Monday, March 08, 2010

What's so funny 'bout ...

.... peace love and understanding?*

I'm struggling to find a way into this post, but once again there's something I need to get off my chest, so for those who prefer not to have to listen to me ranting on at length about a pet peeve, I urge you to look away now.

Right. There we are. Just a few of us left now, so stand by for a little serious spleen venting.

Not long ago I heard from a friend, that they knew someone who held a faith based objection to having their daughter immunized against HPV. Apparently this God-fearing member of the community felt that doing so was giving the poor girl tacit permission to sleep around with all and sundry. I'm sorry but to me this is wrong on so many levels that I had to put finger to keyboard in rebuttal.

And before we go getting carts before horses and saying that dear old Dr J the hippie and flower-child is off on a diatribe about free love and the like, for the record, I'm not. I'll admit to a more liberal interpretation of certain strictures held to more rigidly in other quarters, but there's no such thing as free love, and never has been. Societies order themselves as they will and their mores are adapted to suit the cultural milieu in which they are nurtured, but human animals being as they are behaviour at the individual level is mediated by a whole load of other stuff so that even the most intellectually enlightened and liberal of practitioners of the art can come very easily undone when emotions like jealousy sow seeds of mistrust.

My problem with the position taken by the righteous (self-righteous?) on this is two fold. First, observable evidence tells me that fear of cervical cancer is absolutely not what determines whether a fourteen year old girl has sex. Indeed even fear of pregnancy doesn't appear to enter into the equation for many. There are a great many other drivers that will determine when and if a teenage girl will become (in that most forensically clinical of phrases) sexually active. Peer pressure, alcohol and drug use must be significant actors, as are education and family and social background, and a whole host of subliminal and indeed "liminal" messages from our mass media.

For a few months in the wake of the much publicized Jade Goodie's untimely demise the issue of cervical cancer was very prominent and a great many women sought screening who previously would not have done. I'm not aware that it had any impact on teenage sexual behaviour however.

Putting all this to one side, my second objection is that the main thrust of this argument places all onus on the poor girl, who, as we understand the pathology of cervical cancer, is only exposed to risk by her partner. Granted, more partners adds up to more risk, but outside of a closed community daughters of the most devout families will end up with partners who might not share their up-bringing, or who have come to the religious life late and after a period of youthful experimentation. It is an orthodoxy of Sexual Health practitioners that when you sleep with a new partner then you sleep with everyone that new partner has previously slept with (in a purely metaphorical sense, by and large).

So a failure to vaccinate a young lady against HPV is at best wilfully blinkered and at worst negligent. Worse, it suggests that parents have absolutely no confidence in their daughters, or indeed in their own abilities to educate them and pass on the values that they live by, and hints at attitudes more in keeping with the strictures of the Taliban that the teachings of a God of love and understanding.

* Usual VECHN for first correct attribution of this shamelessly plagiarized title.


alhi said...

Elvis Costello?

I just don't understand why the HPV vaccine isn't being offered to women of all ages who are not sexually active, never mind just 14year olds.

Imogene said...

Drat! Went to the trouble of googling and alhi got here before me! Congrats, alhi!

See, now this is precisely the kind of blinkered-let's-turn-off-our-tiny-little-religion-addled-pea-brains attitude some religious-drone types have, and it makes me so annoyed. (I'll also admit it makes me look most unfavourably on organised religion, which is unfair.) Great advertisement for God, the pea-brain-drones - I'm sure He/She/It is mightily pleased.

The best way to protect our daughters is to bring them up to think for themselves, make sure they develop a good sense of self-worth and point out that the vaccination is available should they want it.

That's all we can do, and it's all we should do.

Doctor Jest said...

Alhi-- Very speedy work there. Well done. The vaccinationrationale is that for "older" ladies either they've already been exposed to enough risk for the vaccine to be ineffective, ot that the screening programme will serve as their protection. It does seem a bit arbitrary, but with all new public health measures we have to start somewhere and maximal health gain will be given if we can get the vaccine in before any risk of exposure.

Imogene-- No worries I'm sure Alhi won't object if I find another VECHN ;-) You could also have had Nick Lowe, or Curtis Stigers, or probably a fair few others, but Elvis' version is special.

Being an old fashioned "paternalistic" sort of Doc, I have to say that I'm all in favour of vaccinating as many young women as possible, so I'd push young ladies quite hard to get "done" and not just leave them to choose, but I do agree we need to encourage them to think for themselves and make well reasoned and sensible choices. We can't depend on others to do that for us. And I'm not in favour of any belief system that "blinkers" its adherents. I don't believe that organized religion per se does this, but as with so much else (and forgive the pun) the Devil is most assuredly in the detail.

Z said...

Scientists could try calling the vaccine a miraculous intervention by God, perhaps?

Let's hope that the option will be open for the girls, by the time they are 18 and can choose for themselves, to go and get vaccinated. And that they have the sense to do so.

A New Kind of GP said...

If one looks at the effects on mass vaccinations of the scares regarding the pertussis vaccine years ago, the MMR more recently, and even more recently, the swine flu vaccine, then it might be appropriate to sit back and wonder about the ultimate effectiveness of government directed heavy handed influences on such programmes.

It seems to me that the public's
ambivalence about the government's vaccination directives is directly related to its lack of trust in politicians. When one appreciates that the public's trust in GPs is always rated much higher than almost all other professional groups,and vastly greater than thier trust in politicians, it makes one wonder if the government would be better advised to delegate vaccination recommendations to those that have a professional obligation to do the best for their patients. For politicians, or their PCT / LHB minions, to continute to assume an increasing responsibility for influencing personal vaccination decisions would only serve to further diminish the authority of a general practitioner (and public health physicians) in this most vital of personal decisions. It emasculates our professionalism.

Surely there is scope for more creative patient involvement in such decision making, making better us of the resources of the internet, professional bodies such as the RCGP and other non-political, professional based organisations.

It all boils down to the profession needing to wrestle more control back from the government in this propaganda war. Government control of these issues has simply not worked in the past.
In the case of HPV vaccination discussed in this post, the thorny issues of religion, promiscuity and societal mores come into play. The GP is clearly best placed here to advise his individual patients and their parents on the best course of action when such delicate matters influence decisions, and will do so with subltety and effectivness. Deregulation here will pay dividends.