Tuesday, September 7, 2010

Fortune, On What "Went Wrong" With Gardasil®

Do go read the whole article, but what surprises me is the level of pro-pharma credulity permeating the piece. It seems to chalk up weak Gardasil® penetration almost exclusively to poor marketing, rather than exploring the deeper issue of whether most parents (in the US, at least) will really be persuaded to vaccinate fifth and sixth grade girls -- for a solely sexually transmitted disease.

Note how the only mention in the article of that dynamic implies that the fault lies primarily with heavy-handed governmental tactics (see first bolded section below), rather than with Merck, and the vaccine itself. It simply sidesteps what I perceive to be the view of most Americans: they don't want their fifth and sixth graders to have sexual intercourse. And, as a corallary -- an education marketing campaign that amounts to "many of them will, anyway" -- is certain to be a buzz-kill. And it ought to be. Remember, this all before we talk about side-effects.

If Merck truly believes this (vaccinating 10 to 12 year old girls) is the only way to prevent 70 percent of all cervical cancers, it might consider aiming at an older audience. It might also consider explaining that only a fairly rare strain of HPV appears to cause cancer.

Both of those would be against Merck's short-term financial interests -- even if they might meet Merck's longer-term ones. In any event, here is a snippet:

. . . .Some parents aren't comfortable vaccinating young children against a virus they can only get from having sex.

In 2007, when Texas governor Rick Perry issued an executive order that all girls entering the 6th grade would receive Gardasil, parents were furious. Some argued that the vaccine would promote promiscuity. The order was eventually overturned.

Merck didn't properly prepare the right doctors.

When Gardasil came out, Merck marketed it to college-age women. This meant that physicians talking to patients about Gardasil were typically gynecologists, not pediatricians. "When you think about those OBGYNs who tend to be the primary physicians for the 19-26 year old group, they're not vaccinators," says Anthony Butler, a pharmaceutical analyst at Barclays. . . .

Indeed -- I wonder why -- could it be that they are better acquainted with the data suggesting relative rarity of the cancer-causing strains of HPV?

As I say -- do go read it all -- but much of it sounds tone-deaf to me.

1 comment:

Condor said...

A note -- I'll use the comment box as a footnoter, of sorts, here.

This note is on the relative rarity of the cancer causing strains, and the overall burden of the disease:

. . . .More than 100 HPV types have been identified, and of these, more than 30 types are known to cause genital infection. These types are broadly classified as high or low risk for cervical cancer, and some 18 types are considered high-risk or oncogenic. Approximately 5 to 10 percent of women infected with oncogenic HPV types develop persistent infections; these women have an increased risk of developing precancerous cervical lesions. If untreated, the lesions can progress to cancer over a period of years. . . .

Secondary prevention of cervical cancer through screening for precancerous lesions and offering treatment as appropriate has proven to be an effective public health strategy. While well-organized cytology programs have significantly reduced the burden of disease in developed countries, infrastructure and other requirements make cytology difficult to implement in many low-resource settings. Alternative screening methods such as visual inspection with acetic acid (VIA) or with Lugol’s iodine (VILI) offer promise as simple, rapid, and effective means of identifying precancerous cervical changes; evidence regarding their impact on burden of disease, when combined with simple outpatient treatment as needed, will be available in the near future. In addition, HPV DNA testing is more objective and generally performs better than other tests in women 30 years and older. However, as currently formulated, the test requires considerable infrastructural and technical capacities that make it difficult to implement in low resource areas. . . .

-- PATH Initiative report (PDF file) -- funded by Bill & Melinda Gates Foundation

But we are talking about the USA, here, oh editors of Fortune.