My father taught law for almost 40 years at the University of Melbourne and achieved considerable fame in certain circles in the process. Many people were shocked to discover I was studying science and arts at the same university. “Didn’t your father want you to study law?” they would say. Certainly not.
For one thing, my father was very opposed to either of his children studying in the faculty at which he was, for a time, the dean. He felt this would create unacceptable conflicts of interest. When my sister wanted to study law she went to Monash. More significantly however, he also didn’t see any reason to study law. He told us (and I believe his students): Students with your marks usually study law, medicine or engineering. If a bridge falls down a doctor will save the lives of the people who are injured, a lawyer will sue the bridge builder but an engineer will prevent the bridge falling in the first place. Which is most useful to the community?”
On that simple example it is clear that the engineer comes first, followed by the doctor. Followed a fair way behind really. However, there are many situations where the engineer cannot prevent ill health and the doctor’s role is very, very important.
However, it also illustrates that the best doctors that do most good for the community are not those that heal the sick, but the ones that prevent people from getting sick in the first place. Sadly however, they do not get the most credit. People who are sick are inevitably deeply grateful to a doctor who cures them. People who never get sick usually have no idea how many doctors stopped them getting sick.
So it is nice, now and then, to see preventative health workers get some credit. This article is truly inspirational – a doctor saving lives through vaccinations in the gay nightclubs of New York. (Thanks Kim Sutton for the link). Closer to home, it’s significant how engaged Green MPs and candidates are in this regard. Former Senator Bob Brown and Senator Richard Di Natale were both doctors before entering parliament. Both had time in hospitals and as GPs, but Richard was also heavily involved in public health programs in India, preventing diseases rather than curing them. As senator Bob took a similar approach – campaigning for the introduction of unsniffable petrol around Alice Springs and for the stockpiling of medication against a flu pandemic, something that might never be required, but would be hugely important if it was.
Now we can add a third name to that list. Dr Tim Read is the Greens candidate for Wills at the federal election. Many years ago I got my flu shots from Tim when visiting the clinic where he then worked, as well as seeking advice on some extraordinary pains that turned out to be diet related. These days however, Tim is working at the Melbourne Sexual Health Centre where he is not only treating people with certain sexually transmitted diseases, but preventing their spread through the community.
Tim has also racked up an impressive publication record studying the effect of the Gardasil vaccine on the spread of the Human Papillomavirus (HPV). Google Scholar brings up eight papers on the topic, of which he is lead author of two. Moreover, three were published in the British Medical Journal.
There are around 100 strains of HPV, many of which appear to be largely harmless, but two of which account for the majority of cases of cervical cancer, killing hundreds of thousands of women worldwide each year. They also contribute to rarer cancers, such as those of the anus, and it is possible the cumulative death toll from these other cancers adds up to more than the toll from cervical cancer. (I discussed this, and the questions of the vaccine’s safety a couple of years ago).
Gardasil was designed to prevent the two main cancer causing strains of HPV, but as cervical cancer takes a long time to develop it will be a long time before we know how well it really works – clinical trials were cut short because it seemed to be working really well and we didn’t want to make people wait, but that does mean we know even less than we might expect.
However, Gardasil was also designed to protect against two strains of HPV that cause genital warts. These are almost never fatal, but they can be painful and embarrassing and people sometimes are so desperate to get rid of them they undertake treatments Read says can be “worse than the disease”. Since warts show up much more quickly than cervical cancer there is a huge opportunity to track what happens to the rates of warts amongst those who have received the vaccine, not to mention the herd immunity conferred on the wider community. Read is part of the team leading the world in this. Success against warts does not guarantee success against cancer, but it would be a pretty good starting point.
The results Read has reported have been quite astonishing. Rates of genital warts have plummeted in Australia, particularly in the age groups where women received the vaccine at school. Even amongst men of the same age, relatively few of whom have had a Gardasil shot, warts are right down compared to previous generations – since men in their early 20s are mostly having sex with women of around the same age, if those women are protected against the warts the men benefit from herd immunity.
Perhaps the most interesting thing however, is that women who have had the vaccine have had a larger drop-off in the number of warts than was expected. It costs money to add protection against each strain of the virus to the vaccine, so only the four most serious were included. It was thought that up to 30% of warts, along with quite a few cases of cervical cancer, were caused by other strains. But the cost of protecting against all 30-40 sexually transmitted strains would be exorbitant, so four was deemed a good compromise. Gardasil’s competitor, Cervarix, only protects against two in an effort to keep costs down.
Despite this it seems that vaccinated women may be experiencing a drop of more than 90% in the rate of warts compared to their predecessors. What is going on here? It’s possible that women in these age groups are just having less sex than previous generations, but it seems unlikely that any difference would be large enough to account for the change.
Tim saw two possible explanations. “It can be hard to be certain which strain of HPV causes a wart, so it maybe 6 and 11 cause more than we thought. Alternatively, there may be cross protection against other strains.” The latter possibility is particularly intriguing, as it would suggest that the vaccine may also provide more protection against cancer than anticipated, although there is no way to state this with confidence as yet.
I find this work interesting and exciting, but I also think that the sort of thinking required to conduct this work is exactly what I want to see in parliament. I wouldn’t vote for Tim on the basis of his science if I disagreed with his politics, but if I was on the fence between him and another candidate this would certainly push me over. In New Jersey’s 12th district Democrats produced bumper stickers that proudly stated “My Congressman is a Rocket Scientist”, in honour of his scientific career before entering parliament. I’d be really happy to be able to stick “My MP is A Public Health Researcher” on my bike, even if it wouldn’t have quite the traction.