth getting vaccinated when there's a 50% chance it's useless? How about 95%? 99.5%? Do you always wait for the crossing lights? Did you ever drink beer or eat bacon ?
You're not wrong about ethical considerations, but the CDC operates socially and politically as well.
Back when the vaccine was new, an objection from some parents was that the vaccine might be viewed as a license or permission for their daughters to be promiscuous. There was a substantial headwind.
The public wasn't yet generally aware that HPV could cause head, neck, and anal cancers in men. If a doctor approached a parent back in 2010 and said they wanted to vaccinate their son against head, neck, and anal cancer, that advice wouldn't have been heeded in many cases, and would have cost the CDC some amount of its standing with the public.
When you hear something from the CDC, there's a decent possibility that it's a blend of medical advice that's been compromised with some value judgements that haven't been expressed to the listener.
What is it with people about the false ethics and recommendation around efficacy this and some bs calculus. The downsides are miniscule, the upsides are reduced cancers across the board.
I just had a doctor offer the HPV vaccine for my daughter as optional, 1, I thought we had already gotten it (my bad) because we ask for all the vaccines and 2, anal, throat and neck cancer. There are many scenarios where HPV could be contracted that aren't voluntary. But preventing HPV is.
And there's the mistake in your understanding. The personal benefit rationale is that they might catch it if they aren't treated. The public health benefit is a reason a government might promote this, but the reason medics will recommend it is personal benefit.
US citizens used to value the adults managing such science oriented endeavors actually doing their homework before making broad proclamations of efficacy. Lately, not so much.
It is either A) underreporting risks or B) not acknowledging risk unknowns and plowing ahead with advice anyway.
This was the major problem and behavior that CAUSED anti-vax opinions. They made safety claims that they couldn't logically make, because they couldn't know. A new vaccine using a new vaccine technology vs a new virus. They did not correctly report the amount of uncertainty and they lost trust. Then folks who "knew better" did their best to manipulate the narriative.
And speaking of manipulating the narrative, you can't use google to find the bits of history that shows the CDC giving contradictory advice because the results aren't there any more. Nearly every result gives the same tone and they're almost all CDC links.
This kind of information control and lack of transparency isn't science, it's power dictating truth.
The actual truth is that the risk of cancers as a result of HPV have a pretty high chance of being prevented if young females get the vaccine, but as you get further away from that group the risk avoided by getting vaccinated gets progressively smaller and runs into the safety uncertainty of taking the vaccine. When you're doing population level risk management you also have to do things like comparing the risk of getting hit by a bus going to the clinic against whatever the clinic could do for you. It is often safer to do nothing than to avoid a very tiny risk because of the very mundane risks you face day to day.
You're missing important stuff here, most notably that recommendations are also based on availability. As the vaccine became more available, more demographics were recommended to take it. Obviously, in the beginning, you want the highest risk groups to take it, then you grow the radius.
They didn't use young girls as some safety experiment. They just had the largest benefit and so, in scarcity, they're prioritized. It's not that scarce anymore.
As an aside, the HPV vaccine also prevents some male cancers, like penile cancer. It also prevents cosmetic, but relatively safe, conditions - like genital and anal warts. That's not the goal of the vaccine so it's not really taken into account. But you, someone who may take the vaccine, should consider it anyway.
i recall the most effective way to distribute the covid vaccine would have been concentric circles from a central point. Obviously that was never going to happen.
> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
Because approval involves evaluating a risk-benefit tradeoff, and the benefits for those groups are wildly different, as are the risk profiles, due to the way HPV strains[0] work. If they tested against a wide and heterogenous population from the start, it would risk demonstrating insufficient effect, which would eliminate the possibility of the vaccine for everyone. Instead, by testing against the group most likely to benefit from it (women, and specifically women of the age to have no prior exposure to HPV) they can see whether the vaccine has any potential at all, and expand from there.
As it turns out, the vaccine was incredibly effective for them, and as we studied it further, it turned out that other groups which had potentially lower benefits (men, older women) or higher potential risks (teenage girls) had a risk-benefit tradeoff that still overwhelmingly supported approval for those groups.
[0] yes, plural, because there are hundrends, and the vaccines (again, plural, because there are more than one) protect against a handful of them (although that fortunately includes the strains that account for 80-90% of HPV-caused cancers
With regards to HPV, when they tried recommmending (and even making it mandatory) for young print the Christian-right cried foul pretty hard. The Texas Governor got a heap of shit over it at the time because abstinence is the only thing teenagers should know about.
> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
Multiple reasons.
The first one is basic ethics. Similar on how you should do rolling upgrades of your SaaS software to catch errors before everything goes down, you got to do the same with vaccines. For there, go for the target group with the highest risk and highest potential of averting damage - and for the HPV vaccine, mid-20 women are the best such group: young enough that they might be lucky and not exposed yet, old enough to fall out of the scope of the usual ethics bureaucracy that (rightfully) comes with doing experimental research involving minors, and not so old that they definitely got exposed and making the effort moot. Then it got rolled out to teenage girls as it was proven safe, and eventually to men as well because we can be asymptomatic carriers (as we are for a lot of STDs).
Obviously if you got the speed of Covid vaccines in mind as a comparison, the HSV vaccine appears slow in rollout speed - but please do not forget, the Covid vaccines went through very speedy trials. We were extremely lucky it worked out the way it did.
The second one is availability. Again, unless it's Covid where everything went into full production power in a matter of months, production has to be ramped up carefully, matching rollout strategies - it doesn't make sense to have a mismatch into either direction.
And the third one is time. With Covid, it was easy to prove effectiveness: the people that got the shot got Covid at waaaay lower rates than the control population (and the risks of side effect were way less than the risk of severe Covid). But with something like HPV that can have years if not decades worth of time between exposure and symptoms, it becomes harder to reasonably judge effectiveness and safety.
My guess is it's cost driven? IIRC insurance would not pay for mine when i was out of the recommendation pool but they did (were legally required to afaik) when the pool expanded to include my age group.
You can only sell medication after trials. The first trials were on young women, and later trials on other groups. Nobody wanted to pay for trials on all demographics before there was evidence it worked from cheaper, more focused trial. There are also barriers to doing trials on high risk groups like the elderly without first testing on lower risk demographics.
This is one reason why so much medication not to be used by pregnant women. The trials have not been done, and trials involving pregnant women are particularly expensive and risky.
Either the vaccine has notable safety issues or it should be at least fine to get the vaccine at an older age.
The reason many people don't trust the CDC's advice is they don't really tell you why or why not.
If you're over 26 you're pretty likely to already be exposed to HPV but not necessarily every strain which would be protected by the vaccine (as it says in the article).
So this pushes the question: why shouldn't I get it even if there's only a small chance it will be beneficial at my age? Is there really a risk they're not telling me about or are they giving bullshit answers? There isn't a third direction.
Vaccine recommendations are based on more than just safety. Efficacy, cost, availability, and prioritization are also considerations.
> Compared with the benefit of the existing HPV vaccination program for adolescents and young adults through age 26 years, the additional benefit of vaccinating people age 27 through 45 years would be minimal.
> Given abundant evidence for safety of HPV vaccines, undesirable anticipated effects are minimal. Also, anticipated population-level benefits are minimal for vaccinating adults over age 26 years. In this scenario, other considerations including cost-effectiveness play an important role in guiding policy-making.
> There’s not a safety issue past age 45. We just aren’t sure how much the vaccine will help men and women who are past that age, because so many of us have acquired HPV by that point, and because it takes many years for cancer to develop after acquiring the virus. However, as the average life expectancy increases, it may benefit the population to increase the age limit for HPV vaccination as well.
Thats nonsense. Their "recommendation" is based on supply and epidemiological trends, not actual need of the drug. If supply gets constrained, its up to the CDC and drug makers to make more, not to tell the population to limit uptake.
This is why I don't trust CDC guidelines, nor doctors who blindly parrot them without explanation or context.
Sure, check with "your doctor" about the vaccine. If they give you no good reason not to take it, then take it.
CDC guidelines are nonsense here and I fail to see why they would give them. Is there a vaccine shortage?
The claim is that you're more likely to catch the virus early in your life and thus "lifetime efficacy" is reduced as you grow older. Duh, this is true of any vaccine. There are various strains of HPV and you can catch them one after the other. Having HPV at 50 is just as painful as when you're 18, if not more since your immune system is less effective.
The second part of I don't understand this advice is that they say there's no HPV test for men because the result is non-actionable. What? HIV is also nearly "non-actionable" but knowing one has it definitely reduces the chances of spreading it, does it not?
I don't get it.
I got the vaccine in my thirties against doctor's advice.
Please get the vaccine if you're sexually active with more than one person, regardless of your age.
And I say this as a man who thought I didn't need it because I can't get cervical cancer. But it turns out oropharyngeal cancer might be just as preventable with the HPV vaccine.
I know very little about this so excuse me if this is a stupid question. In my country all teenage girls have been getting the vaccine for at least the last 15-20 years. Therefore all of the women I'm likely to sleep with are vaccinated. Does it still make sense as a man to get it?
"All". Even if that's true, some time you might travel and be around women who aren't vaccinated, and you get an infection with something bearing the lovely name "genital warts". It has the long-term complications of "cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat". And you can give it to any other women you get with for the next few years, potentially giving them any of those relevant cancers.
So yes. It absolutely makes sense for a man to get it. For selfish reasons, you probably don't want penis cancer. For non-selfish ones, you don't want give other partners cervical cancer.
I guess I am a weirdo, but vaccines are the closest thing we have to space magic. Generally, they are very safe and prevent some of the most devastating diseases. All for the most minor discomfort. I want everything I can get, even if I am unlikely to be exposed to the real infectious agent.
Same. And while the shingles vaccine isn't fun, I've known enough people who described their bouts with shingles as "nearly suicide inducing" that I'll take a temporary minor discomfort that prevents me from ever having to deal with it.
I'm not sure what the effectiveness of the hpv vaccine is, but if it was 95% effective (totally made up number, i dont know what the real one is), then there is a 1 in 20 chance it wont work for someone. If both of you have the vaccine then the chance of both failing would go down to 1 in 400.
That seems worthwhile to me, given there is basically no downside.
(I guess this doesn't account for the affects of herd immunity)
I decided to get it and saw it listed as $160 per dose on the health provider's website. I decided to bite the bullet and get it. When I got the prescription filled at the pharmacy, it was $265 for the first round of three. I want the next two but it's crazy to think I'd be paying like $800 (Canada).
Obviously then your risks are lower, but even then not zero. A dear friend of mine went through stage 4 HPV related cancer after a long "monogamous" marriage. It turned out that it wasn't actually monogamous on the part of her (now ex) husband.
It's excessive to say literally everyone should get the vaccine: if you are especially low risk and don't want to bother, sure. But it's a very easy, safe vaccine. Most people engaging in some average amount of life-time serial monogamy (or with a partner who engaged in serial monogamy) would be better off just getting the vaccine than spending any mental energy on trying to figure out exactly the degree to which they need it.
That's what I'm wondering as well. I've been monogamous for a decade and a half now. If that changes I'll get the vaccine, but right now if either of us had it we both do.
What on earth are you talking about? We have clear evidence that suppressing specific viruses causes the symptoms of associated diseases to subside. Humanity has wiped out smallpox, a virus-causing disease, through vaccination against the disease. The same has almost occurred with Polio.
My innate immune system is here for chewing gum and binding viral glycans, and I’m all out of specific lectins.
Looks like this works by apparently binding complex N-glycans on the viral envelope. I can’t imagine this is particularly specific, but the good news is that in the mucosa, you should see relatively few N-glycans, so I guess it will hit the right stuff?
That has to be one of the best comments I've read on here in a while.. a nice chuckle for the morning.
Original source of the 37-year-old "chew gum" meme: https://www.youtube.com/watch?v=Wp_K8prLfso&t=1s
The antiviral valacyclovir was discussed in an article in The Economist recently. Is used to treat herpes simplex or herpes zoster (shingles). What the Economist article discussed is that the drug seems to reduce the severity and onset of dementia. The drug's patent expired long ago.
I'll be seeing my doc soon and will be requesting to begin treatment.
https://en.wikipedia.org/wiki/Valaciclovir
https://pmc.ncbi.nlm.nih.gov/articles/PMC7045215/
A family member ran into some insane insomnia when they took valcyclovir prophylactically. Like falling asleep at bedtime, and waking up 20 minutes later like they had a good a nap.
YMMV.
This is a great example of why I think dental medicine should not be separate from the rest of modern medical practice. It's all connected.
I never got the HPV vaccine and am now too old. Recently I had a papilloma removed from my soft palate near my uvula. They checked it for cancer but not HPV, even though they said it was almost certainly HPV.
So for $129 I took the OraRisk HPV test which tests for 51 strains, including the ones associated with cancer, and the results came up negative.
So I maybe sort of probably don't have HPV, or may have but don't anymore. Or maybe something like that.
>I never got the HPV vaccine and am now too old
It can still help even with previous exposure. This is outdated information. Also it helps against 9 strains. Most people are not exposed to all 9 instantly.
Further you can be exposed without having intercourse. Skin contact is enough. Even walking barefoot in the gym.
You will have to pay yourself probably, but since you paid $129 for a test I'm assuming you could afford at least one vaccine dose.
Also the NHS did a study and found a single dose is sufficient.
Every source I see says the vaccine is approved only up to age 45, but are you saying my doctor will give it upon request?
So I showed my doctor sources from the NHS (I'm not in England), and he agreed to do it, although I had to obviously pay out of pocket. There's also no safety limit for age[1], so there's no reason not to give it to you if you pay for it.
[1] https://www.mskcc.org/news/think-you-re-too-old-get-hpv-vacc...
Yeah, the whole HPV testing landscape is kind of a mess - lots of "maybe, sort of, probably" vibes even after paying out of pocket for extra tests. It's frustrating how unclear everything still is, especially for something so common.
The old tried and true Pap test is still the best screening tool we have for cervical cancer.
Targeting the mouth - where a lot of these viruses actually spread from - seems like such an obvious approach I'm honestly surprised we don't already have something like this in common use
Any idea why they used a dog (or werewolf?) mouth model in the video?
> The ART-5 is a mastication simulator that mimics human chewing motions, adapts to food texture changes, and provides immediate, reproducible computerized feedback. FRIL release studies in the chewing simulator used PEB buffer that includes protease inhibitors and not human saliva.
It seems to just be a single line of each type of tooth.. but it does look dog like in profile.
https://www.cell.com/cms/10.1016/j.ymthe.2024.12.008/asset/b...
I'm surprised there aren't any commercialized products considering its efficacy and simple origin.
I also wonder if there is any way it could be modified to protect more of the body besides just saliva.
> there aren't any commercialized product
Isn't this relatively new research?
> protect more of the body
There's only one part of my body that chews gum ;)
This sounds like the words of someone who has tried others.
Chewing gum that casually wipes out viruses sounds awesome in theory, but I'd bet scaling it up safely for everyday use is a whole different beast
PSA, everyone should be getting the HPV vaccine, regardless of age and gender.
https://en.wikipedia.org/wiki/HPV_vaccine
https://www.mdanderson.org/publications/focused-on-health/wh...
https://www.cdc.gov/cancer/hpv/oropharyngeal-cancer.html
While this advice is good, the article is discussing HSV (herpes simplex virus), not HPV (human papilloma virus), which have quite different symptoms and epidemiology. There are, as yet, no approved HSV vaccines.
That said, I feel like any thread about viral transmission is probably a good place for an HPV vaccine reminder too
Second part of the PSA, one should keep prophylactic antiviral medication on hand incase you get exposed to someone with HSV. With 60% of the population positive for HSV, everyone should have an antiviral on hand. acyclovir, famciclovir and valaciclovir
https://www.ncbi.nlm.nih.gov/books/NBK525787/
HSV-targeting antivirals like acyclovir lower the chances of transmission when taken regularly by an infected individual. They do nothing if taken by those not carrying the virus. Keeping them on hand accomplishes nothing.
From the page you link:
> If you have genital herpes, you will probably be somewhat less likely to infect your partner if you use antiviral medication for prevention. The medications used for this purpose include acyclovir, famciclovir and valaciclovir. They must be taken every day over a long period of time, though. Using them as a creme or ointment is not suitable.
So it's been a while since I had an HSV scare, but from my research at the time you definitely want to start antivirals as soon as possible after symptoms start(assuming you know since it doesn't always cause symptoms). You want to reduce the viral load and let your body catch up which limits the spread and reduces severity of future breakouts.
I wonder how effective they are on other viruses in the same family as genitel herpes like oral herpes and chickenpox/shingles, Epstein-Barr etc?
And where/how does one acquire them from?
Acyclovir is OTC.
They’re available OTC basically everywhere.
They're not OTC medicines. They are prescription-only medicines.
It depends on the country. There are many countries where oral antivirals are available OTC.
To say this drug is prescription-only is plainly not true.
Prescriptions are easy to come by. Talk to people, their signature unlocks worlds.
[dead]
Annoyed at how the guidance has changed on this over the years. At first it was just a narrow slice of 20 something women. Then girl teenagers. Then men and women under 30. Then under 40.
If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
I am not sure why all the replies are indicating you are anti-science or anti-vax.
It is annoying to be told something from your doctor, internalize it, have your doctor suggest flu and covid vaccine for years but never HPV, and then be told on HackerNews "you should have the HPV" and now I am supposed to tell my doctor I can do his job better than him because I read something on the internet even though most doctors specifically grimace when you do that?
I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.
> I think their Epic Health computer system that needs me to confirm my date of birth every 6 weeks can find some time to suggest the HPV vaccine if it is so damn medically necessary.
You're assuming that the purpose of the EHR (Epic) is to implement public health recommendations or to establish minimum standards of care. That's a reasonable assumption for someone who doesn't work in the field, but unfortunately it's incorrect: neither of those are top-level goals for EHRs.
What are? Let me make a cynical guess:
1. Reducing costs by hiring fewer people.
2. Increasing profits by decreasing care.
Did I nail it or what?
You're on the right track with money, but that's not exactly how I'd describe the goals. My impression is the primary goals are getting things coded and billed properly and thoroughly, and getting things documented in a way that minimizes legal liability.
[dead]
The one computer system that has all my lab results, knows every doctor I have ever visited and has every summary of every medical visit I have had in the last 5 years doesn't want to use the data it is storing to suggest a follow-up?
That sounds like a quid pro quo with some trigger shy lawyers. I can't possibly imagine the long game for Epic is to never use that. It is a shame people are dying of HPV caused cancers because Epic can't use the data it has. Sad. Probably why American medical outcomes are so poor.
Becoming a doctor in America requires studying 1 semester of statistics which can have been satisfied by a passing score on an AP statistics exam in high school, years before entering practices. The only thing you know about an MD is they got a C or better in biology and organic chemistry at some point, then tolerated years of abuse to get admitted to the guild. There is really no reason at all to believe that a typical MD knows how to interpret medical literature better or even as well as you can.
In the United States, you are in trouble if you don’t advocate for your own health.
While I had above average health care in my time Canada, I don't think this advice is limited to the USA.
Correct, though I thought Epic had a stronger foothold in the US than Canada. The CDC is a US government organization.
You should also get vaccinated for shingles if you can. If you are under 50, you will have to twist an arm. https://med.stanford.edu/news/all-news/2025/03/shingles-vacc...
Shingles is also incredibly painful.
I find about 1/3 of doctors are dipshits and utterly shocked that someone would read a scientific paper, or learn about their own conditions or diseases. Half of the doctors are overjoyed when they come across a patient like me.
Shingles vaccine may reduce the risk of dementia | 90 Seconds w/ Lisa Kim https://www.youtube.com/watch?v=unnePZUqi1o
Medical ethics focus on the benefit to a specific individual - your patient.
This defuses the "Should I kill one to save ten?" moral dilemma - the individual is your patient, even if the other ten are also your patients, you must not harm the one. But for vaccines it also means that the wider societal implications are not ethically relevant
So, medics won't recommend that you give patient A an intervention which is of no benefit to A but is really helpful for everybody else. For example, that you vaccinate teenage boys in the expectation that this way they won't infect teenage girls (with whom statistically many of them will have sex) with an STI that harms those girls.
As a result, the guidance cared about proven benefits to you even though taken neutrally you might have been enthusiastic about a vaccine that might or might not protect you but is definitely a good idea for the wider population. The initial studies understandably focused on the numerically larger problem: If we vaccine young female patients does that prevent relevant HPV infections, and then, as a proxy we might assume they also won't get cancer. Such studies can't tell you whether it prevents men getting cancer because that wasn't measured.
So the recommendation to vaccinate boys was delayed because first somebody has to study what might seem obvious - does the vaccine also prevent HPV related cancers in males? It is, after all, possible that some subtle mechanism means the vaccine isn't effective for this purpose, and it would not be ethical to give schools full of boys a vaccine that they personally do not benefit from having - even if societally maybe that's a good choice.
Beyond the female/ male differential, for adults and older, it's basically a stats game. Most adults have sex. Having sex means you're likely to contract HPV, more sex, more exposure. Is it worth getting vaccinated when there's a 50% chance it's useless? How about 95%? 99.5%? Do you always wait for the crossing lights? Did you ever drink beer or eat bacon ?
You're not wrong about ethical considerations, but the CDC operates socially and politically as well.
Back when the vaccine was new, an objection from some parents was that the vaccine might be viewed as a license or permission for their daughters to be promiscuous. There was a substantial headwind.
The public wasn't yet generally aware that HPV could cause head, neck, and anal cancers in men. If a doctor approached a parent back in 2010 and said they wanted to vaccinate their son against head, neck, and anal cancer, that advice wouldn't have been heeded in many cases, and would have cost the CDC some amount of its standing with the public.
When you hear something from the CDC, there's a decent possibility that it's a blend of medical advice that's been compromised with some value judgements that haven't been expressed to the listener.
What is it with people about the false ethics and recommendation around efficacy this and some bs calculus. The downsides are miniscule, the upsides are reduced cancers across the board.
I just had a doctor offer the HPV vaccine for my daughter as optional, 1, I thought we had already gotten it (my bad) because we ask for all the vaccines and 2, anal, throat and neck cancer. There are many scenarios where HPV could be contracted that aren't voluntary. But preventing HPV is.
We literally vaccinate people against diseases they might never personally catch because preventing transmission is part of the goal
> might never personally catch [emphasis mine]
And there's the mistake in your understanding. The personal benefit rationale is that they might catch it if they aren't treated. The public health benefit is a reason a government might promote this, but the reason medics will recommend it is personal benefit.
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US citizens used to value the adults managing such science oriented endeavors actually doing their homework before making broad proclamations of efficacy. Lately, not so much.
Blame the cold war for that one.
This is how science works. Our understanding of a medication's efficacy evolves over time.
No it's not, it's not science working.
It is either A) underreporting risks or B) not acknowledging risk unknowns and plowing ahead with advice anyway.
This was the major problem and behavior that CAUSED anti-vax opinions. They made safety claims that they couldn't logically make, because they couldn't know. A new vaccine using a new vaccine technology vs a new virus. They did not correctly report the amount of uncertainty and they lost trust. Then folks who "knew better" did their best to manipulate the narriative.
And speaking of manipulating the narrative, you can't use google to find the bits of history that shows the CDC giving contradictory advice because the results aren't there any more. Nearly every result gives the same tone and they're almost all CDC links.
This kind of information control and lack of transparency isn't science, it's power dictating truth.
The actual truth is that the risk of cancers as a result of HPV have a pretty high chance of being prevented if young females get the vaccine, but as you get further away from that group the risk avoided by getting vaccinated gets progressively smaller and runs into the safety uncertainty of taking the vaccine. When you're doing population level risk management you also have to do things like comparing the risk of getting hit by a bus going to the clinic against whatever the clinic could do for you. It is often safer to do nothing than to avoid a very tiny risk because of the very mundane risks you face day to day.
You're missing important stuff here, most notably that recommendations are also based on availability. As the vaccine became more available, more demographics were recommended to take it. Obviously, in the beginning, you want the highest risk groups to take it, then you grow the radius.
They didn't use young girls as some safety experiment. They just had the largest benefit and so, in scarcity, they're prioritized. It's not that scarce anymore.
As an aside, the HPV vaccine also prevents some male cancers, like penile cancer. It also prevents cosmetic, but relatively safe, conditions - like genital and anal warts. That's not the goal of the vaccine so it's not really taken into account. But you, someone who may take the vaccine, should consider it anyway.
also availability.
i recall the most effective way to distribute the covid vaccine would have been concentric circles from a central point. Obviously that was never going to happen.
> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
Because approval involves evaluating a risk-benefit tradeoff, and the benefits for those groups are wildly different, as are the risk profiles, due to the way HPV strains[0] work. If they tested against a wide and heterogenous population from the start, it would risk demonstrating insufficient effect, which would eliminate the possibility of the vaccine for everyone. Instead, by testing against the group most likely to benefit from it (women, and specifically women of the age to have no prior exposure to HPV) they can see whether the vaccine has any potential at all, and expand from there.
As it turns out, the vaccine was incredibly effective for them, and as we studied it further, it turned out that other groups which had potentially lower benefits (men, older women) or higher potential risks (teenage girls) had a risk-benefit tradeoff that still overwhelmingly supported approval for those groups.
[0] yes, plural, because there are hundrends, and the vaccines (again, plural, because there are more than one) protect against a handful of them (although that fortunately includes the strains that account for 80-90% of HPV-caused cancers
With regards to HPV, when they tried recommmending (and even making it mandatory) for young print the Christian-right cried foul pretty hard. The Texas Governor got a heap of shit over it at the time because abstinence is the only thing teenagers should know about.
> If it has an association with preventing cancers, not sure why they were so reluctant to immediately open up the patient pool.
Multiple reasons.
The first one is basic ethics. Similar on how you should do rolling upgrades of your SaaS software to catch errors before everything goes down, you got to do the same with vaccines. For there, go for the target group with the highest risk and highest potential of averting damage - and for the HPV vaccine, mid-20 women are the best such group: young enough that they might be lucky and not exposed yet, old enough to fall out of the scope of the usual ethics bureaucracy that (rightfully) comes with doing experimental research involving minors, and not so old that they definitely got exposed and making the effort moot. Then it got rolled out to teenage girls as it was proven safe, and eventually to men as well because we can be asymptomatic carriers (as we are for a lot of STDs).
Obviously if you got the speed of Covid vaccines in mind as a comparison, the HSV vaccine appears slow in rollout speed - but please do not forget, the Covid vaccines went through very speedy trials. We were extremely lucky it worked out the way it did.
The second one is availability. Again, unless it's Covid where everything went into full production power in a matter of months, production has to be ramped up carefully, matching rollout strategies - it doesn't make sense to have a mismatch into either direction.
And the third one is time. With Covid, it was easy to prove effectiveness: the people that got the shot got Covid at waaaay lower rates than the control population (and the risks of side effect were way less than the risk of severe Covid). But with something like HPV that can have years if not decades worth of time between exposure and symptoms, it becomes harder to reasonably judge effectiveness and safety.
My guess is it's cost driven? IIRC insurance would not pay for mine when i was out of the recommendation pool but they did (were legally required to afaik) when the pool expanded to include my age group.
You can only sell medication after trials. The first trials were on young women, and later trials on other groups. Nobody wanted to pay for trials on all demographics before there was evidence it worked from cheaper, more focused trial. There are also barriers to doing trials on high risk groups like the elderly without first testing on lower risk demographics.
This is one reason why so much medication not to be used by pregnant women. The trials have not been done, and trials involving pregnant women are particularly expensive and risky.
> PSA, everyone should be getting the HPV vaccine, regardless of age and gender.
This is false, please don't take medical advice from an HN post. CDC guidelines do include quite a bit of discussion of patient age. [1]
1. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
Either the vaccine has notable safety issues or it should be at least fine to get the vaccine at an older age.
The reason many people don't trust the CDC's advice is they don't really tell you why or why not.
If you're over 26 you're pretty likely to already be exposed to HPV but not necessarily every strain which would be protected by the vaccine (as it says in the article).
So this pushes the question: why shouldn't I get it even if there's only a small chance it will be beneficial at my age? Is there really a risk they're not telling me about or are they giving bullshit answers? There isn't a third direction.
Vaccine recommendations are based on more than just safety. Efficacy, cost, availability, and prioritization are also considerations.
> Compared with the benefit of the existing HPV vaccination program for adolescents and young adults through age 26 years, the additional benefit of vaccinating people age 27 through 45 years would be minimal.
> Given abundant evidence for safety of HPV vaccines, undesirable anticipated effects are minimal. Also, anticipated population-level benefits are minimal for vaccinating adults over age 26 years. In this scenario, other considerations including cost-effectiveness play an important role in guiding policy-making.
https://www.cdc.gov/acip/evidence-to-recommendations/HPV-adu...
Elsewhere:
> There’s not a safety issue past age 45. We just aren’t sure how much the vaccine will help men and women who are past that age, because so many of us have acquired HPV by that point, and because it takes many years for cancer to develop after acquiring the virus. However, as the average life expectancy increases, it may benefit the population to increase the age limit for HPV vaccination as well.
https://www.mskcc.org/news/think-you-re-too-old-get-hpv-vacc...
Yeh. The NHS has a pretty focussed set of criteria https://www.nhs.uk/vaccinations/hpv-vaccine/
Thats nonsense. Their "recommendation" is based on supply and epidemiological trends, not actual need of the drug. If supply gets constrained, its up to the CDC and drug makers to make more, not to tell the population to limit uptake.
This is why I don't trust CDC guidelines, nor doctors who blindly parrot them without explanation or context.
Sure, check with "your doctor" about the vaccine. If they give you no good reason not to take it, then take it.
CDC guidelines are nonsense here and I fail to see why they would give them. Is there a vaccine shortage?
The claim is that you're more likely to catch the virus early in your life and thus "lifetime efficacy" is reduced as you grow older. Duh, this is true of any vaccine. There are various strains of HPV and you can catch them one after the other. Having HPV at 50 is just as painful as when you're 18, if not more since your immune system is less effective.
The second part of I don't understand this advice is that they say there's no HPV test for men because the result is non-actionable. What? HIV is also nearly "non-actionable" but knowing one has it definitely reduces the chances of spreading it, does it not?
I don't get it.
I got the vaccine in my thirties against doctor's advice.
Please get the vaccine if you're sexually active with more than one person, regardless of your age.
Even if you are monogamous partners cheat, people suffer sexual assault better to have it and not need it than to need and not have
Yeah, and masks don't work. If it is recommended for adults aged 45, when you turn 46, it kills you.
The CDC is just a government organization. Don’t put too much stock in appeals to authority.
Seconded!
And I say this as a man who thought I didn't need it because I can't get cervical cancer. But it turns out oropharyngeal cancer might be just as preventable with the HPV vaccine.
I've thought about getting one myself, since I identify as a gay man. Though last I checked it was not covered by my insurance...
https://www.goodrx.com/gardasil-9
I know very little about this so excuse me if this is a stupid question. In my country all teenage girls have been getting the vaccine for at least the last 15-20 years. Therefore all of the women I'm likely to sleep with are vaccinated. Does it still make sense as a man to get it?
"All". Even if that's true, some time you might travel and be around women who aren't vaccinated, and you get an infection with something bearing the lovely name "genital warts". It has the long-term complications of "cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat". And you can give it to any other women you get with for the next few years, potentially giving them any of those relevant cancers.
So yes. It absolutely makes sense for a man to get it. For selfish reasons, you probably don't want penis cancer. For non-selfish ones, you don't want give other partners cervical cancer.
I guess I am a weirdo, but vaccines are the closest thing we have to space magic. Generally, they are very safe and prevent some of the most devastating diseases. All for the most minor discomfort. I want everything I can get, even if I am unlikely to be exposed to the real infectious agent.
Same. And while the shingles vaccine isn't fun, I've known enough people who described their bouts with shingles as "nearly suicide inducing" that I'll take a temporary minor discomfort that prevents me from ever having to deal with it.
Vaccines aren't 100% effective.
I'm not sure what the effectiveness of the hpv vaccine is, but if it was 95% effective (totally made up number, i dont know what the real one is), then there is a 1 in 20 chance it wont work for someone. If both of you have the vaccine then the chance of both failing would go down to 1 in 400.
That seems worthwhile to me, given there is basically no downside.
(I guess this doesn't account for the affects of herd immunity)
The CDC is still not recommending the vaccine for people over 45.
Is the vaccine still useful post infection?
yes. many different strains and even if your body clears infection with one doesn’t protect against other strains
Anecdotal evidence of curative effects even for long term symptomatic infection exists.
I decided to get it and saw it listed as $160 per dose on the health provider's website. I decided to bite the bullet and get it. When I got the prescription filled at the pharmacy, it was $265 for the first round of three. I want the next two but it's crazy to think I'd be paying like $800 (Canada).
What if I'm monogamous?
Obviously then your risks are lower, but even then not zero. A dear friend of mine went through stage 4 HPV related cancer after a long "monogamous" marriage. It turned out that it wasn't actually monogamous on the part of her (now ex) husband.
It's excessive to say literally everyone should get the vaccine: if you are especially low risk and don't want to bother, sure. But it's a very easy, safe vaccine. Most people engaging in some average amount of life-time serial monogamy (or with a partner who engaged in serial monogamy) would be better off just getting the vaccine than spending any mental energy on trying to figure out exactly the degree to which they need it.
Even if you are, your partner may not be. Or, god forbid, you could be sexually assaulted. Low, but non-zero chances.
That's what I'm wondering as well. I've been monogamous for a decade and a half now. If that changes I'll get the vaccine, but right now if either of us had it we both do.
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> Nobody is able to prove them being pathogens
What on earth are you talking about? We have clear evidence that suppressing specific viruses causes the symptoms of associated diseases to subside. Humanity has wiped out smallpox, a virus-causing disease, through vaccination against the disease. The same has almost occurred with Polio.
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this is the first time I am seeing spam on HN