"Tarts" cancer jab will "ruin lives"
Expensive at the point of entry"Gardasil is almost 100% effective against Human Papilloma Virus, the main cause of cervical cancer, which can be fatal, and genital warts. It is now being prescribed in
Cervical cancer charity Jo's Trust has called for a nation-wide programme of vaccination in secondary schools to be launched by the end of the year, even though no tests have been done on girls of that age and long-term side-effects are as yet unknown.
The use of the vaccine which prevents cervical cancer has been condemned by a Christian prayer and lobby group."Stephen Green, National Director of Christian Voice, said today:Madness.
'The best way of not getting cervical cancer and genital warts is to stay a virgin and marry a virgin. Why don't these officials want young people to do that? Why don't we raise their expectations and ours and treat them with some respect?' (Christian Voice)
I saw Alice, a sixteen year old girl, this morning. She is not a tart. She is a schoolgirl. She has not been able to have a Gardasil immuisation because of prudery and government delay (Patricia saving pennies again) and now she cannot even get contraception.
Yesterday afternoon, after school, Alice had intercourse with her boyfriend. The condom split.
This has not happened to her before. She went to the local chemist to get the “morning after pill”. The well known high street chemist that she visited charges £25 to provide one levonorgestrel pill. (Levonelle 1500)
Alice is a school girl. She is hard up. She did not have £25 and nor did her boyfriend. Together, they could only raise £11.
Alice’s parents do not know she is sexually active. In fact, they think she is not. She was nervous about coming to the family doctor because I know her parents. And her sister. However, she is a sensible girl, and realised that it was essential that she got the morning after pill so she set off to school very early this morning and was waiting at the door of the surgery when I arrived.
In 2006 there were approximately 194,000 abortions in the UK, nearly five percent more than the previous year.
Contraception is supposed to be free in the UK. Chemists are allowed to sell the morning after pill without prescription to make it easier for young girls like Alice to get help.
And it is easier.
If they can afford it.
Utter madness.
Labels: gardasil, morning after contraception
38 Comments:
To add to your stats I posted these this morning:
Female population: 30.7 million
Females 12-13 years: c. 380,000
No. of new cases of cervical cancer per annum: 2800
No. of deaths from cervical cancer per annum: 1120
Cost of treatment per case: £2150
Cost of treatment all cases per annum: £6.02 million
Cost of annual pap smear: £12.50
Cost of vaccine: £250
No. of cases prevented by the vaccine: 70% - 1960
Cost of all treatment all cases per annum with a vaccination programme: £1.8 million (saving 4.2 million)
Make up your own mind.
Green is a known nutter who came to prominence over the Jerry Springer the Opera affair (I never burned my TV license because the BBC fund Songs of Praise).
Basically these people just hate women. The ideal in their world is that a woman should be foreced to carry a rapist's anacephalic child to term and then die of cervical cancer 20 years later.
I'm a Christian, and I can't relate to the hard line attitude of some Christians. Which of us is perfect? Is cervical cancer really a just punishment for an evening's sinning? So much for forgiveness.
I don't think women should sleep around, but I don't think they should be forced to run an unnecessary risk of death for doing so.
On the basis that most girls will have sexual intercourse at some time in their lives, where is the problem in providing them with protection against a sexually-transmitted cancer in advance? I cannot see any moral problem in planning ahead.
Dr C i would like to think you gave her a prescription which she means she can get the pill for free as she is a school girl.
Religion (more specifically religious hard liners)... pah.
No wonder the UK is becoming more secular.
The cost of the vaccine is £300 per person and 700 will die from it yearly.
USE CONDOMS. But it passes from skin contact as well. So... while we are at it let's vaccinate the boys as well.
Now wouldn't that cause a stir.
It was tested for only five years on girls in Africa and India. What the hell are we unleashing on our young women. I'm anti-religion btw but I do think that this is a sledgehammer to crack a nut.
It's be free anyway Funny Pseudonym as technically it's counted as a contraceptive, which are exempt from prescription charges.
Do you not have a pharmacy patient group directive in your PCT Dr Crippen? My PCT has one which enables me to give Levonells, free of charge, to anyone meeting certain criteria. No appointment necessary and it's anonymous. I probably do 10 or so a week, mostly to patients like "Alice" Very rarely do I get patients as thankful as my "EHC girls"
I'm still battling to get them to relaise it's not just for the morning after. Useful upto 72 hours after coitus, and there is data that it is effecive for longer than this.
If this was a vaccine preventing prostate cancer I don't think we'd hear a whimper of protest, regardless of any association with sexual activity that might be suggested.
The small minded misogyny that proposes that young women should only be protected from a malignant, horrific, difficult to treat, nasty cancer by abstinence when there is a jab that would save lives is frankly preposterous.
This vaccination is a phenomenal breakthrough and should be greeted with banners balloons and cake!
We should definitely raise their and our expectations, we should all expect a world that prizes lives saved over outdated prejudice.
Are you suggesting that cervical cancer is a 'tarts' disease?
Call yourself a doctor?
Just as well the young woman you saw was sixteen. Contraception is free in this country. If you're going to the trouble of hiding the fact that you're having sex from your parents then you can go the whole way and get yourself tooled up with barrier methods. Sorry your 'story' doesn't wash.
It costs £3.95 to buy a packet of condoms.
*nods* - agree re the stupidity; though I would imagine the outcome was probably better for her overall, as you would have been able to discuss her future contraceptive needs with her/refer her to a specialist family planning clinic and/or GUM clinic, rather than simply supply her with emergency contraception. [and yes, I know patients can self-refer to FPC/GUM clinics - she probably doesn't]
I'd also suggest that if emergency contraception were available free from pharmacies to everyone it would act as a disincentive to people sorting out their contraception in advance (AIUI emergency contraception isn't meant to be used every time one has intercourse) and might even discourage condom use - often people worry more about pregnancy than STDs. If pregnancy can be prevented by a trip to the pharmacy in the morning, the importance of using a condom to prevent STDs might well be overlooked.
I think there's a happy medium somewhere between free and £25 for pharmacies, particularly when it *is* available free from GPs/family planning clinics.
Hello, yet another anonymous, can't leave this comment unanswered.
+++++++++++
Anonymous said...
Are you suggesting that cervical cancer is a 'tarts' disease?
[It is much commoner in prostitutes. Anyone who has had intercourse is at risk, but the more partners you have (particularly if you start young)the higher the risk. I thought that was common knowledge]
Call yourself a doctor?
[Er...yes]
Just as well the young woman you saw was sixteen.
[Why? I would have prescribed her contraception whatever age she was]
Contraception is free in this country.
[Yes...if you are prepared to go to a clinic or a doctor. Some young girls cannot cope with that. Which is why it was made available OTC]
If you're going to the trouble of hiding the fact that you're having sex from your parents then you can go the whole way and get yourself tooled up with barrier methods.
[Not much trouble. There are thousands of sexuallly active teenagers who have not told their parents, and there are thousands of parents who sincerely and incorrectly believe their children do not have sex.]
Sorry your 'story' doesn't wash.
[I don't know which planet you are visiting from but this "STORY" as you call it happens in every general practice on a regular basis.
Girls should not be intimitated by contracepion. They should be helped.
Not by you, I feel.]
John
I'd also suggest that if emergency contraception were available free from pharmacies to everyone it would act as a disincentive to people sorting out their contraception in advance
++++++
Now THERE is a sensible comment, unlike the last one, and I agree.
And yes, with any girl who comes for the MAP I take the opportunity to discuss better contraception and also to talk about chlamydia and HIV.
If there were genuinely walk in contraception clinics with same day appointments then we would not need chemists to sell the MAP. But there are not.
But I do agree, a difficult balance.
John
PGDs are the way to go. In my experience few girls see emergency hormonal contraception (EHC) as anything other than that. Maybe i'm being naive but my highly unscientific observations suggest that in most instances the condom has split or something else that could not be helped, hence the need for EHC, rather than not bothering with any contraception at all.
Most young girls are unaware of the fact that they can get it free from many pharmacies under a PGD and I would hate to think they're being put off by the potential cost-£25 is a lot for a 15yr old.
Even if an older woman comes in who can't get it for free I always make them aware of where they can do so-walk in centres etc. I always try to give some general advice about contraception althought a lot of them genuinely don't need it and have just been unlucky.
I think we should go even further and allow women to buy it in advance to keep at home for emergencies (perhaps not the younger girls who may be more in need of some advice).
I do think it the boys should be included in any programme; it's the only way to get herd immunity.
anonymous: EHC is only licensed for OTC use in girls aged 16 or over. You can sell it to girls under 16, but the pharmacist takes on more liability. The guidance from RPSGB has changed fairly recently to allow advance sales of EHC, though I've not had any requests yet.
I only locum in community occasionally so i must bow to your superior knowledge! Pleased to hear that it can be supplied in advance now-I didn't know that. I know that it's only licensed for girls aged 16 and over but lets be honest we all know many of them aren't. I'm sure i've worked places where the PGD specifies that it can be supplied to under 16s even though that's outside the licence. Obviously in that very young age group there are more issues raised about why they're having unprotected sex and who with- but it's important that they're not put off trying to get hold of EHC from pharmacies by technicalities.
Anonymous said...
Green is a known nutter. The ideal in their world is that a woman should be forced to carry a rapist's anacephalic child to term
where else are the next generation's nutters and lawyers going to come from?
sorry Crippen,I know you have a law degree.
Hugh
Grumpy Med Reg said...
If this was a vaccine preventing prostate cancer I don't think we'd hear a whimper of protest, regardless of any association with sexual activity that might be suggested.
do you mean lack of sex activity?
I thought that a lot of ejaculations in one's early sex life helped to protect against prostate cancer?
Aren't we missing the real tragedy here?
Alice has taken the decision to have sex with her partner and decides to use a condom. There can surely be few 16 year olds out there who do not know that condoms are not 100% safe. Yet she, and he, decide to go ahead.
The only thing that causes them to stop and reconsider their decision is a lack of £25. Let's hope her boyfriend gets a job or that her parents have some savings because she's one step away from a 16 year long £100,000 investment. She has almost stuffed her education and maybe her best chance of improving her life.
I'm no rabid conservative religious nutter, but I can't help thinking that kids today have access to more sex education than ever, from school/TV/net/peers/parents/magazines/whatever - but the teenage pregnancy rate keeps going up.
What is needed is not more sex education.
What is needed is some responsibility education. You won't get that by just telling every teenage boy to carry a condom, dishing out EHC like smarties or by vaccinating the entire country against HPV.
Yet she still sought medical help.
Surely this means she is unlikley to "stuff up her education".
I use condoms, i know they are not 100%, should i just not bother?
the reliability is good enough for a lrge number of the population.
She sounds fairly sensible to me, at 16 i was sexually active and thankfully condoms were enough. I don't know if i would have been sensible enough to get a girl to go straight for the morning after pill in that situation.
my wife went to the doctors to get morning-after pill and the receptionists told her to go away and pay for it from Boots.
Is this a sensible attitude from them?
Sounds like Alice is a very sensible and brave young lady, having received the right infomation she will be able to pass on the benifit of her experience to others in the play ground, insted of spending the next few weeks chewing her finger nails and wondering if she will need an abortion!
I wonder how Alice got on during her visit to the chemist.
I have bought the morning after pill twice since it became available over the counter.
The first time was at a "major high street chemist" in Birmingham. After a consultation with the pharmacist, and being given the packet, I took the packet to a till to pay for it with some other things - the pharmacist did not put it thorough herself. The till assistant looked at the packet, and said to me (I paraphrase as this is some years ago) "did you know if you use this more than twice it can make you infertile?" She was a large, respectable looking lady in her 40s or 50s - it wasn't a "goofy girlie comment".
The second time I went to a branch of the same chemist in Oxford. The only pharmacist there said that she did not prescribe the morning after pill "for ethical reasons" - that normally a (presumably, unethical) colleague would step in and do this for me, but that since this was a Sunday, and she was the only pharmacist available in the shop,I would have to go elsewhere. Only problem was, this being a Sunday, there were no other open pharmacies within walking distance....so I waited till Monday.
Not a major problem, but it did give me the impression that this "major high street pharmacy" has something to learn about customer care. I'd go to my doctor if I had to get it again, which I hope I won't.
Maybe the problem is that teenagers think they can't tell their parents.
Cherry, I should think that if you had complained to the large high-street chemist, the till assistant would have been sacked. I would like to think that the pharmacist would have been disciplined too, but I don't know - any pharmacists out there know what corporate policy in this area would be? If I were Boots I would have it in my offer letters (ie contracts of employment) for pharmacist jobs that post-holders were required to use the law of the land as their only guide to the ethical suitability of what they dispensed, and also in my till-assistant offer letters than giving out medical advice would lead to summary dismissal, I think.
The idea that being innoculated against cervical cancer would turn someone who hadn't previously wanted to sleep around into a Girl of the Playboy Mansion is beyond mockery. I really don't know what to say.
A few years ago (when I was still working full time in GU medicine , rather than my MAU secondment) our consultant decided to see about offering emergency contraception as well as a clinic to give advice/prescribe ordinary contraception. Seemed like a perfectly good idea to the rest of us. We were blocked from doing so- partly because the Trust and PCTs couldn't agree who should foot the bill, partly because we hit a snag in terms of who should provide the follow up care (i.e us or GPs). A few months later we were also told that we were no longer able to provide smear testing as routine...only for those that the consultant felt were "at risk". I wonder with this vaccine whether GU medicine will have any involvement at all? Working in A&E I saw enough distressed women who were pregnant but in denial to last me a lifetime. All we could do was refer them back to their GP or BPAS etc...I can understand that abortion is a very emotive issue but do we really want to return to the days before there were relatively safe ways to help? I will never forget the young girl who was dumped in A&E by her family after she tried to self abort- and this was only 5 years ago. She had been too scared to ask for help and the note that she had left indicated that she thought that she deserved to die. Anyone who thinks that if you remove the abortion clinics you will stop people seeking abortions, is sadly deluded. All you will do is push these women into backstreet clinics, or worse.
The access to emergency contraception in this country is terrible. It is not just 16 year olds who have trouble getting it but reasonsible adults in permanent relationships.
I am 32, happily married and the father of a planned 7 month old boy. 2 years ago I was living with my now wife a few months bwfore we got married and we had an accident which required emergency contraception. We were staying with my parents at the time (we visted them in order to plan our wedding) in a large town in Derbyshire (Glossop). They knew that we were sleeping towgether and had provided a double bed for us but we didn't tell them what had happened because frankly it was none of their business. None of the Chemists in this town would provide Levonelle OTC and because it was Sunday all of the GPs were closed. We ended up having to catch the train to Manchester ("for shopping") and had to visit a large number of Chemists before we found one (a huge Boots in the Arndale centre). One of the chemists that we visited (Superdrug) told us that they stocked EHC but that they had already used up their quota for the day (how stupid is that?). Eventually we got the Pill, but it cost us £25 and about 5 hours. If we couldn't have afforded £25 or if we couldn't have spared the time, we mght have been tempted to not bother.
As I say it is a disgrace. One needs to rember that this isn't just an issue of youngsters having sex it is about everyone having the right to control their reproduction including middle aged middle class people. I don't recall any teenage pregnancies at my School but I do know two professional collegues in their late 20s to 30s who have had unplanned pregnancies.
What really worried me was that the government are only thinking of providing the vaccine for 12 year olds.
IMO we need to be vaccinating the entire secondary school cohort now and then vaccinating as children leave primary school.
The churches of all faiths need to learn to keep their mindblowingly ridiculous comments to themselves.
Funny pseudonym:
> I use condoms, i know they are not 100%, should i just not bother?
the reliability is good enough for a lrge number of the population.
Fine with me, as long as the small failure rate is something you are prepared for; either by being savvy enough to get ECH(as thankfully she was), being prepared to consider a termination or being prepared to continue with the pregnancy. A legacy of the whole HIV/AIDS/80/90s campaign is the idea that a condom is "good enough" without thinking too much about the consequences of an unplanned pregnancy, such as the financial cost, the fact that her education and social life is going to be on hold for a few years, her partner may well walk out, the risk of winding up on benefits or in a low paid job and so on.
The irony I saw in the story was not her thinking "How can I afford to raise a child" but her thinking "I haven't got £25".
> She sounds fairly sensible to me, at 16 i was sexually active and thankfully condoms were enough.
You said it - thankfully.
Maybe Alice has learned more from this than she did during her personal/social/sex education classes and hopefully she will think things through a little more next time. If her friends can take something from this too, so much the better.
The Fundies annoy me so much. I mean, by their logic everyone who isn't a Good Christian Girl deserves HPV? Of course we know it's only bad, wicked girls that are sexually abused or raped and get HPV through that route. I also love their presumption that you have to be some sort of cockfiend to get it, when one encounter with one infected partner is enough.
How will they weasel their way out of their 'beliefs' when confronted with their own daughters, who 'waited' until marriage, then caught it from their spouse?
I hope this country does not end up like the US, although the frighening tale related above about the pharmacist who warned that Levonelle causes infertility, and the other who wouldn't dispense it because of her beliefs, shows that we could follow in America's footsteps. A scary thought indeed.
Oh and Doctor TC - sex education in schools is woeful at best. Too little info, delivered too late, and often by someone not suited to the job. At least 'Alice' used condoms, a lot of kids don't. Would you rather she was denied ECP and forced to carry a child as penance for her wanton ways?
Anon:
I only locum in community occasionally so i must bow to your superior knowledge! Pleased to hear that it can be supplied in advance now-I didn't know that. I know that it's only licensed for girls aged 16 and over but lets be honest we all know many of them aren't. I'm sure i've worked places where the PGD specifies that it can be supplied to under 16s even though that's outside the licence. Obviously in that very young age group there are more issues raised about why they're having unprotected sex and who with- but it's important that they're not put off trying to get hold of EHC from pharmacies by technicalities.
=========================
Sorry, my terminology was not as precise as it should have been. The P product is only licensed for use in girls aged 16 or over. PGDs use the POM product, so it can be supplied to girls under 16 (my local PGD goes down to 12), but to be able to supply on PGD you have to undertake extra training.
Cherry:
sorry to hear about your experiences. The first case is unacceptable and the assistant should be sacked. The pharmacist should probably be disciplined as well - I don't think it's acceptable to allow an assistant to put EHC through the till. The second situation is more difficult. Some pharmacists (and some doctors as well I'm sure) hold strong religious views and refuse to supply EHC because of their beliefs. The RPSGBs Code of Ethics states that they are allowed to do this, but must inform the patient of alternative sources. You should definitely have complained about the first case.
another anonymous: I think the superdrug just ran out of stock. A pharmacy can only carry a finite amount of stock, and although we keep more stock than we use on a normal day there are going to be times when demand surges and you simply don't have any stock left.
Elburto:
> sex education in schools is woeful at best. Too little info, delivered too late, and often by someone not suited to the job. At least 'Alice' used condoms, a lot of kids don't. Would you rather she was denied ECP and forced to carry a child as penance for her wanton ways?
Since I'm not a teacher and my daughter is way way pre-school I wouldn't be in a position to judge how appropriate sex education is in schools. It's probably a bit more advanced than the biology lessons in my day but as I said the teenage pregnancy rate is still frighteningly high.
When do you think it should start, what do you think it should include and who do you think should do it? Are you involved in this?
The idea that a condom will stop all evils befalling you from AIDS to lightning strikes is one that has been pumped out for the better part of 20 years. Yet as you say, some kids don't bother. Others do, only to find that they fall off, split or whatever.
Finally - your last comment is downright insulting. The answer is no. Apology awaited.
cherry- If the "major high street chemist" you're talking about is Boots then Levonelle cannot be wanded through the till by anyone other than the pharmacist.
When I was twelve, all of the girls in our class were lined up and jabbed against rubella (showing my age here...) on the grounds that getting it when pregnant would damage our unborn children (the boys got to go off and do extra woodwork). I don't recall any massive fuss about 12yo girls being encouraged to go and get pregnant. It just seemed sensible to get us young, before it was likely to happen.
I really don't understand the current fuss now about what was exactly the same thinking regarding the Cervical cancer jab...
Disgruntled commuter, I shared your thoughts until I realised that vaccinating girls/women against rubella doesn't protect them, it protects their unborn child, who is by far more important. It's ok to get cervical cancer and die from sex as long as your baby isn't hurt.
A friend of mine has just found that the "minor abnormalities" found on his fiancee's smear 6 months ago are actually widespread cervical cancer - she went in for laser treatment last week and was told the bad news. She had her MRI yesterday to find out how far it's got and she has to have a radical hysterectomy.
Vaccination should be routine.
Disgruntled communter and kirsten - thank you, that's exactly what I've been thinking. Sod the 12 year old girl, if she has sex at a young age she can BURN IN HELL (or die of cervical cancer, y'know, whichever) but we must protect the child! I know ruebella also protects the girl, but I remember being given SUCH grief by my form teacher because I was prevaricating over having the jab done at school (I hate needles) and she basically inferred that I was commiting some cruel and inhuman act against my unborn children. Kind of heavy on a 12 year old... somehow I managed to avoid going out and having sex and getting pregnant immediately after being vaccinated. Took all my will power though :-)
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